J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 DOI 10.1007/s12663-017-1052-5

ABSTRACTS

42 Annual Congress of AOMSI Nagpur 16–18 Nov 2017

 The Association of Oral and Maxillofacial Surgeons of India 2017

Scientific Oral Paper

References/Bibliography

Section: Cranio Maxillofacial Trauma

Manisali M et al, Retromandibular approach to the mandibular condyle: a clinical and cadaveric study. International Journal of Oral and Maxillofacial Surgery 32(3) June 2003, 253–56.

ABS0015 Open Treatment of Mandibular Sub Condylar Fractures via the Retromandibular Approach Dr Imran Khan

ABS0023 A Comparative Evaluation Between Conventional Titanium Miniplate & Customised Titanium CRB Omega Miniplate for the Management of Anterior Mandibular Fractures

Faculty of Dentistry, Jamia Millia Islamia, New Delhi-110025 Abstract Background/Introduction Injuries to the mandible often result in mandibular condylar fractures. Various approaches have been advocated for accessing the mandibular condyle. Objectives The aim of this paper is to evaluate the results of retromandibular approach in management of condylar fractures of the mandible. Methods From January 2014 to January 2017 (Three years) Total number of 38 patients with mandibular condylar fracture were open treated, Retromandibular approach was used in 31 patients, Preauricular approach was used in 03 patients & extended submandibular approach was used in 04 patients. All the cases were evaluated for intraoperative and post operative complications like haemorrhage, Injury to the facial nerve, infection, signs of salivary fistula, discrepancy in occlusion and function of the temporomandibular joint. Results None of the patient suffered from any major intraoperative or postoperative complications and all patients had good functional and aesthetical results. Conclusions Retromandibular approach was found to be most convenient in managing mandibular condylar fractures with open treatment & almost insignificant surgical scar.

Dr. Chandrashekhar R. Bande Swargiya Dadasaheb Kalmegh Dental College & Hospital, Wanadongri, Nagpur Abstract Background/Introduction The mandible is the second most common bone involved in facial fractures. The weakest areas of mandible which are prone to fracture are the condylar neck, angle and the parasymphysis region. The goal of treating mandibular fractures is to obtain the pre-morbid anatomical form, proper function and appreciable aesthetics. This aim must be accomplished by means that will produce the least disability, smallest risk and shortest recovery period for the patient. In today’s scenario the patients demand for early return of normal function and lifestyle, likely favouring treatment by open reduction and internal fixation (ORIF) for treating fractures than conservative treatment modalities like closed reduction and intermaxillary fixation (IMF). In developing counties like India, cost and economic viability are also important treatment considerations. This study was aimed to compare the efficacy and surgical outcome of customised titanium CRB omega miniplate with the conventional titanium miniplates in the management of parasymphysis fractures of mandible, with or without involving mental nerve on the basis of clinical and radiographic evaluation.

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S2 Objectives This study was aimed to compare the efficacy and surgical outcome of customised titanium CRB omega miniplate with the conventional titanium miniplate in the treatment of anterior mandibular fracture with or without involving mental nerve on the basis of clinical and radiographic evaluation. Methods A total number of 252 patients with anterior Mandibular fracture were selected for the study and divided randomly into two groups, Group A 126 patients and Group B 126 Patients. The Group A patients underwent open reduction and internal fixation using conventional titanium miniplates and Group B patients underwent the same using customised titanium CRB omega miniplate. The surgeries were carried out by the same operating surgeon. Duration of surgery was measured for every case from the placement of incision to the closure of defect. Subsequent postoperative follow up for occlusion, postoperative complications like paraesthesia, infection, hardware failure were assessed. Radiological healing was evaluated for all patients at 1st, 3rd and 6th months post operatively. Results A major difference in results of surgery is seen between both the groups with less duration of surgery and less postoperative complications like paraesthesia, infection, hardware failure along with good radiological bone healing seen in customised omega CRB miniplate (Group B) patients. Conclusions It led us to the conclusion that customised titanium CRB omega miniplate is effective option in treatment for anterior mandibular fracture.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Methods A 17 years old female reported to our department with complaint of pain in left ear region and difficulty to open mouth since 40 days. Patient sustained injury to chin region due to RTA (road traffic accident) and was managed for conservatively with IMF for 04 weeks at some other centre. On clinical examination patient had deviation of mandible to left on mouth opening, trismus and posterior open bite on left side. Radiographic examination revealed patient as a case of malunited condylar fracture left side. Patient was managed with EVRO and extracorporeal fixation of left condylar fracture using miniplates under general anesthesia. Results Patient showed marked improvement in esthetics and function postoperatively. Facial height was restored with satisfactory occlusion, no deviation of mandible on mouth opening and good rehabilitation of TMJ. Patient’s follow up was done at 1 month, 03 months and 06 months. Six months follow up radiographic examination showed condylar head remodeling with well united osteotomized segments. Conclusions EVRO and extracorporeal fixation is a viable treatment option in malunited condylar fracture where access to the malunited proximal segment is very difficult. References/Bibliography 1.1. Ellis E III, Walker RV. Treatment of malocclusion and TMJ dysfunction secondary to condylar fractures. Craniomaxillofac Trauma Reconstr. 2009; 2:1–18.

References/Bibliography 1. Agrawal M., Meena B., Gupta D. K., Tiwari A. D., Jakhar S. K. A prospective randomized clinical trial comparing 3D and standard miniplates in treatment of mandibular symphysis and parasymphysis fractures. J. Maxillofac. Oral Surg. 2014; 13(2): 79–83. 2. Booth PW, Schendel SA, Housamen J-E, Maxillofacial Surgery (2007), vol. 1, 2nd edn Churchill Livingstone, London, UK, pp 74–76.

ABS0031 Management of Malunited Condylar Fractures Using Extraoral Vertical Ramus Osteotomy: Report and Review Maj (Dr.) Shanender Singh Sambyal, Maj Gen (Dr.) NK Sahoo, Lt Col (Dr.) N Mohan Rangan Command Military Dental Centre, Lucknow Abstract Background/Introduction Malunited condylar fractures due to delayed/unsuccessful treatment can lead to decreased ramus height, malocclusion and deranged function of Temporomandibular joint (TMJ). Here we present our experience of a case of malunited condylar fracture managed successfully using extraoral vertical ramus osteotomy (EVRO). Objectives To present a viable option for the treatment of malunited condylar fractures.

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ABS0034 Co Relationship of Midface Fractures and Ophthalmic Injuries: A Clinical Study Dr Bobby John, Dr Sobitha G Govt Dental College Kottayam, Kerala Abstract Background/Introduction Trauma to face, particularly above the level of mouth, require a careful examination to assess ophthalmic and orbital injuries. Inappropriate diagnosis and inadequate care for these injuries can result in blindness with social and medico legal implications. The early detection of vision threatening injuries and timely referral to an ophthalmologist is needed to reduce the incidence of vision loss in midface trauma. By the study we can assess the prevalence of ophthalmic and orbital injuries in midface fractures and how often a surgical intervention is required in the correction of these injuries. The co-relationship between various midface fractures and ophthalmic injuries is assessed in this study. Objectives To assess the proportion of ophthalmic injuries in midface fractures. To classify ophthalmic injuries in mid face fractures based on the severity. Methods The study assessed 401 patients with midface fractures. The various mid face fractures assessed included Lefort I, Lefort II, Lefort III, zygomatic complex and nasoethmoid fractures. Each patient was assessed and the mild, moderate and severe ophthalmic injuries recorded. Thorough clinical examination with various test specific for injuries was used for assessment. A comprehensive ophthalmological examination was done by an ophthalmologist to assess the various ophthalmic injuries.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284

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Results The results showed that zygomatic complex fracture was mostly related with ophthalmic injuries. The most frequent mild ophthalmic injury in the study was periorbital odema (99.8%) followed by ecchymosis (96.5%), subconjunctival haemorrhage (98.5%), chemosis (38.2%) etc. The main moderate ophthalmic injury in the study was Infraorbital dysesthesia (95%), followed by enophthalmos (54.5%), traumatic optic neuropathy (16.7%), antimangaloid slant (32.6%), traumatic telecanthus (12.7%) etc. Diplopia (15.7%) and hypoglobus (12.7%) was the most common severe ophthalmic injuries. Loss of vision reported in the study was 1.5% only. Incidence of retrobulbar haemorrhage was only 0.5%. Conclusions Based on the study it can be concluded that all mid face fractures need a comprehensive ophthalmological evaluation to rule out vision threatening injuries. As per the study the occurrence of vision threatening injuries are low. Early surgical intervention was needed in the correction of enophthalmos, hypoglobus, diplopia, antimangloid slant, traumatic telecanthus etc. Zygomatic complex fracture was the main mid face fracture associate with highest incidence of ophthalmic injuries.

fractures and 11 patients had isolated mandible fractures, 4 patients presented with panfacial trauma. About 37 patients were observed with significant bradycardia which resolved with the cessation of stimulus, however 1 patients developed asystole which needed administration of atropine. Conclusions TCR is a physiologic response which may mimic a closed cranial injury or a cardiac dysarrythmia in a post traumatic patient. Though the reflex resolves without complications however whenever surgery is planned in maxillofacial region and if TCR is anticipated, continuous and closed ECG monitoring is important. The reflex cannot be neglected in maxillofacial injuries.

References/Bibliography

ABS0038 A Retrospective Evaluation of Efficacy of Sphenozygomatic Suture Fixation for Restoration of Orbital Volume

Shantha Amrith, Seang Mei Saw, Thiam Chye Lim, Timothy Kam Yiu Lee. Ophthalmic involvement in cranio-facial trauma. Journal of Cranio –Maxillofacial Surgery 2000; 28:140–147. Al-Qurainy IA, Stassen LF, Dutton GN, Moos KF, el-Attar A. The characteristics of midfacial fractures and the association with ocular injury: a prospective study. British Journal of Oral and Maxillofacial Surgery 1991; 29:291–301.

ABS0035 Trigeminal Cardiac Reflex in Faciomaxillary Trauma Patients Altaf H Malik Govt Dental College Srinagar Abstract Background/Introduction Trigemino cardiac reflex (TCR) is a sudden physiological response due to the pressure effect or stretching of the largest cranial nerve, the trigeminal nerve. TCR is a triad of bradycardia, bradypnea and gastric motility changes due to the efferent activation of the vagal nerve in response to the pressure distribution in V5. TCR is seen in most of faciomaxillary procedures in maxilla or mandible. It is important to have knowledge of this sudden physiological response in maxillofacial surgery. The paper highlights the importance of this reflex during management of facial fractures. Objectives The study intends to evaluate the effect of the reflex in maxilla-facial fracture patients and its subsequent implications. Methods A total of 46 patients were included in the study who visited the Department of Oral and Maxillofacial Surgery Govt. Dental College Srinagar from Oct 2016 to July 2017 for the treatment of maxillofacial fractures. Only ASA 1 patients were included in the study. The patients were evaluated for the fracture after proper investigations. Results The study showed male predominance with more susceptibility in 18 to 32 year age group. About 31 patients presented with maxillary

References/Bibliography 1. Lu¨bbers HT, Zweifel D, Gra¨tz KW, Kruse A (2010) Classification of potential risk factors for trigeminocardiac reflex in craniomaxillofacial surgery. J Oral Maxillofac Surg 68(6):1317–1321.

Lt Col (Dr.) Rohit Sharma 11 CDU, C/O 56 APO Abstract Background/Introduction Lateral displacement of high energy fracture zygomaticomaxillary complex (ZMC) can cause significant increase in orbital volume leading to enophthalmos. Objectives The objective of this study was to evaluate the efficacy of sphenozygomatic (SZ) suture fixation for restoration of orbital volume after elevation of the temporalis in cases of fracture ZMC where the fixation of zygomatic arch (ZA) was deemed necessary through latero-posterior approach. Methods 43 operated cases of fracture ZMC using 4-point fixation were divided into two groups. Group I (n = 24) had undergone reduction and fixation of SZ suture as fourth point of fixation by elevating temporalis muscle using hemicoronal approach. Group II (n =19) had undergone reduction and fixation of Infraorbital (IO) rim as fourth point of fixation using preseptal transconjunctival approach. Both the groups were analyzed separately and compared for restoring the increased orbital volume on CT. Results Difference in the pre-surgical orbital volume of both the groups was found to be statistically insignificant [p=.678]. In group I, the average bony orbital volume significantly reduced by 3.6 cc from 25.5 cc to 21.9 cc [p = .000] post-surgically. In group II, the average bony orbital volume reduced by 1.5 cc from 25.6 cc to 24.1 cc post-surgically. There was a significant difference in the reduction of the increased orbital volume among the 2 groups (Group I: 3.6 cc, group II: 1.5 cc). Orbital volume reduction was more and statistically significant [p= .000] in group I. Conclusions SZ suture fixation is reliable in reducing fractures ZMC and restoring the increased orbital volume where the fixation of zygomatic arch (ZA) was deemed necessary through latero-posterior approach.

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S4 References/Bibliography Sharma R, Muralidharan CG, Roy ID, Jain NK, Patrikar S. Radiological evaluation of sphenozygomatic suture fixation for restoration of orbital volume: A retrospective study. J Craniomaxillofac Surg 2016; 44(12): 1903–08.

ABS0054 Binocular Blindness Following Maxillofacial Trauma… A Report of Two Mechanisms Dr. Usha Giridhar MDS, Dr. Varun Muthuraman, MDS Best Dental Science College Abstract Background/Introduction Loss of vision after a, Maxillofacial injury is a rare complication, the incidence being 0.32% and 9% (Ansari). Ocular injuries can be a result of injury to the globe or indirect cause. The globe is protected from direct injury due to the prominence of the facial bones and natural reflexes. The optic canal is also protected because of the presence of dense bony ring. The presence of injuries to certain regions of the Maxillofacial region that appear innocent can result in irreversible injury to the eye. These indications should alert the examiner as to the probability of an impending danger of losing the vision in the eye. A case with contrasting injuries that produced binocular injuries is presented. Objectives Case report. Methods Case report. Results Case report. Conclusions A relatively trivial nature of injury to critical areas of the max facial region can produce irreversible damages. References/Bibliography 1. Blindness after Facial Fractures A 19 year retrospective study. Ansari et al. JOMS 2005. 2. Blindness following severe mid facial trauma Johannes et al. JCMS 2012.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 present day high speed transport modalities in a medical college of Western part of Rajasthan comprising of 4 major districts. Objectives To compare and present the changing trends in epidemiology presentation and management of maxillofacial trauma in present era in a developing state of India within given resources. Methods Data were obtained from the Operation register in MDM Hospital Jodhpur associated with Medical College, which included all major trauma patients undergoing Surgery for facial trauma under general anaesthesia in Jodhpur. Data collected included demographic and injury details, and operative procedures carried out. In this study we analyze etiology and pattern of MF trauma. Results 478 patients included in the study consisting of 93.7% male and 06.3% female, and the male-to-female ratio was 4.8:1. Mean age was 40.3 ± 17.2 years with a range of 18 to 97. 77.4% of the patients were between the ages of 18–39 years and predominantly male. Above 60 years of age, referrals were mostly woman. The most common cause of injuries were road traffic accidents 80% violence 15%, followed by falls The primary cause of injuries were RTA between ages 20 and 49 and falls after 60. In earlier times most common fractures were reported of mandible which gradually increased to panfacial traumas some cases reused fall even under lefort classification given by Marciani et al. history revealed travel by bicycle resulted in fracture dentoalvolus or mandible some times ZMC, slowly as economy developed with 150 cc motorcycle and suvs complicated fractures started occurring. 9% of the patients had brain injury and only frontal fractures is significantly associated. Male gender has statistically stronger association for suffering male (p \ 0, 05). No statistically significant data were revealed between alcohol consumption and presence of fracture. Conclusions The need for preventive strategies to be reinforced has been highlighted as high speed transport-related injuries remain high especially in the younger age groups. References/Bibliography 8. Gratten E, Hoobs JA. Mechanism of injury to the face in road traffic accidents. In: Rome NL, Williams J, editors. Maxillofacial injury. London: Churchill-Livingstone; 1985:37–74.

ABS0058 Comparison of Subciliary and Subtarsal Incisions as Surgical Approach to Infraorbital Rim Fracture

ABS0056 Emerging Trends in Maxillofacial Trauma: A Medical College Experience

Dr. Pravin Chouhan, MDS (OMFS); Dr. Varsha Manekar, MDS (Asso. Prof., OMFS)

Dr Chandrashekhar Chattopadhyay, Assistant Professor

Abstract Background/Introduction Orbito-zygomatic fractures represent one of the frequent conditions encountered today. Transcutaneous approaches includes subciliary, subtarsal and infraorbital incisions. The study is planned to see the accessibility, functional and aesthetic aspects of subciliary and subtarsal incisions for approaching the infraorbital rim fractures. Objectives 1. Assess the intraoperative ease of surgical access and exposure achieved. 2. Compare the aesthetic outcome of the incision at intervals of 15 days, 1 month and 3 months after surgery. 3. Assess

Dr S N Medical College Jodhpur Abstract Background/Introduction Trauma has been identified as a major public health problem both in India and globally. The incidence and epidemiological causes of maxillofacial (MF) trauma varies more widely. The objective of this study is to point out maxillofacial trauma patients’ emerging trends and trauma patterns with changing era from slow moving vehicles to

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Govt. Dental College & Hosp., Nagpur

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 postoperative complications such as scleral show, ectropion, lid edema. Methods A randomized, prospective, comparative, clinical study was done on 20 patients having infraorbital rim fractures with or without other facial fractures. Patients divided into Group A (Subciliary incision) & Group B (Subtarsal). The patients were evaluated intra-operatively and postoperatively for various parameters at the 15 day, 1 month & 3rd month. Results The exposure was adequate in 7 patients (70%) of Group A and in all 10 patients (100%) of Group B. In group A at 3 months, the scar was barely visible in 2 patients (20%) and in 5 patients (50%) in group B. At 3 months, scleral show was present in 50 % of group A patients and 10% in group B. Ectropion persisted in only 1 patient (10%) in group A and none of the patient in group B at 3 months. 1 patient (10%) in group B was showing persistence of lid edema. Conclusions When scar and edema is concerned, subciliary incision has better outcome and when ectropion and scleral show is concerned, subtarsal incision has less complications.

S5 Conclusions Styloid fractures may be found co-existing with mandibular fractures. It is mandatory to treat these fractures either conservatively or surgically on the basis of severity of clinical features. Hence, careful radiological assessment of styloid region is essential in mandibular fractures. This classification would be helpful in future to manage these cases. References/Bibliography Blythe JN, Mathews NS, Connor S. Eagle’s syndrome after fracture of elongated styloid process. Br J Oral Maxillofac Surg 2009;47: 233-5.

ABS00175 Retrospective Analysis of 100 Mandibular Fractures: An Institutional Experience Dr. Ramdas Balakrishna, Dr. Bhuvaneshwari S, Dr. Sudarshan, Dr. Veena Gc, Dr. Suhas Prabhakar

References/Bibliography Ridgway EB, Chen C, Colakoglu S, et al. The incidence of lower eyelid malposition after facial fracture repair: a retrospective study and metaanalysis comparing subtarsal, subciliary, and Zygoma Reconstruction 199 transconjunctival incisions. Plast Reconstr Surg 2009;124:1578–86.

ABS00150 Stylo-Mandibular Complex Fracture: A Protocol to Recognise and Proposal of New Classification with Critical Review of Literature Nanda Kishore Donepudi; Bapuji Dental College and Hospital Abstract Background/Introduction The incidence of either isolated Styloid process fracture or in combination with mandibular fractures is rare. Fractures may occur with or without an obvious relation to trauma. Since there are a number of symptoms on presentation and the overlapping with adjacent anatomic areas, cases of symptomatic styloid process may be misdiagnosed and mistreated. Styloid fractures may cause symptoms that are vague and inconsistent as seen in the case of Eagle’s syndrome. In the review of literature, majority of the patient’s were treated conservatively, while few demonstrated the necessity of surgical intervention. There is a definitive need for protocol to recognize and classify styloid fractures based on which treatment may be planned. This presentation focuses on proposal of its classification with critical literature review. Objectives 1. To explore the biomechanics resulting in styloid fracture and rationalize the need for its either conservative or surgical management 2. To propose a standard classification of stylomandibular complex fracture based on which treatment can be planned. Methods Not applicable. Results Not applicable.

KLE Society’s Institute of Dental Sciences Abstract Background/Introduction Of all the maxillofacial bones; mandible is the second most common bone affected in maxillofacial trauma. With its higher incidence in the present modern world; evaluation of the etiology, pattern and distribution of such fractures is quintessential in understanding its mechanism and management. Objectives To evaluate the age, gender distribution, site distribution, etiology and common patterns of mandibular fractures. Methods Systematic retrospective review of records of 58 patients with 100 mandibular fractures treated in a single institution. Results Of the 58 patients; 49 males and 9 female patients belong to the age group of 4–62 years (average 31.57 yr). Among the various etiologies i.e., assault, road traffic accident (RTA), self-fall, work place injury and sports-related injury; RTA accounts for 37.93% and self-fall for 36.02% of cases. Of the 100 fractures analyzed, 36% are unilateral fractures and 64% are bilateral. Side affected among these are left (54 %), right (43 %) and symphysis or midline (3%). The site distribution is as follows:- Symphysis – 3; Parasymphysis – 42; Body- 7; Angle – 26; Subcondylar – 22. The most common fracture pattern is the ipsilateral parasymphysis with contralateral angle (16 cases). Open reduction and internal fixation was the predominant modality of treatment. Complications were observed in 25.86 % of patients. Conclusions Surveys play a vital role in better understanding the biomechanics of the mandible fractures. Furthermore, analysis of the treatment modalities used and their respective outcomes are of paramount importance in guiding the surgeons to evaluate their efficacy. References/Bibliography Cheng CS, Ching YC, Sulaiman WAW, Rahman SA. Five-Year Analysis of Mandible Fracture and its Associated Factors. IOSR Journal of Dental and Medical Sciences, Volume 16, Issue 3 Ver. II (March. 2017), P 118–124. SB KSN, Kamath RAD, Lakshmi SS, Deepthi V, Prabhakar S. Mandibular trauma in Central Karnataka, India – An outcome of 483 cases at a regional maxillofacial surgical unit. Journal of Oral and Maxillofacial Surgery, Medicine and Pathology, 27, 2015, P 308–317.

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ABS00190 Maxillofacial Injury Caused by Bear Mauling: Case Series Pranali Nimonkar Govt Medical College, Nagpur Abstract Background/Introduction Animal bites has a special place in traumatology owing to its high complication rate when compared with similar soft tissue wound otherwise caused during trauma. Bear attacks are very rare constituting only 0.1 % of all animal attacks in India. However, among other animal attacks bear mauling is inflicted on face most commonly. Major concern is prevention of postoperative infection in such cases owing to the fact that Bite wounds are contaminated with variety of pathogens and are further soiled with mud, grass which is forced during the struggle in the course of attack. Hence management of bites require both systemic and local consideration. Excellent blood supply of face poses it to low risk of post treatment infection but it can result in facial disfigurement with distressing physical and psychological consequence. Objectives To present a case series of maxillofacial injuries caused by bear mauling and to propose a rationalized treatment approach for management of bear mauling attacks. Methods Routine blood investigations, diagnostic imaging were performed. Swab cultures from the wound were sent. General condition was assessed and necessary management was done. Post-trauma anti tetanus prophylaxis, post exposure prophylaxis and broad spectrum antibiotics were administered to all the cases. Thorough debridement of wound and primary closure was done in first surgery. Rehabilitation was planned for one of the case with hard tissue loss. Open reduction and rigid internal fixation was done for another case. Results Acceptable aesthetic out come and control of infection with functional rehabilitation was achieved. Conclusions Maxillofacial reconstruction should aim at functional rehabilitation and esthetic camouflage. Management of such injuries regularly require multidisciplinary approach and several secondary interventions to treat the secondary defects. References/Bibliography 1. Patil SB, Mody NB, Kale SM, Ingole SD. A review of 48 patients after bear attacks in Central India: Demographics, management and outcomes. Indian Journal of Plastic Surgery. 2015;48(1):60–65. 2. Shah AA, Mir BA, Ahmad I, Latoo S, Ali A, Shah BA. Pattern of bear maul maxillofacial injuries in Kashmir. Natl J Maxillofac Surg 2010;1:96–101.

ABS00238 Removal of Complex Type Penetrating Cranio Maxillo Facial Foreign Bodies Caused by Industrial Accidents: Case Series Dr. Sajid Ahmed Sanadi, Dr. Jamil Ma Shargavi Al-Noor Specialist Hospital Makkah, KSA Abstract

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Background/Introduction Rapid growth in the Gulf region has fueled an explosive pace of construction and a rise in risks of occupational injury. The construction workers are usually highered from developing countries, these workers usually do not have enough experience of latest machineries and work over time without complete training and safety measures. Objectives The aim of this study was to discuss the peculiarity of the multidisciplinary approach in treatment of five victims of an industrial accidents where patients were brought to Emergency department with Foreign bodies (FB) retained in intra craniomaxillo facial region. The Objective of the study is to find out the possible etiology, time, level of education and safety measures used during industrial accidents. Methods A retrospective study is carried out at Al-Noor Specialist Hospital Makkah, after approval from ethical clearance committee. Five patients who were surgically treated for removal of intra craniomaxillo facial FB. They include two most commonly encountered types of these injuries: cutting disc, nail gun and one rare caused by machine bolt of huge crane. In all the patients’ CT scan was done pre operatively to see proximity of FB and vital structure. FBs were removed successfully under general anaesthesia. All patients received antibiotics post operatively. Results All patients were male, and received in hospital in emergency after regular working hours. In all cases FB was removed successfully with no death reported. One of the patient developed brain deficit, unilateral loss of vision, two developed facial nerve palsy and scar. Conclusions Immigrant workers’ exposure to unhealthy and unsafe working conditions, and their corresponding susceptibility to workplace injuries and illnesses. References/Bibliography 1. Rathod JM Danger and Dignity: Immigrant Day Laborers and Occupational Risk, Seton Hall Law Rev. 2016;46(3):813–82. 2. Tucker P et al. Work time control, sleep & accident risk: A prospective cohort study Chronobiol Int. 2016 Apr 15:1–11.

ABS00257 Etiology and Incidence of Maxillofacial Trauma in High Altitude: A Two Year Experience at 9100 Feet Dr (Lt Col) Yuvraj Issar, Dr (Maj) Bhargava D Army Dental Corps CMDC (SC) Pune Abstract Background/Introduction The management of Cranio-Maxillofacial trauma may be somewhat similar in Maxillofacial centers around the world, however the etiologies vary vastly as we work in different parts of the world. Very little scientific literature is available for remote high altitude areas. Our share our experience of operating in such region. Objectives To evaluate the features of the population victim of facial trauma as to gender, age, occupation, origin, type of fracture and its cause, at an isolated multi-speciality hospital at an altitude of 91000 feet above sea level.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Methods A Retrospective study at an altitude of 9100 feet above sea level. Patients who were treated for Oral and Maxillofacial injury from Jun 2015 to Jul 2017 (25 months). Data regarding incidence, age and sex distribution, causes, types and site of injury, treatment modalities and trauma associated complications were collected and analysed. Results A total of 59 patients were studied. There was a higher incidence of facial trauma on men (85.5%), and with an average age of 28 years. Regarding occupation, the trauma was occurred to Construction workers/Saw mill workers/ professional woodcutters (22.5%) second were Policemen /Soldiers (16.6%) and students (15.5%). Mandible was the most commonly fractured (35.2%), followed by zygoma (19.7%) and by the nasal bones (15.4%), most patients presented a single facial fracture (85%). Among the causes, Road Traffic accidents (34.6%), accidental falls (28.3%), Animal Assaults (12.7%) and aggressions (10.4%) were the most common. Head/neck (50.29%) and limb injuries (27.2%) were the most prevalent associated injuries. Conclusions Road Traffic Accidents closely followed by fall from height and Animal assault are the main causes of facial trauma in isolated high altitude region of the Indian peninsula. Whereas, construction workers are the most common segment of society suffering facial trauma in sharp contrast to most parts of the world. References/Bibliography 1. Brook M and Wood N. Aetiology and incidence of facial fractures in adults Int Journal Oral Surg. 1983; 12:293–298. 2. Boffano P, Kommers SC, Karagozoglu KH, et al. Aetiology of maxillofacial fractures: a review of published studies during the last 30 years. Br J Oral Maxillofac Surg. 2014; 52:901–906.

ABS00261 Are Maxillofacial Surgeons in India Trained to Manage Life Threatening Injuries in Emergency Department Dr Kunwar Satish, Reader Teerthankar Mahaveer Dental College and Research Centre, Moradabad, UP Abstract Background/Introduction With increase in number of trauma cases, health service sector is coming up with more number of trauma centres across the country. Head and neck injuries constitute 50 % of 12 millions wounds treated in emergency room. Management of fresh trauma cases in general require quick assessment, performing life saving procedures and exact documentation with little scope for flaws. Objectives 1. To asses the level of training for maxillofacial postgraduates in management of trauma patients 2. To recommend improvement in the level of training of maxillofacial surgeons of India in management of life threatening conditions. Methods 1. Set of questions were given to post graduate trainee to respond 2. Questions were based on hours of duty in emergency, management protocol followed at their centre, record maintenance of such cases, any special training to handle life threatening conditions, response were analysed.

S7 Results From survey, it was concluded that most of the trainees were capable of managing maxillofacial injuries with normal physiology. Most of them referred the patients/intervened when condition was critical. Trainees had difficulty in managing of airway, bleeding and shock. Maintenance of records were not standard. Conclusions Need to strengthen certain areas of training for maxillofacial surgeons such as management of ABC, better understanding of anatomy and physiology of body and concept of maintaining accurate medico legal records. References/Bibliography Advance trauma life support course manual, atlas of operative maxillofacial trauma surgery.

ABS00273 Is Delta Plate a Better Option than Single Miniplate for Management of Condylar Fracture of Mandible? 1. Dr Archana D. Deshpande, Assistant Professor, 2. Dr Prashant K. Pandilwar, Professor, 3. Dr Abhay Datarkar, Professor & HOD 1. Govt. Dental College, Nagpur; 2. Govt. Dental College, Aurangabad; 3. Govt. Dental College, Nagpur Abstract Background/Introduction Management of mandibular condylar fracture is one of the most controversial topic in maxillofacial surgery. Single miniplate is generally used for open reduction and internal fixation with some disadvantages while two miniplates, though having good results are difficult to place 1. Hence there was need to explore the use of suitable device. Delta plate was evaluated for stable osteosynthesis. Objectives To compare the efficacy of Delta Plate versus Conventional Single miniplate in the fixation of condylar fracture of mandible. Methods 20 adult patients with displaced unilateral subcondylar fracture were selected for RCT. Patients were randomly equally divided into two groups and fractures were reduced with delta plate and single 4-hole miniplate respectively. Materials used 1. 3-Dimensional titanium Delta Plate. 2. Single 4 hole titanium miniplate. Following parameters were evaluated after 1 week, 1 month and 6 months respectively. 1. Maximum Inter Incisal Distance, 2. Mandibular Deviation, 3. Occlusion, 4. Need for Inter Maxillary Fixation, 5. Post operative complications 6. Radiological evaluation The statistical analysis was performed using SPSS 18.0 (SPSS Inc.) software and the statistical significance was evaluated at 5% level. Results Sn Parameters Used Delta Plate Single 4 Hole p-value for (MeanValue) Maniplate difference in (MeanValue) two Groups 1 Inter Incisal Distance 39.3mm 35.6mm 0.3131 (NS) 2 Mandibular Deviation 1.0mm 2.6mm 0.0071 (S) 3. Normal Occlusion 90% 30% 0.0048 (S) (Immediate Post Operative) 4. Inter maxillary 10% 70% 0.0225 (S) Fixation Required 5 Displacement of Condyle in Coronal Direction in degrees 5.95 9.7 0.0125 (S) 6 Loss of Ramus Height 0.7mm 1.7mm 0.0294 (S) 7 Complications (Plate bending, screw 0% 30% 0.2104 (NS) loosening, etc). Conclusions Open reduction and internal fixation of mandibular condylar fracture with Delta condylar plate is found to provide Stable osteosynthesis,

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S8 internal stability, optimal leverage with minimal thickness of plate and is suitable for the treatment of mandibular condylar fractures 2. References/Bibliography 1. Gu¨nter Lauer, A New 3-Dimensional Plate for Transora Endoscopic-Assisted Osteosynthesis of Condylar Neck Fractures. J Oral Maxillofac Surg 2007;65:964–971. 2. Dominik Haim, Biomechanical Study of the Delta Plate and the TriLock Delta Condyle Trauma Plate. J Oral Maxillofac Surg 2011; 69:2619–2625.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 2. Ellis E 3rd. A study of 2 bone plating methods for fractures of the mandibular symphysis/body. J Oral Maxillofac Surg. 2011 Jul;69(7):1978–87.

ABS00298 Efficacy of 3 Dimensional Plate in Maxillofacial Trauma Dr. Deepa BV

ABS00276 A CBCT Analysis of Buccal Bone Thickness in Maxilla and Mandible and Its Clinical Significance in Monocortical Screws Placement Kartik Shyam Tank, Ramdas Balakrishna, G C Veena, Rahul Maheshwari, S Bhuvaneshwari Consultant Oral and Maxillofacial Surgeon, Nagpur; Professor and Head of the Department, Oral and Maxillofacial Surgery; K.L.E Society’s Institute of Dental Sciences, Bangalore; K.L.E Society’s Institute of Dental Sciences, Bangalore; Consultant Oral and Maxillofacial Surgeon, Dibrugarh; K.L.E Society’s Institute of Dental Sciences, Bangalore Abstract Background/Introduction The placement of monocortical screws may carry the risk of damage to the tooth roots and important anatomical structures during treatment of fractures. Objectives 1. To determine the buccal bone thickness in maxillary and mandibular arches through CBCT. 2. To predict the safest length of monocortical screw that can be placed without damage to roots of the teeth or important structures like mandibular nerve. Methods 100 samples including 50 maxillae and 50 mandibles were assessed using CBCT. The measurement of buccal bone thickness was done from canine to second molar; from outer buccal cortex to inferior alveolar nerve canal (IANC) and from the outer buccal cortex to floor of the maxillary sinus/nasal floor. Results In mandible the buccal cortical bone thickness increased from canine to second molar at the level of the apex. In maxilla the mean buccal cortical bone thickness at the level of apex was highest in the region of second molar (5.22 ± 1.54 mm) and least in the region of first premolar (1.96 ± 0.97 mm). At the level of floor of the maxillary sinus the mean buccal cortical bone thickness was highest in the region of first premolar (4.13 ± 2.04 mm) and least in the region of second molar (2.66 ± 1.09 mm). Conclusions This study showed that if longer length of screws are to be used for better stability they need to be directed such that damage to the tooth roots or important anatomical structures is avoided. References/Bibliography 1. Al-Jandan BA, Al-Sulaiman AA, Marei HF, Syed FA, Almana M. Thickness of buccal bone in the mandible and its clinical significance in mono-cortical screws placement. A CBCT analysis. Int J Oral Maxillofac Surg. 2013 Jan;42(1):77–81.

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JSS Dental College and Hospital, Mysuru Abstract Background/Introduction Maxillofacial trauma is a cause of alarming concern due to the increasing road traffic accidents, violence and sports injury. The treatment options in the management of maxillofacial injuries are numerous and not without controversies. The management of trauma evolved from the supportive bandage to splints and has changed from close to open reduction and direct fixation using bone plates and screws. Michelet et al began experimenting with mono-cortical non compression miniplates. He described the treatment of fractures using small, easily bendable, non compression miniplates, anchored with mono-cortical screws. Champy et al. showed that the superior mandibular border was subjected to tension and splaying, and the inferior border was subjected to compression plates placed along the ideal line of osteosynthesis were thought to provide optimal fixation and stability. As these plates were small and the screws mono-cortical, it simplified surgery and reduce surgical morbidity. However they fail to surpass the predictability of rigid fixation using compression and reconstruction plates. Farmand et al in 1992 developed the concept 3D miniplates. Their shape is based on the principle of the quadrangle and geometrically stable configuration for support. Objectives The primary objective is to identify papers reporting the results with treatment of Maxillofacial fractures with the aim of comparing the different techniques using different miniplates designs (3D). Methods The study was done by referring and reviewing the various publications on the related topic from 2000 to 2017. Results The biomechanical and technical constraints of the conventional rigid internal fixation devices have prompted the use 3D miniplates as a viable treatment modality. Conclusions The purpose of this paper is to highlight the versatility of 3D miniplate in the management of maxillofacial trauma. References/Bibliography 1. G. Mittal, R.R. Dubbudu, K.M. Cariappa. Three dimensional Titanium Miniplates in Oral and Maxillofacial Surgery: A Prospective clinical Trial. J. Maxillofac. Oral Surg. (Apr-Jun 2012)11(2):152–159. 2. Shreyas H Gupteshruti Chaddava et al. Evaluation of Efficacy of 3 dimensional stainless steel miniplates in the treatment of fractures of the mandible: A prospective Study. Journal of Orthopaedic Case Reports 2016 Nov-Dec:6(5):35–40.

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ABS00324 Management of Zygomatico-Maxillary Complex Fracture Using Two Point Versus Three Point Fixation: A Prospective Study Dr Mayur Janardan Gawande Abstract Background/Introduction Zygomatico-Maxillary complex functions as the principle buttress of the face and is the cornerstone to an individual’s aesthetic appearance. Zygomatic complex fractures are one of the frequently occurring maxillofacial injuries owing to its position and facial contour. Assaults, road traffic accidents and falls are the common causes leading to fracture of the zygomatic bone. Displacement of the fractured fragments leads to aesthetic and functional disturbances. Objectives To evaluate: Post operative Stability Duration of surgery Facial Aesthetic Neurological Assessment Radiographic Assessment Associated complications. Methods 10 patients of Zygomatico-Maxillary complex fracture reported to the Department of Oral and Maxillofacial Surgery were randomly divided equally into two groups. In group A, 5 patients were treated by ORIF using three point fixation by mini-plates and in group B, 5 patients were treated by ORIF using two point fixation by mini plates. They were evaluated for their complications during and after surgery with their advantages and disadvantages. Results We found that post-operative complication like decreased malar height and vertical dystopia. Conclusions Based on this study, ORIF using three point fixation by miniplates is the best available method for the treatment of zygomatico-Maxillary complex fracture. References/Bibliography Prachur Kumar, Suhas Godhi, Amit Bihari Lall, C. S. Ram; Evaluation of Neurosensory Changes in the Infraorbital Nerve following Zygomatic Fractures; J. Maxillofac. Oral Surg.; (Oct-Dec 2012); 11(4):394–399. Edward Ellis, and Winai Kittidumkerng, Analysis of Treatment for Isolated Zygomaticomaxillary Complex Fractures; American Association of Oral and Maxillofacial Surgeons;1996;54;386–400.

ABS00369 A Comparative Evaluation of Efficacy of Intraoral & Extraoral Internal Fixation Technique in Mandibular Angle Fracture Presenting Author – Dr. Dilpreet Trilochansingh Rajkhokar, Lecturer. Co-Author-Dr. Pravin Lambade, Consultant Department of Oral & Maxillofacial Surgery, Government Dental College, Raipur, Chhattisgarh, India; Oral & Maxillofacial Surgeon, Nagpur, Maharashtra Abstract Background/Introduction Treatment of mandibular angle fractures is plagued with highest postsurgical complication rate amongst mandibular fractures.

S9 Intraoral & extraoral internal fixation technique in these fractures have their own advantages and disadvantages which often puts the surgeon into a dilemma. Objectives In the light of these factors, the aim of this study was to compare treatment outcomes between extraoral and intraoral fixation for management of mandibular angle fractures. Methods A prospective randomized comparative study was conducted to compare open reduction and internal fixation of mandibular angle fractures via intraoral approach according to Champy’s ideal line of osteosynthesis (group A) versus extraoral approach with application of an inferior border plate (group B). In both groups 2mm, 4 hole with gap miniplates and 2x10 mm screws were used. Clinical and radiographic assessment was done preoperatively, immediately postoperative & 1st week, 6th week, 3rd month and 4th month. Intraoperative assessment was done in terms of Surgical approach, Surgical complications, hardware complications & Operative time. Postoperatively treatment scoring system (V Uglesic 1993) was used to assess the complications, occlusion, chewing and appearance of the scar. Data were evaluated by t-test and Chi square/fisher exact test; P \ 0.05 was considered statistically significant. Results There was no significant difference between the two groups with regard to complication rates. Functional outcome was better in group B. The intraoperative time was shorter in group B. Conclusions Both approaches (intraoral or extraoral) for fractured mandibular angle provide adequate stability and similar treatment outcomes. However, extraoral approach was considered to be easier for severely displaced and unfavourable fractures. Still, surgeon should consider the best approach for treatment based on severity of displacement, location of fracture, ability to visualize & reduce the fracture. References/Bibliography 1. Uglesic V., Virag M., Aljinovic N., Macan D. ‘‘ Evaluation of mandibular fracture treatment ’’. J Cranio Maxillofacial Surg. 21: 251–257, 1993. 2. Ellis E., Lee W. Treatment of mandibular angle fractures using one non compression miniplates. J Oral Maxillofac Surg. 54: 864–871, 1996.

ABS00389 Intraoral Fixation Over External Oblique Ridge Compared to Lateral Cortical Plate Fixation in the Treatment of Mandibular Angle Fractures: A Prospective Clinical Study Dr Shweta Gupta Abstract Background/Introduction Since the initial description by Michelet et al. and research by Champy et al. the placement of a single, four-hole, monocortical, osteosynthesis plate has been considered an acceptable method of fixation for a fracture of the mandibular angle. The aim of this study is to compare the treatment outcome of fixation of mandibular angle fracture through intraoral and transbuccal approaches. Objectives Objectives of this study are assessment and comparison of these two surgical approaches. The patients are evaluated for operative time,

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S10 difficulty in access to surgical site, postoperative occlusion, fracture displacement, infection rate, complications, postoperative neurosensory disturbances and quality of external scar. Methods Patients were randomised to having their angle fractures treated with a ridge plate placed intraorally or transbucally. The patients were evaluated preoperatively, intra-operatively for various parameters and post-operatively at 1st week, 1 month & 3rd month. Results Of the 40 angle fractures, there was a highly significant difference in infection and complication rate in intraoral approach. Transbuccal plates were far less likely to need removal for infection than intraoral ridge plates. There is no significant difference in post-operative occlusal outcome & post operative fracture displacement. The incidence of facial nerve palsy was zero in case of both the groups and the scar was inconspicuous in all patients treated via transbuccal approach. Conclusions Thus it can be concluded that if mandibular fractures are being treated according to the principles of Champy et al a monocortical osteosynthesis plate placed against the lateral cortex or the buccal side of the mandible by a transbuccal approach would be better as it gives promising results in terms of function and esthetics and associated with fewer complications. References/Bibliography 1. Ellis III E, Walker LR. Treatment of mandibular angle fractures using one noncompression miniplate. J Oral Maxillofac Surg 1996;54: 864–72.

ABS00416 Surgical Management of Double/Triple Mandibular Fractures Involving the Condylar Segment: Our Perspective Dr. Sunil S Nayak. Co Author: Dr. Abhay T Kamath, Professor and Head Department of Oral and Maxillofacial Surgery Manipal College of Dental Sciences, Manipal, Karnataka State, India, Phone: 9845308590, Email: [email protected]; Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal, Karnataka State, India Abstract Background/Introduction Surgical management of double/triple mandibular fractures is a unique challenge. Our experience in the management and sequencing of double/triple mandibular fractures involving the condyle is described. Objectives To analyse and evaluate the different techniques and sequencing employed in the surgical management of double/triple mandibular fractures involving a condylar fracture. Methods A series of 3 surgical cases operated in our unit are considered. Deviating from the normal sequence of reducing and fixing the dentate segment first, we addressed the condylar segment first. In the first case, a combination of the preauricular and retromandibular approach were advocated to manage a medially displaced condylar segment. The accessibility was further facilitated by using Hegar uterine dilators. In the second case, a periangular approach, a

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 vestibular and a retromandibular approach were used to address bilateral condylar and parasymphysis fractures. In the third case, a preauricular and intraoral approach were advocated. Results In all the cases, good anatomical reduction was achieved and occlusion was stable. Facial nerve weakness was found to be negligible in the first case and totally absent in the other two cases. Discussion: Fixation of the condylar segment first would prevent lateral flaring of the gonial angle, which is a common occurrence at the time of application of Intermaxillary fixation on a free floating dentate segment. In addition the vertical height of the ramus can be restored easily. Conclusions The condyle first approach in the surgical management of double/ triple mandibular fractures, is a reliable and efficient technique and can be a valuable alternative to the conventional technique. References/Bibliography 1. Giovanni DO, Vincenzo A, Salvatore D, Giorgio I: Surgical sequence of reduction in double mandibular fractures treatment. Ann. Ital. Chir 85:207–213, 2014. 2. Mauro PA, Knut ER, Matthias F, Kawe N, Hans Karcher: The mandibular symphysis as a starting point for the occlusal-level reconstruction of panfacial fractures with bicondylar fractures and interruption of the maxillary and mandibular arches: Report of two cases. Journal of Cranio-Maxillo-Facial Surgery 42:e51– e56, 2014.

ABS00423 Frontal Bone Fracture Management; Our Experience in Last Four Years in a Single Hospital Dr Om Prakash MDS DNB FIBOMS Lecturer Dept of Oral & Maxillofacial Surgery and Oral Implantology Dental Institute RIMS, Ranchi (Ex-Consultant Maxillofacial Surgeon, Bhagawan Mahaveer Medica Superspecialty Hospital, Ranchi) Abstract Background/Introduction Frontal bone fractures are relatively uncommon and can be associated with significant morbidity. the frontal sinus is protected by thick cortical bone and is more resistant to fracture than any other facial bone. The surgical management of frontal bone fracture has been always a challenge and controversial because of associated anatomy, involvement of different speciality and other associated injuries. This paper a retrospective study, deals with our experience of frontal sinus fractures and its management to overview the fracture pattern, patient characteristics, surgical approaches, short term complications associated with the cases managed in a single super specialty centre in Ranchi in last four years. Objectives To review our cases retrospectively to overview the fracture pattern, patient characteristics, surgical approaches, short term complications associated with frontal bone fractures in last four years in the single hospital and to share our experiences. Methods A retrospective study was designed with a set proforma to record details like age, mode of injury, neurological status, other associated injuries, mode of treatment and post operative complications in the patient who were surgically treated for frontal bone fractures in last

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 four years in the mentioned hospital. The data was tabulated and compared. Results Total 35 patients with frontal bone fracture were included in this study. The age of patient varied from 7 years to 60 years, with road traffic accident as the only cause of injury. Either old laceration or coronal incision was used to reach to the surgical site. Titanium mesh or multiple plates made up of titanium were used for stabilization of fractured segments. In only one patient there was exposure of titanium mesh through the laceration as early post operative complications, which was managed successfully with aggressive debridement, dressing and use of both topical and systemic antibiotics. In another incident of complication, four months after surgical correction reported with painless swelling, which was managed conservatively with medication. (Statistical results will be submitted before the conference if required). Conclusions Deformity in frontal bone region is very prominently visible and is primarily noticed, so it requires the attention of surgeon for early management of any defect in the region. Frontal bone is important and unique because of frontal sinus, fronto nasal duct and peculiar activity of frontal recess. Displaced frontal bone fractures should be managed surgically for better out come. Coronal incision is the best incision for exposure and minimal visible scar. It is not always mandatory to remove sinus mucosa unless it is disturbed because of trauma. Local use of antibiotics has always prevented incidence of post operative infections. Team work and involvement of different specialists in planning of surgery always helps in better outcome and minimization of complications. References/Bibliography 1. Arthur A. Gonty, DDS, * Robert D. Marciani, DMDf and Dominick C. Adornato, DMDf; Management of Frontal Sinus Fractures: A Review of 33 Cases; J Oral Maxillofac Surg 57:372–379, 1999. 2. Rodriguez ED, Stanwix MG, Nam AJ, St Hilaire H, Simmons OP, Christy MR, Grant MP, Manson PN.; Twenty-six-year experience treating frontal sinus fractures: a novel algorithm based on anatomical fracture pattern and failure of conventional techniques. Plast Reconstr Surg. 2008 Dec;122(6):1850–66.

ABS00433 Evaluation of Retromandibular Approach in the Management of Condylar Fractures of the Mandible Dr Kshitij Bang MDS OMFS Assistant Professor Dept of OMFS VSPM DCRC Nagpur Abstract Background/Introduction Management of condylar fractures is a controversial topic among oral and maxillofacial surgeons. Some favour open reduction and rigid fixation of condylar fractures, while some prefer conservative management. However, an increasing number of articles report better results for surgically treated condylar fractures in terms of occlusion, bone morphology and articular function. Condylar and subcondylar fractures can be exposed through different approaches. The more commonly used extraoral approaches comprise the sub-mandibular, retromandibular and preauricular methods. The retromandibular

S11 approach has the advantage of being immediately over the fracture, allowing direct access for reduction and fixation. Objectives Evaluation of outcome of Retromandibular approach in the management of condylar fractures of mandible. Methods Trauma patients operated in Department of Oral & Maxillofacial Surgery, V.S.P.M’S DCRC from June 2013 to June 2016 who underwent open reduction and internal fixation of fractured mandibular unilateral/bilateral condyles through Retromandibular approach were selected for the study. Patients of condylar fracture treated by other approaches than retromandibular approach and with preoperative facial paralysis were excluded. The data collected were age, gender, mechanism of injury, anatomic location, concomitant facial fractures, follow-up time and complications. Results 26 patients, 31 condyles (19 males, 7 females); age-19 to 55 years, mean-(39.3 ± 4.1) met the inclusion criteria. The mean follow-up time for all patients was at least 6 months. 3 cases (9.68%) of temporary facial nerve paralysis, 1 cases (3.2%) of infection, 1 case of salivary fistula, 1 case of deranged occlusion and 1 case of chin deviation were observed. There were no cases of sialocele. Conclusions Retromandibular approach provides an excellent and safe approach for the management of mandibular subcondylar fractures and complications associated with this approach are rare. References/Bibliography 1. Ellis III E, McFadden D, Simon P, Throckmorton G: Surgical complications with open treatment of mandibular condylar process fractures. J Oral Maxillofac Surg 58: 950, 2000. 2. Bouchard C, Perreault MH. Postoperative complications associated with the retromandibular approach: A retrospective analysis of 118 subcondylar fractures. Journal of Oral and Maxillofacial Surgery. 2014 Feb 28;72(2):370–5.

ABS00437 Clinical Outcome of Pediatric Maxillofacial Fracture Management Dr. Supreet Gill, Dr. Kannan Balaraman Abstract Background/Introduction The growing patient with facial injuries presents the clinician with a series of complex and thought-provoking circumstances. while determining the optimal treatment strategy for a pediatric fracture, planning must factor in the patient’s age, anatomy, stage of dental development and fracture site. Careful consideration must be given to the possibility of long term growth disturbances secondary to various fracture patterns and types of treatment. Objectives The aim of this study was to retrospectively evaluate the treatment methods and outcome of pediatric fractures. Methods The study included a total of 24 patients up to 16 years of age who reported to Department of Maxillofacial surgery, Ganga hospital Coimbatore form 2015 to 2017. The etiology of trauma, treatment methods used and postoperative complications were noted. Patients with dentoalveolar fractures and those managed non surgically were excluded from the study. The treatment methods included

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S12 circummandibular wiring or open reduction internal fixation depending on the type and nature of injury. Results The age range of patients was 5–16 years. The most common cause of injury was road traffic accidents followed by playground injuries. The most prevalent site of fracture was mandible particularly parasymphysis and condyle which were 14 out of 24 patients. There were 4 midface fractures, 2 panfacial fractures, 2 nasal complex fractures, 1 orbit and 1 frontal bone fracture. Pediatric fractures comprised 3–4% of maxillofacial injuries encountered at out center over a period of two and a half years. Out of 24 patients, 11 patients were treated with closed approach and remaining treated with open approach. Conclusions Pediatric trauma requiring surgical intervention though is less in incidence, however the treatment has to be tailored depending on individual scenario. The main objective of treatment should be early rehabilitation and restoration of normal form and function.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 end of 2nd week postoperatively, all patients had satisfactory occlusion in group A, however, in group B, 3 patients (20.0%) still showed deranged occlusion. At the end of 6th and 12th week postoperatively, all patients had satisfactory occlusion in both the groups. References/Bibliography Biomechanical study of the delta plate and trilock delta condyle trauma plate (JOMS 2011).

ABS00621 Epidemiology and Assessment of Maxillofacial Trauma in a Tertiary Health Care Centre: A 5 Years Retrospective Study

References/Bibliography Management of pediatric mandible fractures. Erik M et al, Otolaryngologic Clinics of North America.

ABS00476 A Comparative Study of 3-D Delta Plate and Double Miniplate in Osteosynthesis of Sub Condylar Fracture Dr. Neelam Shakya Govt. College of Dentistry Indore Abstract Background/Introduction Condylar fractures account for 25–45% of mandibular fractures and deserve a special consideration apart from rest of the mandible due to their anatomical differences and healing potential. The debate continues over how to best manage subcondylar fractures and the question of which fractures should be treated surgically has yet to be answered. Objectives To compare the efficacy of 2mm 3-D titanium delta-shaped plate with 2mm conventional titanium miniplate. To evaluate the stability of Delta plating system over conventional miniplate. To evaluate postoperative occlusion and mouth opening, incidence of complications like infection, pain, hardware failure and paresthesia. Methods A total of 30 patients who required open reduction of a subcondylar fracture of mandible were selected for the study. The patients were randomly divided into two groups of 15 each. Group I comprised of patients treated with titanium delta shaped plate and Group II were treated with two non compression miniplate. The patients were assessed for malocclusion, lateral deviation on opening, infection, plate removal, facial nerve function in both the groups. Results Postoperatively at 72 hours, occlusion was deranged in 2 patients (13.3%) in group A and 4 patients (26.7%) in group B. At the end of 2nd week postoperatively, all patients had satisfactory occlusion in group A, however, in group B, 3 patients (20.0%) still showed deranged occlusion. At the end of 6th and 12th week postoperatively, all patients had satisfactory occlusion in both the groups. Conclusions Postoperatively at 72 hours, occlusion was deranged in 2 patients (13.3%) in group A and 4 patients (26.7%) in group B. At the

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NJ Budhraja, SR Shenoi, P Ingole, A Garg, VS Kolte, KO Bang Abstract Background/Introduction The epidemiology of facial injuries varies in different countries and geographic areas [1,2]. Objectives This study aimed to identify the cumulative incidence, causes and pattern of maxillofacial trauma amongst the patients reported in a tertiary health care centre from January 2012 to December 2016. Methods Hospital records of 302 patients were reviewed retrospectively after obtaining clearance from the institutional ethics committee. Data collected included patient’s name, sex, age, etiology, history of alcohol consumption, interval of reporting after trauma, primary care administered, radiological investigations, pattern of facial fractures and interval between date of admission and surgery. Results There were records of total 302 patients of trauma reported in the tertiary health care centre in the defined period. The incidence of facial fractures was more in males (88.7%), with highest number in age group of 21–25 years. Road traffic accidents were the most frequent cause of facial fractures (94%). A majority of patients were brought directly from the site to our emergency room i.e. 60.6% of cases whereas 90.7% of patients reported within 1 to 5 days after trauma. Plane radiography was found to be adequate in only 22.18% of cases; whereas in about 44.7% of cases computed tomography was the only imaging modality of choice. Mandible was found to be the most common facial bone to get fractured followed by zygomatic complex and maxilla. In mandible, parasymphysis (36%) was the most frequently involved site. The period between admission and surgery was 1 to 5 days in 87.4% cases. Conclusions This study is in consonance with the global literature that motor vehicle accidents are the most common cause of facial fractures. The results of the study indicate the necessity for strict enforcement of road safety rules and regulations to check the growing cause of trauma in central India. References/Bibliography 1. Rezaei M, Jamshidi S, Jalilian T, Falahi N. Epidemiology of maxillofacial trauma in a university hospital of Kermanshah, Iran. Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology. 2016;17.

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ABS00637 Malunited Maxillofacial Fractures: Protocol in Their Management

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ABS00696 A Comparative Evaluation Between One Point Versus Two Point Fixation for Zygomaticomaxillary Complex Fractures

Umashankara K.V, Kirthikumar Rai Bapuji Dental College and Hospital Abstract Background/Introduction Injuries to the face, head and neck are relatively common and yet, in the overall trauma literature, very little attention has been paid to malunited fracture cases of maxillofacial region. Fractures of maxillofacial region have been treated by a number of methods, including closed reduction, external pin fixation, internal wire fixation and more recently, open reduction and internal stable fixation using plates and/ or screws. In last few years maxillofacial surgery emerged out as major field in modern era of surgical practice. But due to lack of awareness and specialist expertise availability in most of the areas of our country such injuries may go undiagnosed or most of the times wrongly diagnosed and treated as well. Malunited fractures have always been a big challenge to the surgeon. As such there is no treatment protocol available in the literature which can guide us to build a definitive line of treatment in managing these fractures. However we can follow certain basic principles for management of post traumatic skeletal deformity. Most important of all in approaching such cases is to have a proper history and requirement of the patient. The one which is most concerned to the patient should be on top priority. Occlusion is a point on which no compromise is acceptable. Minimally invasive procedures and relatively simple measures can sometimes yield a marked improvement in net result. So a calculated approach should be taken while operating such cases. Treat each case as a new case and set criteria of your own depending upon the patient situation and its requirement. This paper is all about presenting such few cases of malunion treated in our unit and discuss the challenges and complications encountered during their management. Objectives Not applicable. Methods Not applicable. Results Not applicable. Conclusions Not applicable. References/Bibliography Sung-Suk Lee, Su-Gwan Kim, Seong-Yong Moon, Ji-Su Oh, JaeSeek You. The treatment of malocclusion after open reduction of maxillofacial fracture: a report of three cases. J Korean Assoc Oral Maxillofac Surg 2014;40:91–95.

Dr. Vrinda Kolte (Professor and Guide), Dr. S Khandaitkar, Dr. S R Shenoi, Dr. A Garg, Dr. K Bang, Dr. P Ingole, Dr. N Budhraja VSPM’s Dental College and Research Centre, Nagpur Abstract Background/Introduction The zygomaticomaxillary complex consists of 4 pillars attached by 4 suture lines. It includes the frontozygomatic suture, part of the orbital floor lateral to the infraorbital fissure, buttress region and zygomatic arch. Aim of a treatment should be adequate reduction and stable fixation to provide esthetic and functional stability. Various literatures are present regarding protocols of reduction and fixation of ZMC fractures. The aim of the study was to compare between one point versus two point fixation for zygomaticomaxillary complex fractures. Objectives To compare between one point versus two point fixation for zygomaticomaxillary complex fractures in terms of stability, esthetics and functional outcome. Methods This retrospective study from 2015 to 2017 June included 30 patients, who needed to undergo open reduction and internal fixation for zygomaticomaxillary complex fracture and were divided into two groups A and B, depending upon the points of fixation. In one point; fixation was done on zygomatic buttress region while in two points fixation plating was done on FZ suture and zygomatic buttress region. Results In undisplaced and minimally displaced fractures, adequate stability, good esthetics, and functional outcomes were achieved in group A while in displaced fractures these parameters were more satisfied in group B. Conclusions One point fixation is a treatment of choice for minimally displaced fractures with good esthetic and functional outcome however displaced and unstable should be fixed at two points to get better esthetic and functional stability. References/Bibliography Kim ST, Go DH, Jung JH, Cha HE, Woo JH, Kang IG. Comparison of 1-point fixation with 2-point fixation in treating tripod fractures of the zygoma. Journal of Oral and Maxillofacial Surgery. 2011 Nov 30;69(11):2848–52.

ABS00724 Role of Drug Abuse and Alcohol in Maxillofacial Trauma Kavita Raghotham Department of Oral & Maxillofacial Surgery, Geetanjali Medical College & Hospital, Udaipur Abstract Background/Introduction

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S14 Excessive consumption of alcohol and Opium abuse results in impaired judgement and plays a major role in Road traffic accidents and interpersonal violence. This study describes the experience of alcohol and patients with Opium abuse-related Maxillofacial trauma. Objectives Aim of the study was to investigate the impact of alcohol and Opium abuse in facial trauma. Methods Retrospective database of patients presenting to Oral and Maxillofacial Surgery unit at the Geetanjali Medical College & Hospital during a 13 month period was reviewed. Variables recorded were type of fracture, mode of injury, location of fracture, treatment received and days of hospitalisation. Results Over 480 patients were evaluated. 55% of the patients were under the influence off alcohol. 40% of the patients admitted to drinking alcohol on a daily basis and were not sure of the quantity. 12% admitted to Opium dependence. Around 70% of the maxillofacial trauma was attributed to Road Traffic Accidents, 10% to interpersonal violence and 8% to falls. Around 60% of the patients reported were Motorbike riders or pillions without the use of helmets. Mandible and zygoma were reported at 35% and 37% respectively. Lefort 1 and Lefort 2 fractures were reported at 10%. 50% of the patients presented with soft tissue lacerations. Mean age was 26 years. Conclusions Alcohol and Opium abuse contributed to the majority of Road traffic accident and interpersonal violence leading to Maxillofacial trauma of varying degree. Hence, calls for a need to address the public, especially the young on the harmful effects of alcohol and drug abuse. Also, raises a concern about unsafe driving practices in the country and a need to push for education. References/Bibliography 1. Alcohol abusive use increases facial trauma? Med Oral Patol Oral Cir Bucal. 2016 Sep 1;21(5):e547–53.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 studied the incidence of slot misalignment, screw driver slippage, and difficulty in screw fastening using these systems. Methods After patient selection, the sites of fracture fixation were divided into 2 groups, sites were allotted to respective groups by lottery method of sample selection and were matched for fracture site. Groups containing 68 and 69 Sites where cross recess screws and monoslotted screws were used to secure the miniplate into place respectively. A standardized data sheet was formulated and relevant clinical findings of time were noted in seconds. Results Time taken for loading the screw, time for fastening the screw and total time taken were presented as Mean ± Standard Deviation (SD). and were studied by performing independent t-test. Slot misalignment, difficulty in fastening and slippage on fastening were compared across different dimension of screw by performing Pearson’s chi square test. Time taken for loading, fastening and total time required for consecutive batches (after every 17 screws) of 17 screws each was compared by one-way ANOVA test. Findings were significant (p \ 0.005) for the 1.5 mm X 4 mm and 2 mm X 10 mm cross slotted monocortical screws only. Conclusions The Cross slotted screw design has a significant mechanical advantage in the extremes of sizes used for internal fixation in common Cranio - Maxillofacial Trauma, but the aforementioned distinction fails to hold up in other commonly used categories of screw sizes possibly negating its mechanical advantages. References/Bibliography 1. Colton C, Orson J. Screws – Form and function. AO Trauma. 2. Chen L. Effects of Different Screw Head Designs on Screw Head Slippage [Master’s Thesis]. China. 2014. [cited on – 2015 Sept, 7]. Available from: http://pc01.lib.ntust.edu.tw/ETD-db/ ETD-search-c/view_etd?URN=etd-0722114-103038.

ABS00756 Monoslotted Screws: Are They Still Relevant?

ABS00762 The Pattern of the Maxillofacial Fractures in North Bengal: A Retrospective Study

Dr. S. R. Shenoi, Dr. Vrinda Kolte, Dr. Kshitij Bang, Dr. Pranav Ingole, Dr. Chinmay Rao

Dr. Sumit Agarwal

VSPM Dental College and Research Centre Abstract Background/Introduction Bone plates and screws have today become the mainstay in the management of fractures in the maxillofacial region. The screw head allows for the attachment of the screwdriver and to arrest forward motion. Monocortical screws for use in internal fixation are commonly available with a single slot and a cruciate slot, the later said to provide a measure of redundancy. Despite this the monoslotted screws are in widespread use in the Indian Subcontinent. The authors have endeavoured to verify the touted advantage of the cross slotted monocortical screws as against the monoslotted screws in rampant use today. Objectives To evaluate the cross recess monocortical screws as against the monoslotted monocortical screws in miniplate fixation in terms of; the time required to load the screw on to the screw holder, the time required to fasten the screw into place, and the total time required to fasten the screw from loading to fastening. Further, the authors also

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The Specialist’s Dental & Maxillofacial Centre Siliguri Abstract Background/Introduction The incidence and etiology of maxillofacial fractures vary widely between different geographical areas. Understanding the cause and pattern of these injuries can assist in establishing clinical and research priorities for more effective treatment and prevention of maxillofacial injuries. The study aimed to evaluate the etiology and pattern of maxillofacial fractures in trauma patients hospitalized in North Bengal in India. Objectives The present study was planned to investigate the etiology of maxillofacial injuries and to analyze the pattern of maxillofacial factures as well as the various factors influencing their distribution. Methods A retrospective analysis of all maxillofacial fracture patients admitted/referred to the Department of Oral and Maxillofacial Surgery was performed during a period from June 2015 to September 2017. Recorded data included age, sex, cause of trauma, and the pattern of maxillofacial fractures/injuries.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Results 425 patients sustaining maxillofacial injury were referred to the department of maxillofacial surgery out of which 210 patients underwent treatment. The most commonly fractured facial bone was the zygomaticomaxillary complex followed by mandible. Most fractures occurred in the second-fourth decade of life with male predominance. Main etiology was road traffic accidents. Motor vehicle collisions constituted the highest incidence as a cause of traumatic maxillofacial injuries followed by fall from height, assault and sport related injuries in young population. Conclusions In most other epidemiologic studies of maxillofacial fractures, MVA was the main cause of injury; and midface the most common site of fracture. However, the vagueness and imprecision in the classification and nomenclature of maxillofacial fractures has led to confusing results that are difficult to compare. References/Bibliography Naveen Shankar A, Naveen Shankar V, Hedge N, et al. The pattern of the maxillofacial fractures: A multicentre retrospective study. J Craniomaxillofac Surg. 2012; 40 (8): 675–679. The pattern of maxillofacial fractures in central India A Unicentric retrospective study Dr. Rajanikanth K, Dr. R.M. Borle, Dr. Nitin Bhola, Dr. Shivam Volume 13, Issue 1 Ver. X. (Feb. 2014), PP 28–31 IOSR-JDMS.

ABS00775 Evaluation of Various Fixation Methods in the Management of Subcondylar Fractures of Mandible Dr D Sathya Kumar Prof & Head Dept of OMFS, Narayana Dental College, Nellore Abstract Background/Introduction Fractures of mandibular condyle account for 20–30% of all mandibular fractures. The treatment of subcondylar fractures remains one of the most controversial topics in maxillofacial surgery. Though closed reduction has been the preferred treatment, but owing to demerits like poor patient compliance to IMF, possibility of internal derangement, ankylosis etc & the development of better fixation devices, refinement of surgical approach technique makes ORIF as gold standard treatment method for subcondylar fractures. Objectives The aim of the study was to evaluate the Clinical & Radiological outcome of patients with mandibular subcondylar fractures treated with six different types of fixation techniques. Methods This retrospective clinical case record study includes 78 patients with unilateral subcondyle fractures treated over a period of 7 years (March 2010 to June 2017) by Open reduction & Internal fixation with Six different types of fixation techniques. Results The results of our retrospective study suggest that in all cases initial anatomic reduction was good in all six fixation techniques. Stability of different fixation techniques is in the decreasing order of Delta plate Trapezoidal plate 4 hole plate?2 hole plate Double 2 hole plate Single 4 hole plate Single 2 hole plate.

S15 Conclusions Our retrospective case study shows that Delta plate & TCP miniplate fixation technique showed almost equally highest stability. References/Bibliography Three-dimensional assessment of unilateral subcondylar fracture using computed tomography after open reduction. Indian Journal of Plastic Surgery May-August 2014 Vol 47 Issue 2.

ABS00832 Orbital Floor Reconstruction Titanium Mesh Versus Autogenous Bone Graft: Clinical Study Dr. Shashwat Magarkar Assistant Professor, Dr. Ketaki Joglekar, Dr. Vyankatesh Sahu, Dr. Kavita Sahu Government Dental College and Hospital, Nagpur; Email: [email protected], 9975635634, 115, Reshimbagh Godavari Nagpur-440009 Abstract Background/Introduction The complexity of anatomy of the orbit makes the treatment of traumatic orbital injuries a formidable challenge to the maxillofacial surgeons. The list of substances called on to reconstruct the orbits original anatomy encompasses- autogenous, synthetic, allograft, xenograft, or a combination, which successfully achieves its purpose. Objectives To study and evaluate the effectiveness of autogenous bone graft and of titanium mesh (alloplastic material) for repairing traumatic orbital floor defects and compare these results in terms of level of improvement in function as well as aesthetics at a rural hospital setup. Methods A prospective - orbital floor fractures of 10 patients were analyzed. The patients were divided into 2 groups: (1) those in which orbital floor fractures were treated with titanium mesh and (2) patients in which orbital floor fractures treated with titanium mesh. Patients were clinically evaluated for the presence of enophthalmos, diplopia and restriction of the ocular muscles and change in ocular level. Results It was observed that diplopia as well as the restriction in the extraocular movements was completely corrected at the end of 6th postoperative month in all the patients in which TM was used for reconstruction, also enophthalmos and hypoglobus were inadequately corrected in only one patient in which TM was used. 5 cases in which ABG was used for reconstruction of orbital floor, diplopia as well as the restriction in the extraocular movements were persistent in one case, while there was inadequate correction of the enophthalmos and hypoglobus in two cases after 6 months. Conclusions Orbital floor defects can be reconstructed using titanium mesh with good functional as well as aesthetic results as compared to autogenous bone graft by avoiding donor site morbidity, reduced operating time and eliminating the risk of resorption.

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ABS00834 Evaluation of Craniofacial & Cervical Injuries in Two Wheeler Road Traffic Accident (RTA) Victims, With or Without Wearing a Helmet

ABS00835 Comparative Study of Combination of Drill Free Screws (DFS) Versus Self Tapping Screws for Osteosynthesis of Fractures

Dr Vyankatesh Sahu, Asst Prof, Co Author: Dr Kavita Vyankatesh Sahu (Gupta), Dr Shashwat Magarkar Asst Prof, Dr Ketaki Joglekar

Dr Kavita Vyankatesh Sahu (Gupta), Co Author: Dr Vyankatesh Sahu Asst Prof, Dr Shashwat Magarkar Asst Prof, Dr Ketaki Joglekar

Government Dental College & Hospital, Nagpur Department of Oral & Maxillofacial Surgery; Max Care Multispeciality Clinic Sahu’s Dental Clinic, Nagpur, India; Government Dental College & Hospital, Nagpur Department of Oral & Maxillofacial Surgery; Smilekraft Maxillofacial Surgery and Dental Hospital, Nagpur, India

Max Care Multispeciality Clinic Sahu’s Dental Clinic, Nagpur, India; Government Dental College & Hospital, Nagpur Department of Oral & Maxillofacial Surgery; Government Dental College & Hospital, Nagpur Department of Oral & Maxillofacial Surgery; Smilekraft Maxillofacial surgery and Dental Hospital, Nagpur, India

Abstract Background/Introduction India has one of the highest RTA rates in the world, nearly 80,000 get killed and 3,40,000 are injured every year in about 3,00,000 accidents. There is an accident every minute and death every 8 min in India. Motorcycle is considered the most dangerous of all motorized vehicle due to its nature and design e.g. absence of outer body, airbags and seat belt to reduce impact in the event of a collision. Many of these injuries can be severe and some can be prevented or reduced in severity by wearing a helmet. Objectives To describe the pattern, incidence and characteristics of maxillofacial and other concomitant injuries in two wheeler accident cases and explore potential factors related to the type of Helmet and pattern of Facial, cervical, head and other injuries. Methods A prospective and observational study was conducted in which a total of 200 patients was screened within a period of 20 months who had a two wheeler RTA and survived at the time of examination and following sequence of events was performed: Through Case History recording, Clinical Examination and Radiographic Evaluation was done. Results Mandibular fractures were the most commonly encountered fractures followed by maxillary & nasal fractures and ZMC fractures. 60% patient sustained dental injuries. It was statistically seen that not wearing a helmet had direct association with upper and middle facial third injuries, deranged occlusion, fracture of mandible and other facial bones. Direct association existed between failure to wear a helmet and head injuries, concluding helmet is protective against head injury. Helmet is not protective against cervical injury and an association exists between wearing a full type of helmet and cervical injury. Conclusions Hence, two wheeler RTA’s are a source of a large number of maxillofacial injuries and wearing a helmet significantly decreases the severity and extent of maxillofacial and head injuries.

Abstract Background/Introduction In general, osteosynthesis screws were inserted into bone after drilling a pilot hole. Although the application of self tapping & DFS is virtually universal in craniomaxillary surgery, the inevitable time consuming procedure of drilling a pilot hole in self tapping has some potential disadvantages. DFS have specially formed tips and cutting flutes, which act like a cork-screw & can be inserted into bone without predrilling. Therefore, a prospective study was performed to investigate the efficiency of DFS in clinical use in maxillofacial traumatology. Objectives To evaluate the efficacy, advantages & disadvantages, ease of fixation, stability & functional load bearing capacity, complications etc provided by mini & micro DFS in maxillofacial trauma. Methods 2O Healthy individuals were selected having maxillofacial fractures. 10 patients were selected as Group A and Group B respectively. Patients were treated with open reduction & internal fixation. Miniplates with DFS screws and self tapping screws of 1.5/2mm used in fracture of maxilla or mandible respectively. Patient were kept on regular follow up, 1st postoperative week, followed by weekly visits & thereafter monthly visits. Patient were evaluated for post operative discomfort, pain, numbness, palpable screws & periodic radiographs were performed. Results It was concluded that DFS is more effective in terms of time taken for fixation, less stripping of the bone threads, less damage to nerves, tooth roots or tooth germs, less thermal necrosis to the bone and avoidance of drill bit breakage as predrilling is not required. It is also useful if there is sudden loss of electricity and lastly less armamentarium as the motor handpiece system is not required. The only drawback of the DFS is that it is difficult to use it in communited fractures. Conclusions It was concluded that DFS is more effective in terms of time taken for fixation, less stripping of the bone threads, less damage to nerves, tooth roots or tooth germs, less thermal necrosis to the bone and avoidance of drill bit breakage as predrilling is not required. It is also useful if there is sudden loss of electricity and lastly less armamentarium as the motor handpiece system is not required. The only drawback of the DFS is that it is difficult to use it in communited fractures.

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Oral Presentation Section: Craniofacial Anomalies

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ABS00540 Clinical Audit of 111 Procedures in 75 Patients in a Craniofacial Centre Dr. Arjun Krishnadas, Dr. Pramod Subash, Dr. Suhas Udayakumaran

ABS007 Maximising the Effectiveness of Temporalis Flap for Facial Augmentation in Progressive Hemifacial Atrophy. A Simple Technique Lt Col S Sudeep MDC Kirkee (West) Estate Abstract Background/Introduction Progressive Hemifacial Atrophy or Parry-Romberg’s syndrome is an uncommon degenerative condition of unknown aetiology and is characterized by insidious unilateral facial atrophy. Treatment is challenging and is aimed primarily at aesthetic correction and achieving long term stable results is difficult as, there is progressive regression of augmented soft tissue. Objectives To describe a novel technique for positioning temporalis muscle flap in augmentation of facial tissues in mild to moderate Hemifacial Atrophy for improving the aesthetic outcome. Methods Three cases of Hemifacial atrophy of mild to moderate severity based on clinical and MRI evaluation were taken up for augmentation of atrophied facial tissues using temporalis flap and porous polyethylene implants. A transcutaneous tethering technique was utilized for positioning the temporalis flap. Following surgery patients were evaluated clinically for the aesthetic outcome at intervals of 6 months for a period of at least 1 year. Results No severe postsurgical complications occurred in any patient. The mean follow-up was 20 months. There has been no loss of the projection achieved and the facial contour was comparable to the unaffected side one year after the procedure at the end of one year. Conclusions In this preliminary study, the transcutaneous tethering technique for positioning temporalis muscle flap in augmentation of facial tissues in mild to moderate Hemifacial Atrophy yielded stable aesthetic results and excellent facial symmetry at the end of one year post-operative. However, long-term follow-up is necessary.

Amrita Institute of Medical Sciences, Kochi Abstract Background/Introduction Craniofacial Surgery has evolved over the years and with the advent of recent techniques and technology it has progressed exponentially. With the increasing numbers of Craniofacial deformities, it is the responsibility of a Craniofacial Unit to collect, analyze and audit patient data, outcome of which in turn can be utilized to set standards and quality of care. Objectives To retrospectively analyze standard procedures, their outcome and morbidity following surgical management of craniofacial deformities in 75 patients during July 2014 and August 2017. Methods 111 procedures in 75 patients were classified as Simple (n = 28, Single Suture Non Syndromic Craniosynostosis) Complex (n = 46, Multi-suture synostosis and Syndromic Craniosynostosis) Craniofacial Conditions. Duration of the Procedure, Intra-operative blood loss, Intra and Post operative Blood transfusion, Post operative pyrexia, Duration of antibiotic administered, Hospital stay, Morbidity and Mortality were assessed. Results There was no mortality or any significant morbidity in our series. The average procedure time for a simple condition was 5.8 hours and 9.2 hours for complex. Blood loss was higher in the complex (513 ml) compared to simple group (115ml). 96% and 44% patients received Intra-op and Post-op transfusion respectively. Post-operative pyrexia was seen in 42.6% of the patients. Patients received antibiotics for an average of 3.5 days, post-operative pyrexia and presence of distractors determining the longer duration of administration. Hospital stay was relatively the same for both. Conclusions Clinical audit is necessary to understand and analyze the issues encountered and helps us to improvise on the technique and care delivered to the patients. References/Bibliography 1. Kirkpatrick et al.: Paediatric transcranial surgery: a review of 114 consecutive procedures. British Journal of Plastic Surgery (2002) 55, 561–564.

References/Bibliography 1. Goldhammer Y, Kronenberg J, Tadmor R, Braham J, Leventon G. Progressive hemifacial atrophy (Parry-Romberg’s disease), principally involving bone. J Laryngol Otol. 1981;95:643–7. 2. Pensler JM, Murphy GF, Mulliken JB. Clinical and ultrastructural studies of Romberg’s hemifacial atrophy. Plast Reconstr Surg. 1990 May;85(5):669–74.

ABS00831 A Questionnaire Survey on Implications of Navigators in Correction of Craniofacial Anomalies Dr. Shweta S. Sonwane (Kamble) Associate Professor, Dr. Abhay Datarkar Professor & Head, Dr. Siddharth S. Sonwane Associate Professor GDCH Nagpur; Mansarovar Dental College Bhopal Abstract Background/Introduction Navigation surgery is simple localization tool used in operation theatre, implication of navigators in surgery facilitate in localization and

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S18 orientation of targeted anatomical area with more safer, less invasive procedures. Objectives This questionnaire survey was conducted to evaluate the use of advanced technologies (navigators) in correcting craniofacial deformity and to evaluate the final outcome by means of with and without navigators. Methods The questionnaire study was designed and conducted among the young and experienced oral surgeons, ENT surgeons and plastic surgeons. Sum of 75 surgeons were included and equally divided in to three groups containing 25 surgeons in each. An appropriate typed questionnaire (as per WHO questionnaire format) was given and collected back for evaluation. To minimize errors the question numbers were altered and questionnaire was given to similar participants. Both first and second answers were compared. Results Majority of oral and maxillofacial surgeons and plastic surgeons were found to be operating without navigators among the total sample. However, most often and most of the ENT surgeons were using the navigators in routine surgical procedures. Inter group comparison was done with kruskal walli test, and there was significant difference was between ENT surgeons and oral surgeons and plastic surgeons (p=0.144). Within oral surgeons and plastic surgeon the kruskal walli test showed no significant difference. Conclusions Implication of navigators in surgery is most reliable and accurate method in reconstruction of craniofacial deformities. However, it is always depending upon experience, knowledge, and skills of the surgeons to reproduce results accurately with or without use of navigators. Hence, implication of navigation system is technique sensitive, time consuming and cost-effective method. References/Bibliography 1. Yu, H., Shen, S. G., Wang, X., Zhang, L. & Zhang, S. The indication and application of computer-assisted navigation in oral and maxillofacial surgery-Shanghai’s experience based on 104 cases. J Craniomaxillofac Surg 41, 770–774 (2013). 2. Chen, X. et al. A surgical navigation system for oral and maxillofacial surgery and its application in the treatment of old zygomatic fractures. Int J Med Robot 7, 42–50 (2011). 3. Zhang, S., Gui, H., Lin, Y., Shen, G. & Xu, B. Navigation-guided correction of midfacial post-traumatic deformities (Shanghai experience with 40 cases). J Oral Maxillofac Surg 70, 1426–1433 (2012). 4. Yu, H., Shen, G., Wang, X. & Zhang, S. Navigation-guided reduction and orbital floor reconstruction in the treatment of zygomaticorbital-maxillary complex fractures. J Oral Maxillofac Surg 68, 28–34 (2010). 5. Yu, H. B., Li, B., Zhang, L., Shen, S. G. & Wang, X. D. Computer-assisted surgical planning and intraoperative navigation in the treatment of condylar osteochondroma. Int J Oral Maxillofac Surg (2014). 6. Cai, M. et al. Navigation-assisted mandibular body distraction osteogenesis: a preliminary study in goats. J Oral Maxillofac Surg 72, (168), e161–167 (2014). 7. Collyer, J. Stereotactic navigation in oral and maxillofacial surgery. Br J Oral Maxillofac Surg 48, 79–83 (2010). 8. Kaduk, W. M., Podmelle, F. & Louis, P. J. Surgical navigation in reconstruction. Oral Maxillofac Surg Clin North Am 25, 313–333 (2013). 9. Sun, Y., Luebbers, H. T., Agbaje, J. O., Lambrichts, I. & Politis, C. The accuracy of image-guided navigation for maxillary positioning in bimaxillary surgery. J Craniofac Surg 25, 1095–1099 (2014).

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Section: Cleft Lip and Palate ABS0041 Primary Bilateral Cleft Lip Repair Using Pfeifer’s Technique: A Study of 129 Cases Dr. R.V. Kishore Kumar, Professor, Dr. Sivanagendra Reddy, Director Narayana Dental College, Nellore, Andhra Pradesh; Durga Hospitals, Visakhapatnam, Andhrapradesh Abstract Background/Introduction Primary Repair of bilateral cleft lip depends on sound knowledge of anatomy, identification of landmarks, clinical variation of presentation, surgical expertise of the operator etc. Here with we are presenting a series of 129 cases done in our study. Objectives Evaluation of pfeifers technique in primary bilateral cleft lip repair. Methods The study was carried out in patients attending Narayana Dental college, Nellore and Durga Hospitals, Visakapatnam, Andhrapradesh were considered for study. All cases were done using pfeifer’s technique. Pfeifer in 1970, described a technique which involves changing the lip skin Incision to a wavy line, thus making it less conspicuous. Pfeifer designed this incision using the concept of ‘‘morphological order’’. The basis of this is that a skin incision between two points can be lengthened if both points are joined in a curved or wavelike manner and not in straight line. Results The results were evaluated and found to be good in terms of white roll match, vermilion match, Cupids bow, nasal architecture etc; clinically and statistically. Conclusions Though the technique is not new, but the literature available for the Pfeifer‘s technique is less either in books or internet. The technique is easy to learn and teach. Good results were observed clinically and statistically. References/Bibliography Closure of cleft lips with wave line incisions according to Pfeifer Michael Bergermann, Hamm (Germany) and Cordula Tilkorn, Wellington (New Zealand).

ABS0045 A Correlation of Incidence of Preoperative URTI and Surgical Outcomes in Patients with Cleft Lip and Palate Dr. VR Chandra Babu Pamidi, Dr. RM Borle GSL Dental College Abstract Background/Introduction The SMILE TRAIN guidelines suggests that patients are taken up for surgery only in the absence of RTI but don’t specify URTI or LRTI. Since there is no evidence to postpone endotracheal intubation and

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 surgeries in presence of URTI alone, this study benefits in interest of patients and academicians. Objectives 1. To study the association of perioperative and intraoperative respiratory complications in cleft lip and palate. Methods A randomised clinical trial included 150 patients with cleft lip and palate and common cold questionnaire under standard protocol. Diagnosis of URTI was done based on clinical, radiological, nasal swab findings. Results Out of 150, 58 patients were positive for URTI preoperatively out of which 36 patients experienced URTI postoperatively. Conclusions The incidence of URTI was more in cleft palate than cleft lip patients. The significant association was found in regards to incidence of URTI preoperative and postoperative patients.

S19 Conclusions Presurgical Naso-alveolar molding can be a useful adjunctive treatment modality for management of cleft lip and palate patients. This technique being a cost effective is more beneficial in reducing the number of future surgeries required like secondary rhinoplasties and alvelolar bone grafting in the management of cleft lip and palate patients. References/Bibliography 1. Alzain I, Batwa W, Cash A, Murshid ZA. Presurgical cleft lip and palate orthopedics: an overview. Clin Cosmet Investig Dent. 2017;9:53–59. 2. Shetty V, Agrawal RK, Sailer HF. Long-term effect of presurgical nasoalveolar molding on growth of maxillary arch in unilateral cleft lip and palate: randomized controlled trial. Int J Oral Maxillofac Surg. 2017;46(8):977–987.

References/Bibliography 1. Dr. Kothur P.F. Surgical repair of cleft lip and palate in children with URTI, Indian J anaesthesia, 2006:50(1);58–59. 2. Allen R. Tait et al. Interoperative respiratory complications in patients with upper respiratory tract infection. Can J Anaesthesia 1987;34:300–303.

ABS00258 Anthropometric Evaluation of Unilateral and Bilateral Cleft Lip Repair Dr. Anil Kumar Desai, MDS Professor

ABS00154 Presurgical Naso-Alveolar Molding in Cleft Lip and Palate Patients: A Critical Review Dr. Nagaveni N. B. Professor Department of Pedodontics, College of Dental Sciences, Davangere 577004, Karnataka, India Abstract Background/Introduction The management of infants with cleft lip and palate is a challenging task and has revolutionized dramatically in recent years. The quest over the concern for final nasal form lead to the introduction of new treatment approach called pre-surgical naso-alveolar molding. Objectives To evaluate and assess the current scientific evidence pertains to the efficiency and usefulness of Presurgical Naso-alveolar molding in cleft lip and cleft palate patients and to describe the changing paradigms in the management of patients with cleft lip and palate using the same. Methods A comprehensive scientific literature search was carried out using electronic databases (PubMed and EMBASE) which focus on the current concept of Presurgical Nasoalveolar molding and those which critically analyze its long term effects in the treatment of cleft lip, palate and nasal deformity. The search was carried out using the different terminologies like presurgical nasoalveolar molding, nasal molding and infant orthopaedics and documented articles over a period of 25 years were selected for the critical review. Results It is evident from the critical review that Presurgical Naso-alveolar molding appears to be more effective and useful in management of cleft lip and palate patients.

Maxillofacial Surgery, Department of Cranio-Facial Surgery and Research Centre, S.D.M. College of Dental Science and Hospital, Dharwad Abstract Background/Introduction Cleft lip and palate may be symmetrical or asymmetrical due to complex aspects like the size, shape and growth of the segments. To improve functional and aesthetic results an accurate evaluation and quality assessment of surgical outcomes is required. Exact and detailed anthropometric measurements are necessary to detect shortcomings and to focus further efforts on improving these. Objectives Aim of the study is to assess basic quantitative data of lips and nose preoperatively and postoperatively by anthropometric methods from cleft lip and palate patients and to compare the data with normal individuals. Methods Prospective study on patients with cleft lip palate between February 2014 to September 2016 with age range of 6 months to 3 years was carried out. Anthropometric measurements were taken preoperatively & postoperatively at 1& 2 years. Results Total of 60 patients were included out of this, 30 were unilateral cleft patients and remaining 30 were normal individuals of same age group. In the results mean value of Vertical lip length, Nasal Tip Projection, Bialar width and Nostril Width Cleft side in study group preoperatively was 5.43mm, 4.80mm, 28.87mm and 13.67mm respectively, while in control group values were 8.27mm, 7.70mm, 23.37mm and 7 mm respectively. On postoperative two years the values of VLL, NTP improved to 8.83mm, 9.63mm and were similar to the control group, while BAW and NWC which was more preoperatively, decreased at 2 yrs to 27.13mm and 10.10mm. Conclusions Anthropometric measurements can provide valuable information in assessment of facial disharmonies which helps us in planning surgical reconstruction.

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ABS00292 Congenital Cardiac Anomalies Associated with Cleft Lip and Palate and Its Impact on Treatment Planning

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284

ABS00431 Analysis of Unilateral Cleft Lip Repair Using Modified Rotation Advancement Technique: A Retrospective Analysis

Dr Gautam Rao 1. Dr. Karan Mehta, Assistant Surgeon 2. Dr. Nisheet Agni, Director Subbaiah Institute of Dental Sciences and Hospital, Shimoga Mumbai Cleft Centre, Navneet Hi-Tech Hospital, Dahisar, Mumbai Abstract Background/Introduction Cleft lip and palate are the most commonly seen forms of craniofacial anomalies. Oral clefts are common birth defects occurring rather in isolated or in association with other malformations in approximately 1.3 to 1.7 per 1000 live births. Congenital heart diseases occurs in 5.5 to 8.6 per live births, which is approximately six times greater than the incidence of cleft lip and palate. Congenital heart diseases (CHDs) have been reported in 1.3 to 27% of the patients with oral clefts. Although many studies have shown strong association between congenital cardiovascular malformations and cleft lip and/or palate, the nature of cardiovascular malformations has not been described in detail in these subjects, nor has the impact of these cardiovascular malformations in management of these cleft patients been mentioned. Objectives To study the prevalence, type of congenital heart diseases in cleft lip and/or palate patients and to know the impact of these congenital heart diseases on treatment planning. Methods A total of 1381 non-syndromic cleft lip and palate patients reporting to SDM Craniofacial center, Dharwad were included in the study. The data was collected from clinical examination of the patients, evaluating the chest radiograph, and 2D Echocardiographs. Based on this information’s total incidence of congenital heart diseases and its impact on treatment planning was evaluated. Results There were 32 (2.32%) cleft lip and palate patients with congenital heart diseases (CHDs). The defects in the septa, valves and vasculature was 1.07%, 0.79% and 0.79% respectively. In 2 patients surgery was delayed by 6 to 9 months. Subacute bacterial endocarditis (SABE) prophylaxis was administered in 7 patients. Cardiac surgery was advised prior to cleft surgery in 3 patients. There were no intraoperative and postoperative complications in these patients. Conclusions The results emphasize the association between clefting and CHD. The collected data suggests that there should be careful examination of children with cleft lip and palate for signs of heart disease. This could significantly reduce the morbidity/ mortality of cleft surgery making it safer and predictable. References/Bibliography The impact of cardiovascular malformations on the assessment and surgical management of infants with cleft lip and/or palate. Harry BL et al, Cleft Palate J 2013; 50(3): 323–329. 4.

Abstract Background/Introduction Most common technique for unilateral cleft lip repair is the Millard’s rotation advancement technique and its modifications. Mohler’s modification has an advantage of lip lengthening using columella. Objectives To analyze the surgical outcomes of Modified (Mohler’s) Rotation Advancement technique for Unilateral Cleft lip repair. This is a retrospective analysis of unfavorable outcomes after unilateral cleft lip repair performed by single surgeon over a period of two years. Methods Thirty three patients who have undergone primary unilateral cleft lip repair using Mohler’s Modification of Millard’s Rotation Advancement technique since September 2015 were included in the study. The cleft nose was not addressed during the primary surgery. Skin closure was done using 5-0 Vicryl rapid suture. Surgical results were analyzed over a period of 6 months to 2 years. Unfavorable results were studied. Results Out of 33 patients, Vermillion notching was seen in 2 patients who had a mild injury during the first week postsurgery. Thick scar with contracture was seen in 4 patients who had not followed the massage protocol. White roll mismatch was seen in 3 patients and inadequate rotation was seen in 1 patient. Two patients were lost to follow-up. Conclusions Good, predictable results can be achieved using Mohler’s technique. Scar contracture seen in early postoperative period settles over 6 months with diligent massage of the scar. Postsurgery massage of the scar is necessary to avoid scar contracture. References/Bibliography 1. Narayanan P V, Adenwalla HS. Unfavourable results in the repair of the cleft lip. Indian J Plast Surg. 2013;46(2):171–82.

ABS00460 Anterior Maxillary Distraction Using a Tooth Borne Palatal Distractor Tailored for Cleft Maxillary Hypoplasia: A Review of 30 Cases Dr Dipesh Rao, Dr Pritham Shetty, Dr Krishnamurthy Bonanthaya Bhagwan Mahaveer Jain Hospital, Bangalore Abstract Background/Introduction The stigmata of cleft Maxillary hypoplasia has been well documented. The treatment options ranging from orthodontic camouflage, Growth modulation, Orthognathic surgery and Distraction have provided the answer for the deformity for many years.

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Objectives In recent times the role of anterior Maxillary Distraction (AMD) has gained popularity for its ease of procedure and cost effectiveness. We conducted a study to understand the effectiveness of this procedure in the 30 patients that we treated over the last 5 years. Methods Thirty consecutive patients undergoing AMD for Cleft Maxillary Hypoplasia were included in the study. Patients having a secondary Orthognathic/Distraction procedure for the Maxillary or those patients with simultaneous need for mandibular procedure were excluded from the study sample. Results The results showed an improved facial profile, increased arch length and no effect on speech outcome. Conclusions A relatively easy technique which is tailored for the cleft Maxillary Hypoplasia. The soft palate maintains its position and the increased arch length provides for dental rehabilitation in cleft patients where the occurrence of Hypoplastic teeth/missing teeth is higher.

S21 Further research is needed concerning the incidence, including interpopulation differences, and type of additional congenital malformations in cleft cases. References/Bibliography Balagir RS, Mitra SS. Congenital cleft lip and cleft palate anomalies: a dermatoglyphic study. J Postgrad Med. 1986;32:18–23.

ABS00501 Speech Outcome After Maxillary Advancement in Cleft Patients Sony G Pullan, Pramod Subash, Arjun Krishnadas Department of Craniofacial Surgery, Amrita Institute of Medical Sciences, Kochi

References/Bibliography 1. Gunaseelan R1, Cheung LK, Krishnaswamy R, Veerabahu M Anterior maxillary distraction by tooth-borne palatal distractor J Oral Maxillofac Surg. 2007 May;65(5):1044–9.

ABS00497 Dermatoglyphic Patterns in Cleft Lip and Palate: Is There a Correlation? Dr. Alok Bhatnagar, Reader Faculty of Dental Sciences, SGT University, Gurugram, Haryana Abstract Background/Introduction Dermatoglyphics is the study of dermal ridge configurations on the fingers, palms and soles. The word ‘‘Dermatoglyphics’’ has Greek roots derma = skin and glyphic = carvings. The term was coined by Harold Cummins & Midlo in 1926. Dermal Patterns are fully developed at birth, and once formed remain consistent throughout life. Dermatoglyphics is considered a window of congenital abnormalities and is a sensitive indicator of intrauterine abnormalities and is known to be one of the best available, inexpensive, easy to master and reproducible diagnostic tools in genetic disorders. Objectives Observe any positive correlation of the different dermatoglyphic patterns in cleft lip and/ or palate cases. Methods Sample of the study chosen from the OPD of the Nav-Muskan Clinic: A Cleft Care Initiative by SGT University reporting with non syndromic primary or secondary cleft lip/ palate. Bilateral finger prints obtained on executive bond paper by guiding the hand to inked stamp pad and pressing firmly on the paper placed on a smooth surface. The obtained fingerprints were then classified into arches, loops or whorls with the help of magnifying glass (2X). Results Statistically significant differences have been observed that suggest genetic aetiology for congenital cleft lip and palate malformations and likelihood of the manifestation of chromosomal aberrations. Conclusions

Abstract Background/Introduction Outcome assessment is important to analyze results of techniques as well to modify/improve standard of care. Effect of maxillary advancement procedures on speech in cleft patients is poorly studied and documented in literature. Objectives To assess speech outcome in patients who underwent maxillary advancement surgery. 1. Subjective – with questionnaire 2. Objective • Perceptual speech assessment • Videoflouroscopy • Nasoendoscopy. Methods For subjective assessment, 22 patients who underwent Maxillary advancement and their parents were asked about post operative speech status. Objective assessment was done by analyzing pre and post surgery Videoflouroscopy, nasoendoscopy and perceptual speech assessment records of 7 patients who underwent maxillary osteotomy alone or along with mandibular setback (after a minimum period of 3 months). Speech was recorded both pre surgery and post surgery and it was analyzed by 2 speech pathologists for lisping, intelligibility, hyper-nasality and distortion. In all cases except one, the magnitude of movement was greater than 8mm (Mean – 10.8mm). Results In subjective analysis most of the patients and parents reported that there was no significant change in the speech (no change-11, improved-7, worsened-4). Even though Velopharyngeal gap increased in resting position and as well as during speech in most patients, distortion of sounds and hypernasality improved in most of cases, where as lisping and intelligibility didn’t show significant improvement. Conclusions In our series of cases speech did not worsen as expected with the magnitude of movement rather remained unchanged or even showed improvement in articulation and hypernasality. References/Bibliography The effects of Left 1 osteotomy with maxillary movement on articulation, resonance and velopharyngeal function. Cleft palate journal. July 1989, vol 26. no 3.

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ABS00515 Efficacy of NAM and Nasal Conformers in Comparison with Open Rhinoplasty to Achieve Nasal Symmetry in Unilateral Cleft Lip

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ABS00521 ‘‘Rapide’’: Not so Rapid for Better Cosmesis in Cleft Lip! Dr Anil K. Sheorain, Professor

Dr. Aafreen Aftab Faculty of Dental Sciences, SGT University, Gurugram Hke’s S.N. Dental College and Research, Gilbarga Abstract Background/Introduction Most of the primary cleft lip repair techniques do not address the nasal deformity; result in poor nasal outcomes leading to gross nasal asymmetry. Several techniques and maneuvers which are employed to minimize this have varying degree of success. Objectives To assess the efficacy of various modalities employed to establish nasal symmetry in unilateral cleft lip. Methods 100 patients with complete unilateral cleft lip/palate were operated for primary cheiloplasty with modified Millard’s rotation advancement technique, for all the 5 groups. Subjects were divided into 5 groups of 20 each. Group 1 subjects operated employing modified Millard’s technique alone. In group 2, subjects underwent NAM therapy followed by lip repair. Group 3 subjects underwent lip repair followed by placement of a nasal conformers for 12 months postoperative. Group 4 patients were treated using NAM therapy followed by lip repair and placement of conformers. Group 5 underwent lip repair with primary rhinoplasty. All patients were evaluated after minimum period of 12 months post operatively, except those using conformers were evaluated 12 months after discontinuing the same. Parameters like Alar inclination angle, Nostril apex overhang, Nostril height and diameter, Columellar length and deviation angle were evaluated on 1:1 standard photograph. Results All parameters were statistically significant in group 4 and group 5 compared to the other groups. Conclusions Maneuvers like NAM and placement of nasal conformers have a significant influence in establishing nasal symmetry. However, open tip rhinoplasty establishes better nasal symmetry. References/Bibliography 1. Chang C.S, Por YC, Liou EJ-W, Chang C-J, Chwen PK-T, Noordhoff MS (2010) Long-term comparison of four techniques for obtaining nasal symmetry in unilateral complete cleft lip patients: a single surgeon’s experience. Plast Reconstr Surg 126:1276–1284. 2. Nakajima T., Yoshimura Y., Augmentation of the nasal splint for retaining the corrected contour of the cleft lip nose. Plastic Reconstructive Surgery vol 85 no 2.

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Abstract Background/Introduction The type of suture material used in surgery has been a long-standing debate among surgeons. In this study we compared rapidly absorbable suture material (Vicryl Rapide/Irradiated Polygalactin 910) with nonabsorbable suture material (Nylon or Polyamide) in patients with nonsyndromic congenital unilateral cleft lip. Objectives To compare the appearance and course of scar, wound infection and patient’s perception between two groups. Methods Twenty patients of Unilateral Cleft Lip, in the age group of 3–18 months were randomly allocated to two groups with 10 patients each. Skin suturing was done with 6-0 Polyamide and 6-0 Irradiated Polygalactin in the respective groups. Patients were evaluated at 1 week, 1 month, 3 months, 6 months and 1 year postoperatively by the observer and patient’s parent. Results According to Observer, the difference between two groups was significant regarding pigmentation and height of scar at 3 months, 6 months and 1 year with P\0.05; the values being higher in irradiated Polygalactin 910 group. Conclusions We conclude that the Vicryl Rapide showed poorer cosmetic outcomes regarding height and pigmentation of scar as compared to nylon sutures. References/Bibliography Parell GJ, Becker GD. Comparison of absorbable with non – absorbable sutures in closure of facial skin wounds. Arch Facial Plast Surg 2003;488–90.

ABS00564 Comparison of Nasal Results Following Nasal Hook with Lip Taping to PNAM Dr Radha Prabhu, Dr Renu Parmar, Dr Krishnamurthy Bonanthaya Abstract Background/Introduction The nose is the most prominent structure on the face. Cleft nose carry the cleft stigma in the society with immense impact on the child in its growing years. The presurgical correction of the same to bring post operative results closest to normal is one of the aims of PNAM and the Nasal hook with lip taping. Objectives The purpose of this study was to compare the Nasal parameter results following application of Nasal hook with lip taping to PNAM. Methods 90 unilateral cleft lip and palate patients who underwent treatment at Bhagwan Mahaveer Jain Hospital, smile train cleft center, Bangalore between September 1, 2012, and September 1, 2015 were evaluated. Out of the 90 subjects shortlisted, 30 patients had nasal hooks and lip

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 taping another 30 patients had PNAM as part of their presurgical preparation and 30 others served as control. The nasal base width, nasal dome height and columella angle were the three parameters assessed. Results The results of Nasal hook with lip taping are comparable to those of PNAM. Conclusions The findings of this study will be presented at the meeting suggesting a definite role for Nasal hook with lip taping in presurgical nasal molding. References/Bibliography 1. Comparative study of Nasoalveolar moulding methods: Nasal elevator plus Dynacleft versus NAM Grayson in patients with complete unilateral cleft lip and palate. Monasterio L et al; The cleft palate-craniofacial Journal 50(5) 548–554: September 2013. 2. The Nasal alar elevator: A new device that may reduce the need for primary operation of the nose in patients with cleft lip. Abdiu A et al; Scandinavian Journal of Plastic reconstructive surgery Hand surgery, 2009; 43: 71–74.

ABS00568 Analysis of Quality of Cleft Lip Repair Using Tennison Randall Technique: A Retrospective Study Dr T Devika Das, Dr Sankalp Chaudhari, Dr Amit Mahajan; K.M Shah Dental College, Vadodara Abstract Background/Introduction Cleft lip and Cleft palate accounts to 65% of all head and neck anomalies. Numerous methods have been described for repair of the cleft lip deformity. Since then, the two most popular types of repairs have been the Tennison and Millard techniques with many modifications. Various authors have deliberated on the importance of assessment of cleft lip management. Incidentally, most of the existing and popular ‘‘ Ascher McDade system’’ gives a non-descriptive qualitative assessment like very poor, poor etc. This is subjective and extremely variable between individual assessors. A more relevant rating scale should be based on realistic weighing of residual anatomic deformity and the scoring should immediately communicate the type of structural deficit present and hint on the type and extent of further surgical correction that might be required. In this paper we evaluated the surgical outcome of unilateral cleft lip repair using image analyse software. Objectives 1. To evaluate post operative quality of scar 2. To evaluate post operative wound dehiscence 3. To evaluate vertical lip length achieved 4. To evaluate horizontal lip length achieved 5. To evaluate Cupid’s bow width achieved 6. To evaluate vermilion length achieved 7. To evaluate nasal floor width achieved. Methods Retrospective data from January 2006 to January 2017 who have undergone cleft lip repair using tennison –randall method were collected from department of Oral and Maxillofacial Surgery for this study. All patients operated by a same operating surgeon for unilateral cleft lip who have complete records were chosen. Malnourished patients, patients with systemic and intra operative complications were excluded from the study. 1 month follow-up photographs were included in the study. The photographs, by Farkas’ cleft-related anthropometric lip landmarks were marked on the enlarged images

S23 using ImageJ software of 1 month follow up of the lip area. Using these points, the anthropometric measurements of the lip were made. These linear measurements give an indication of the horizontal and vertical lip length, the vertical vermilion length as well as the width of the Cupid’s bow and nostril floor. Based on the image parameters like quality of scar, presence or absence of wound dehiscence, vertical and horizontal length achieved, Cupids bow width, Vermillion length, nasal floor achieved were assessed. The parameters are used to work out a ‘‘ Cleft Lip Component Symmetry Index’’ that could be used to compare objectively the various components of the lip and nose and the scar is assessed using ‘‘ stone brook scar evaluation scale ‘‘. Results As the study is an ongoing one, results are awaited. Conclusions No Definitive conclusion can be made at present as it is an ongoing study, but the study will surely help in knowing the surgical outcome using tennison –randall technique in our center. References/Bibliography 1. Sabitha S, Veerabahu M, Vikraman B: Esthetic evaluation of treated unilateral cleft lip using phothographs and image analysis software: A retrospective study; J Maxillofac Oral Surg; 2011 10(3). 2. Olusanya A, Akadiri A: Developing a visual rating chart for the esthetic outcome of unilateral cleft lip and palate repair; Ann Maxillofac Surg; 2015 5(1).

ABS00729 Comparative Evaluation of Outcomes of Platelet-Rich Plasma (PRP) and Platelet-Rich Fibrin (PRF) with Cancellous Bone Grafts in Cases of Alveolar Cleft 1. Dr. Abhilasha Yadav Ex Associate Prof, 2. Dr. R. M. Borle Professor, 3. Dr. Suhas Jajoo Professor 1. New State Bank Colony, Nagpur Road, Wardha- 442001 Mob9890002523 Email- [email protected], Dept of OMFS Sharad Pawar Dental College Sawangi (M) Wardha; 2. Dept of OMFS Sharad Pawar Dental College Sawangi (M) Wardha; 3. Dept of General Surgery Jawaharlal Nehru Medical College Sawangi (M) Wardha Abstract Background/Introduction A cleft is a congenital abnormal space or a gap in the upper lip, alveolus, or palate. Any disturbance during the embryonic formation, development and growth of oro-facial region will result in the formation of oro-facial clefts. The oro-facial clefts are congenital deformities, which manifests at birth. Facial aesthetics, speech, mastication, deglutition can be impaired because of oro-facial clefts with a significant impact on the psychosocial aspect of the patients life during his/her life. Objectives The objective of this study was to determine the efficacy of alveolar bone grafting with autologous iliac cancellous bone incorporation with platelet-rich plasma (PRP) and platelet-rich fibrin and evaluate its osteoregeneration. Methods Total 75 patients of cleft alveolus out of which 25 alveolar clefts in 25 patients with grafted autogenous bone and PRP (PRP group), 25 clefts in 25 patients with grafted autogenous bone alone (Control group) and 25 alveolar clefts in 25 patients with grafted autogenous bone and

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S24 PRF (PRF group) were enrolled for the present study. PRP and PRF were extracted from autogenous blood using a plasma centrifuge system. Age range was 7–20 yrs. Quantitative evaluation of regenerated bone was made and compared with controls. Results The average of the volume ratio of regenerated bone was higher in cases with PRF followed by PRP when compared to the control group. Conclusions PRF is a safe and cost-effective source for growth factors and is easy to extract. It could enhance the osteogenesis of alveolar bone grafting in cleft lip and palate patients and may be useful for subsequent orthodontic therapy.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Early identification of the problems and early intervention for the same is indicated in the children with this type of conditions. References/Bibliography 1. Beriaghi S, Myers SL, Jensen SA, Kaimal S, Chan CM, et al. Cleft lip and palate: association with other congenital malformations. J Clin Pediatric Dent 2009; 33: 207–210. 2. P.S. Sekhon, M. Ethunandan, A.F. Markus, Gopal Krishnan, C. BhaskerRao, Congenital Anomalies Associated With Cleft Lip and Palate-An Analysis of 1623 Consecutive Patients. Cleft Palate–Craniofacial Journal 2011; 48:371–78.

References/Bibliography 1. Boyne PJ, Sands NR. Secondary bone grafting of residual alveolar and palatal clefts. J Oral Surg 1972; 30:87–92. 2. Lee C, Nishihara K, Okawachi T, Iwashita Y, Majima HJ and Nakamura N. A quantitative radiological assessment of outcomes of autogenous bone graft combined with platelet-rich plasma in the alveolar cleft. Int J Oral Maxillofac Surg. 2009 Feb;38(2):117–25. doi:10.1016/j.ijom.2008.11.019. Epub 2009 Jan 14.

EPS00736 Incidence of Congenital Cardiac Anomalies in Patients with Cleft Lip and Palate: Its Implications in Surgical Management Dr Akash Kasatwar Sharad Pawar Dental College & Hospital, Wardha Abstract Background/Introduction Cleft lip and palate is one of the most common congenital craniofacial deformities seen in children. Various congenital anomalies are reported in the literature to be associated with cleft lip and palate. Cardiac anomalies are one of the most common congenital disorders associated in cleft lip and palate patients. It includes patent ductus arteriosus, ventricular septal defect, atrial septal defect, transposition of greater vessels, tetralogy of fallot etc. Incidence of congenital cardiac anomalies is reported to be higher in general population. According to ESC/ESA guidelines for non-cardiac surgeries, patients with stable cardiac disease can undergo low and intermediate risk surgeries which include cleft lip and palate surgeries. Objectives To study the incidence of congenital cardiac anomalies in cleft lip and palate patients. Objectives: To study different types of congenital cardiac anomalies /defects in patients with cleft lip and palate and its implications in surgical management. Methods This is a retrospective study carried out for a period of one year. In this study medical records of 200 patients were evaluated and analyzed for presence of congenital cardiac anomalies. Results Out of 200 patients, 30 patients (15%) were associated with congenital cardiac anomalies (CCA) with the male to female ratio of 1:1. Associated congenital cardiac anomalies were most frequently seen in unilateral cleft palate patients (21.05%) The most common cardiac anomaly was Ventricular septal defect (36.6%). Conclusions

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ABS00770 Rhinoplasty: An Approach to the Nasal Skeleton Through the Open Access Dr V Sathyabama Ragas Dental College 2/102, East Coast Road, Uthandi Abstract Background/Introduction Cleft patients undergo a series of surgical procedures early on to correct their cleft lip followed by the palate and deal with its repercussions stage by stage. Objectives To correct the nasal asymmetry and provide a functional nasal apertures. Methods Assess the extent of the deformity. Insinuate a normal anatomy with an open access approach. The bony base with the correction of the anterior nasal spine to the septal correction followed by the soft tissue correction of the alar components. Auricular cartilage procured for augmentation. Results Septal deviation formats the core of the asymmetry. Provides an acceptable facial profile in the society. Henceforth the timing of the procedure needs to be assessed to eliminate retardation of growth versus the social stigma. Conclusions Open access approach gives a complete access to the nasal architecture. However the timing of performing this procedure needs to be audited and assayed as to whether the procedure can be performed early in life once the maxillary arch expansion has been achieved with the closure of the fistula. Secondary Rhinoplasty may be performed later in life after the cessation of growth. References/Bibliography 1. Unique approach to Cleft lip secondary deformity in Cleft Lip Rhinoplasty in Facial Plastic surgery: - P W Hellings, G Hens J Schoeners M Jorrisen B-ENT 2010 6 97–101. 2. Cleft Lip Rhinoplasty - A Review Ashok Jonnalagadda*, Sreeja Jami, Kusuma Latha Pydi Drs. Sudha & Nageswera Rao Siddhartha Institute of Dental Sciences, Gannavaram, Andhra Pradesh.

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Section: Orthognathic Surgery ABS001 Is There Linearity Among Soft and Hard Tissue Change Following Orthognathic Surgery? Tanmoy Nath, Ramdas Balakrishna Abstract Background/Introduction Today treatment planning for orthognathic surgeries has shifted from acetate paper tracings to sophisticated 3D imaging softwares, which are based upon ratios of soft to hard tissue changes. These ratios are mostly dependent upon linear ratios based upon published literature. Objectives The aim of this study is to evaluate the linearity soft tissue changes with skeletal movements by orthognathic surgery. Methods Lateral cephalograms of 24 patients were taken preoperatively at least 1 week before (T1) and, postoperatively (T2) 2 months after the surgery and tracings were done. The maxillary group (Group I) consisted of patients undergoing isolated maxillary orthognathic surgeries. The mandibular group (Group II) consisted of patients undergoing isolated mandibular orthognathic surgeries. Five pairs of soft and hard tissue landmarks were studied preoperatively and postoperatively. Results Both groups showed that relationships between the soft and hard tissues were linear, except for the Sn-ANS pair that showed a nonlinear relationship. Ls-U1E pair of landmark in maxillary group showed a ratio of 0.85:1, Pg’-Pg pair of landmark in the mandibular group, showed a ratio of 1.19:1, which were closest to 1:1 in their respective group. Conclusions When isolated mandibular orthognathic surgeries are performed, the mandibular pairs of soft and hard tissue landmarks show evidence of linear relationship. When isolated maxillary orthognathic surgical procedures are performed, all maxillary and mandibular pairs of soft and hard tissue landmarks showed linear relationship except Sn-ANS. This supports the use of nonlinear ratios for predicting maxillary landmarks in simulation softwares.

ABS0014 Management of Patients with Skeletal Facial Deformities Mismanaged by Other Dental Specialists 1. Dr. Nisharudeen, Consultant, 2. Dr. N. Venkadasalapathi, Head Hannah Joseph Hospital, Madurai; Department of Craniomaxillofacial Surgery, Hannah Joseph Hospital, Madurai Abstract Background/Introduction Patients with skeletal facial deformities in peripheral areas mostly seek dental correction from general dentists or from quakes practicing in the villages who use their limited knowledge try to manage these patients with dental bridges and othodontic camouflage worsening the situation.

S25 Objectives To devise a specific treatment plan and to modify the conventional surgical techniques to achieve desirable results in these patients. Methods Diagnosis was made using clinical and radiographic data. patient’s desires and needs were obtained and surgical plan was framed according to it. surgical methods will be eloborated in the presentation. Results Desirable results were achieved. Patients were satisfied. postoperative stability was good. Conclusions This paper will bring awareness to the general dentists and people of other dental specialties on how to identify and manage skeletal facial deformities. References/Bibliography 1. Trauner R, Obwegeser H. The surgical correction of mandibular prognathism and retrognathia with consideration of genioplasty. I. Surgical procedures to correct mandibular prognathism and reshaping of the chin. Oral Surg Oral Med Oral Pathol. 1957; 10(7):677–689.

ABS0022 Challenging Orthognathic Surgeries: An Experience Dr. Chandresh Jaiswara Faculty of Dental Sciences. IMS BHU Varanasi Abstract Background/Introduction The word orthognathic comes from the Greek word orqos, meaning to straighten, and gnaqos, meaning jaw. Orthognathic surgery thus means to straighten a jaw but actually Orthognathic surgery is the repositioning of basal bone in the maxillo-mandibular deformities. Its results are both esthetic and functional. For adults, improved aesthetics results is becoming increasingly important in these procedures to the point where some patients seek only an esthetic and not a functional one. To achieve their aesthetic purpose, it is becoming progressively more necessary for oral surgeons and orthodontist to collaborate effectively in a well-coordinated effort. Objectives This study is done to evaluate facial changes after orthognathic surgery. Methods group of patients undergoing otrhognathic surgery were assessed for presurgical and post surgical changes. Results The perfect planning and surgical technique selection is vital factors for orthognathic surgery. Conclusions Esthetic considerations form the most important aspect of contemplated orthognathic surgery. References/Bibliography Bell WH. Modern practice in orthognathic and reconstructive surgery. Philadelphia: WB Saunders Company, 1992.

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ABS0060 Extended Lateral Sliding Advancement Genioplasty: A Predictable and Versatile Corrective Procedure for Facial Asymmetry and Retrognathia Correction Dr. Hitesh S. Dewan M.D.S., DNB, Professor Dept. of Oral & Maxillofacial Surgery, Faculty of Dental Science, Dharmsinh Desai University, Nadiad, Gujarat Abstract Background/Introduction Facial Asymmetry associated with retrognathia is a common deformity especially after unilateral ankylosis release although it may be present in other developmental non syndromic conditions also. Plethora of surgical options exist including ramus osteotomies, distraction osteogenesis and onlay grafts. These are tedious technique sensitive procedures which are demanding to the clinician, patient or both. Extended lateral sliding advancement genioplasty is a comparatively simple and predictable technique to achieve optimum esthetic correction. Objectives Achieving facial symmetry without disturbing existing occlusal status thereby increasing patient compliance alleviating the need for extensive distraction procedures. Methods Extended lateral sliding advancement genioplasty performed via intraoral approach and fixation with one miniplate and one chin plate performed in ten patients from 2014–16. Results Optimal esthetic results were achieved in majority of patients. As occlusion was untouched post operative masticatory efficiency was unaltered. Only complication in two cases was temoporary mental nerve paresthesia which resolved in a couple of months. Conclusions Two plate rigid fixation in this procedure ensures maximum stability of the osteotomized chin and no bone grafts are required. Occlusal stability is an added bonus for patients seeking quick and predicatable esthetic correction for asymmetry. References/Bibliography Extended lateral sliding genioplasty for correction of facial asymmetry. Varghese Mani et al, asian journal of oral & maxillofacial surgery, 2004;16:84–90.

ABS00102 Are Orthognathic Surgeries has any Impact on Oral Health Related Quality of Life in Patient’s with Jaw Deformities? A Clinical, Prospective and Observational Study Dr Anshul Rai All India Institute of Medical Sciences Bhopal, MP Abstract Background/Introduction The facial deformities has a significant effects on individual identification. They may be acquired or congenial. They have direct impact on patient’s quality of life, there psychological and social behaviour.

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Objectives The aim of the present study was to see the effect of orthognathic surgery (OS) 1. on oral health related quality of life (OHRQOL) in patient’s with jaw deformities and 2. To identify any improvements in the patient’s psychological and social behaviour. Methods This was a prospective, clinical, observational study. The patient’s reported to our outpatient department with facial deformities between Dec 2014 to June 2017 were included in the study. The 32 subjects reported in whom OS were performed (16 Bilateral saggital split osteotomy, 14 le_fort 1 osteotomy, 5 anterior maxillary osteotomy, 3 genioplasty). All patients treated under General anaesthesia after obtaining the written informed consent. The study was approved by our ethical committee. The oral health was assessed by using Japanese version of oral health impact profile (OHIP). Pre and post operative experience of the patient’s were analysed. Results The OS had a positive impact on OHRQOL. The OHIP which was 62 per operatively comes to 30 after surgery. The psychological and social behaviour of the patient’s improved after surgery. Conclusions The determination of OHRQOL in patient’s with jaw deformities seems to be very useful in 1. Understanding the patient’s problems. 2. Providing appropriate treatment and 3. Assessing the extent of changes in term of patient well-being. References/Bibliography 1. Kim SJ et al. Evaluation on psychosocial status of orthognathic surgery patients. OOOO 2009;108:828–32 2. Yamazaki M et al. Japanese version of oral health impact profile (OHIP-J). J Oral Rehabil 2007;34:159–68.

ABS00399 Augmentation Genioplasty [ 15mm Using Sandwich Bone Grafting: 7 Years Follow Up of Series of Cases Our Experience Dr. Samprati J Badjate MDS. Associate Professor Department of Oral and Maxillofacial Surgery, VSPM-DCRC, Digdoh Hills, Nagpur Abstract Background/Introduction Severely receded chin cannot be treated satisfactorily with sliding genioplasty because of the limitation of advancement upto 8mm– 10mm. To over come this we have treated 10 patients of severely receded chin requiring advancement more than 15mm, by Advancement genioplasty and increasing vertical height at the same time and by rigid fixation and sandwiching free iliac crest bone graft. Objectives Patient requiring advancement genioplasty [ 15mm were treated and follow up was done for 7 years. Methods After routine sliding genioplasty osteotomised segment was advanced by [ 15mm as described by the clinical condition and free iliac crest block bone graft were sandwiched in between the osteotomised segment and secured with bone plates and screws. Results All the patient treated by this technique were found to have satisfactory cosmetic result.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Conclusions The level of satisfaction was significantly high for all the patients. The current findings strongly suggest that this is a reliable procedure for achieving harmony of the lower face. In addition, it permits a simplification of facial reconstruction and rejuvenation. References/Bibliography 1. Sliding Osteotomy Genioplasty for Facial Aesthetic Balance: 10 Years of Experience. Aesthetic Plastic Surgery. August 2007. 31:384–391. 2. Bedoucha V, Boutin F, Frapier L. Impact of genioplasty during puberty on the upper airways. Int Orthod. 2015 Dec. 13(4):421–35.

Section: Distraction Osteogenesis ABS00107 A Retrospective Study to Evaluate Cephalometric Changes in Triad TMJ Ankylosis Patients Who Underwent Prearthroplastic Mandibular Distraction Osteogenesis Neha Aggarwal; Neelam Andrade; Paul Mathai Nair Hospital Dental College Abstract Background/Introduction In the last two decades, mandibular distraction osteogenesis (MDO) became a popular modality in managing the hypoplastic mandible followed by the release of TMJ Ankylosis. Through this study we aim to evaluate cephalometric changes pre and post distraction in Ankylosis patients. Objectives i. To evaluate the result of the distraction vector by measuring the changes in the position of the mandible. ii. To compare differences in the lower anterior facial height before and after distraction iii. To compare differences in SNB angle, occlusal plane angle and plane angle of the distraction vector before and after distraction. Methods This study was a retrospective observational study. The study comprised of a minimum of 30 patients of TMJ Ankylosis who underwent mandibular distraction Osteogenesis for correction of sleep apnoea and micrognathia. Cephalometric records of the patients were digitalized with the help of image scanner (Epson Perfection V800 Photo Color Image Scanner) and the digitalized images were fed into the Nemotec Studio’s Nemoceph 2D Software. The dental and skeletal observations from the study were recorded, tabulated and subjected to statistical analysis. Results Pre and Post distraction hard tissue and soft tissue changes showed statistically significant values (p value \0.05). All patients showed a satisfactory change in profile and an increase in lower anterior facial height. Conclusions Through this study, we conclude that pre arthroplastic mandibular distraction allows satisfactory correction of micrognathia in TMJ ankylosis patients, thus proving to be a good treatment modality with excellent stability and less relapse. References/Bibliography

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ABS00327 Is Anterior Maxillary Distraction an Alternative to Rigid External Distraction in Cleft Maxillary Hypoplasia? Dr. Jaeson M. Painatt, Dr. Ravi Veeraraghavan, Dr. Pramod Subash, Dr. Sherry Peter Amrita Institute of Medical Sciences, Amrita University Abstract Background/Introduction Orthognathic surgery and distraction osteogenesis are the most favored surgical treatment modalities for cleft maxillary hypoplasia. Distraction has various benefits over orthognathic surgery such as evading bone grafting and donor site morbidity and its concurrent expansion of soft tissue envelope. Maxillary distraction with Rigid External Distraction (RED) device has proved to be effective in treating cleft maxillary hypoplasia. However, there are a few disadvantages such as an expensive halo frame and patient discomfort whereas Anterior Maxillary Distraction (AMD) with a tooth borne appliance is more patient compliant. On review of literature, there are no reports comparing the airway and only a report comparing the profile changes of cleft patients on RED and AMD. Objectives To compare the profile changes, airway and stability of patients who underwent RED and AMD in adult patients with cleft maxillary hypoplasia. Methods Three lateral cephalometric radiographs were taken: predistraction (T1), postdistraction (T2) and 1 year after distractor removal (T3). The treatment changes (T1 vs. T2) and the stability (T2 vs. T3) were analysed for patients who underwent both RED and AMD. The lateral cephalograms were digitally analyzed with the help of a software named Dolphin. Results Seven adult patients with CLP who underwent both RED and AMD each were retrospectively analyzed. The convexity of the facial profile had improved significantly in both techniques. The RED patients had an increased total facial height than AMD patients. The upper airway had significantly improved in RED patients whereas in AMD patients, the airway was almost constant. Both the techniques had a certain amount of relapse. Conclusions The clinician should have an understanding of the related hard and soft tissues as well as airway changes which may assist them when planning for maxillary advancement for CLP patients with DO. In our series of cases, some AMD patients required another osteotomy procedure as compared to the RED patients. However, each case is different and case selection for a particular technique is important. References/Bibliography S. Richardson et al, Tooth-Borne Anterior Maxillary Distraction for Cleft Maxillary Hypoplasia: Our Experience With 147 Patients, J Oral Maxillofac Surg 74:2504.e1-2504.e14, 2016. Painatt JM, Veeraraghavan R, Puthalath U, Peter S, Rao LP, Kuriakose M. Pro le changes and stability following distraction osteogenesis with rigid external distraction in adult cleft lip and palate deformities. Contemp Clin Dent 2017;8:236-43.

4. Sadakah AA, Elgazzar RF, Abdelhady AI. Intraoral distraction osteogenesis for the correction of facial deformities following temporomandibular joint ankylosis: a modified technique. Int J Oral Maxillofac Surg. 2006;35(5):399–406.

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ABS00363 Bilateral Biplanar Distraction Osteogenesis Post TMJ Ankylosis Release for Correction of Facial Deformity Dr. Sonal Anchlia, Dr. Siddharth Vyas, Dr. Vipul Nagavadiya, Dr. Ramyata Dayatar Government Dental College and Hospital, Civil Hospital Campus, Ahmadabad Abstract Background/Introduction Biplanar distraction is used to lengthen a severely hypoplastic ramus as well as corpus of the mandible. It simultaneously corrects Obstructive Sleep Apnoea and prevents the most common complication of uniplanar distraction - anterior open bite. Objectives To evaluate correction of facial asymmetry using bilateral biplanar distraction osteogenesis post TMJ ankylosis release. Methods 10 cases post ankylosis were selected with: - advancement required more than 10mm. - severe corpus and ramal deficiency. - with/ without severe OSA Two osteotomy cuts were made bilaterally, in the body and ramus region, distractors placed and activated. Results The total distraction was compared clinically, cephalometrically after callous moulding, then after distractor removal and finally 6 months after removal. The body average was 17, 16, 15 and 14.5 mm. The ramus average was 15, 13.5, 12 and 11 mm. Average follow up: 1.5 years Average post op AHI score: \ 5 Patient satisfaction score was 100%, no compliance issues. No Complications like major relapse, loss of vector or reankylosis. Posterior open bite was noted in 3 patients, corrected significantly by callous moulding. Schanz Pin infection was noted in 2 patients, treated conservatively. Conclusions Bilateral biplanar distraction proves to be extremely efficient in correcting facial asymmetry in terms of mandibular ramal as well as body deficiency. Most importantly, the use of two osteotomy cuts in this study has negated the popular belief that in biplanar distraction: there occurs loss of vector control. - ramal stump goes upwards till the ‘‘cranial stop’’. References/Bibliography Ortakoglu et al: Distraction osteogenesis in a severe mandibular deficiency. Head and face medicine 2007; 3–7.

ABS00484 Histomorphometry of Distracted Callus Maj Amit Bhandari, Maj Gen NK Sahoo, Brig ID Roy, Lt Col Rohit Sharma 4CDU; AFMC Pune Abstract Background/Introduction Bone deficiency in the craniofacial skeleton has posed a challenge to craniomaxillofacial surgeons for many decades. The possibility of bone lengthening by means of distraction osteogenesis was suggested many years ago by Codivilla and later clinically and biologically established by Ilizarov. With very few documented studies in the

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 present literature analysing the histological quality of the consolidating regenerate in humans, this study was conducted to evaluate and compare the histological and histomorphometric interpretation of distracted mandibular callus after 8 and 12 weeks of consolidation. Objectives To evaluate and compare the histological and histomorphometric interpretation of distracted mandibular callus after 8 and 12 weeks of consolidation. Methods Twenty (20) patients of mandibular corpus deficiency were operated for corpus lengthening by Distraction Osteogenesis (DO). The cases were randomly divided into two equal groups. In group A, distractor device was removed after 8 weeks and in group B after 12 weeks. At the time of distractor removal, scraping was obtained from the callus for histological evaluation and histomorphometric interpretation. Results We could not find statistically significant variation between the two groups suggesting that 8 weeks consolidation is optimum as cited by various authors. Our results concurred with previous animal studies validating decreased consolidation of bone and increased remodelling with change in trabecular orientation and mass after 8 weeks. Conclusions The distractor can be safely removed in mandible corpus distraction after 8 weeks of consolidation. References/Bibliography 1. Cope JB, Samchukov ML. Mineralization dynamics of regenerate bone during mandibular osteodistraction. Int J Oral Maxillofac Surg. 2001;30(3):234–42. 2. Hong P, Boyd D, Beyea SD, Bezuhly M. Enhancement of bone consolidation in mandibular distraction osteogenesis: a contemporary review of experimental studies involving adjuvant therapies. J Plast Reconstr Aesthet Surg. 2013;66(7):883–95.

ABS00710 Evaluation of Transport Distraction Osteogenesis in Maxillofacial Region Dr Naresh Kumar (Professor), Dr Neeraj Kr Dhiman (Asst Prof), Dr Ajit Vishwakarma (JR 3) Faculty of Dental Sciences IMS BHU Varanasi Abstract Background/Introduction Transport distraction osteogenesis is the technology to restore bony continuity through the use of in situ bone in an attempt to create an anatomically similar regenerate that is better than bone grafting or vascularised free tissue transfer. In this method, a bone segment is osteotomized adjacent to the defect and then distracted slowly across the defect so that new bone forms continuously in the gap, eventually leading to reconstruction of the bone defect. Costantino et al. were the first to report bifocal distraction (TDO) of the mandible by using an external custom made distraction device to regenerate a segmental defect of 40-mm. Since then there have been rapid advancements in the field of TDO, which has now become an important tool for the reconstruction of composite defects. Zhang and Zhang have described 3–12 cm defects to be optimal for considering TDO in maxillofacial region. Most mandibular defects are composite defects that involve a combination of osseous and soft tissue deficiency. These defects are often congenital, a results of trauma, infection, or resection of benign and malignant tumours. The attraction of applying the distraction

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 technique for mandibular reconstruction is its lack of donor site morbidity and its ability to increase the overlying soft tissues by inducing histogenesis. Objectives To evaluate the role of Transport Distraction Osteogenesis (TDO) in restoration of osseous continuity, alveolar height, arch form, width and acceptable facial form after resection of maxillofacial bony tumor. Methods The study was conducted on those patients who require reconstruction of mandibular defects that result following surgery for pathology. A extraoral custom made bone transport distractor with reconstruction plate was used to transport the two segments created on each side of the mandible (trifocal distraction), and intraoral device used in bifocal distraction. A. anaesthesia: According to cases- GA/LA B-approaches (for mandibular body and ramus) submandibular and intraoral incision transport disc of about 14 to 18 mm osteotomised on mandibular stump. (Special attention paid to avoid lacerating the soft tissue attaching to lingual side of transport disc) distraction device fixed to transport disc & remaining mandible (basal bone) with transport segment in close contact with basal bone. extraoral incision sutured in layers. Activation: 1. After a latency period of 7 days (avg 3–4 days) depending upon the patient age. 2. Distraction rate-0.5mm twice/day. 3. Consolidation period-approx 16 weeks or decided by degree of calcification in distraction gap on panoramic radiograph. Results All the patients irrespective of whether extra-oral or intra oral device was placed had minimal difficulty in the immediate post operative phase. The advantage of using bone transport for reconstruction of mandibular continuity defects is that the neo mandible has the same shape as original mandible with same quality of bone. Additionally all local soft tissue viz. gingiva, buccal and lingual sulci are recreated. With this technique there can be a paradigm change from reconstructive to regenerative surgery. Conclusions The functional and aesthetic reconstruction of the mandible after resection continues to be a formidable problem in maxillofacial surgery. Grafts, flaps, and synthetic materials have been used to reconstruct the mandible. Unfortunately, grafts and flaps result in added morbidity, and may be of limited availability. Transport Distraction Osteogenesis has been proposed as an alternate method of mandibular reconstruction, through which mandibular defects could be replaced by new bone grown from the remaining mandible. References/Bibliography 1. R. S. Neelakandan, Darpan Bhargava. Transport Distraction Osteogenesis for Maxillomandibular Reconstruction: Current Concepts and Applications J. Maxillofac. Oral Surg. (July–Sept 2012) 11(3):291–299. 2. Double-step transport distraction osteogenesis in the reconstruction of unilateral large mandibular defects after tumour resection using internal distraction devices BY J. Chen-Int. J. Oral Maxillofac. Surg. 2012.

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Section: Facial Aesthetic Surgery ABS00279 Management of Mandibular Asymmetry Due to HemiMandibular Hyperplasia-(Report of Cases and Review of Literature) Dr. Thiruneelakandan Sambanthan, Associate Professor Department of OMFS, Rajah Muthiah Dental College and Hospital, Annamalai University Abstract Background/Introduction Facial Asymmetry is predominantly associated with under or over growth of condyle and other growth disturbances which might affect the mandible [primary or secondary]. Objectives Addressing the dilemmas faced by the maxillofacial surgeon in restoring the aesthetics. Methods Analyzing the different treatment procedures with respect to the clinical presentation. Results Satisfactory facial symmetry can be attained by addressing the particular affected region in the mandible namely the condyle, gonium and body of the mandible. Conclusions Specific surgeries in par with the complaints of the patient makes the difference in the surgical outcome{facial aesthetics}. References/Bibliography Int. J. Oral Maxillofac Surg 1995;24;134–41. J Oral Maxillofac Surg 2009;67;2201–9.

ABS00409 Hair Restoration Using Follicular Unit Extraction (FUE) Technique. A Maxillofacial Surgeon’s Perspective Kiran Savant (Private Practitioner, Bangalore), Rakshit Khandeparker, Omkar Shetye, Praveen S Kumar, Saurabh Kamat Goa Dental College and Hospital, Goa Abstract Background/Introduction Alopecia of the maxillofacial region be it the scalp hair, eyebrows, moustache, side locks or beard can occur due to various reasons. Reconstruction of these areas not only animates the face and adds confidence but also breaks the cycle of self pity giving a feeling of completeness and camouflaging the existing alopecia. Hair restoration has come a long way from the days of punch hair transplant to Follicular Unit Transplantation (FUT) to the most recent FUE technique. Although numerous articles have been published on FUE for scalp restoration, it’s efficacy for various situations in the maxillofacial regions is yet to be evaluated.

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S30 Objectives To evaluate the efficacy of FUE technique for treating Alopecia of the maxillofacial region secondary to different causation. Methods A total of 242 patients with Alopecia of the maxillofacial regions secondary to either androgenetic, autoimmune, post traumatic, post burns or post surgical causes were treated using FUE technique with 0.9 mm motorised punches. In patients needing multiple sittings, 8 to 10 months period was allowed between the sittings. Patients were followed for at least 1 year and the level of patient satisfaction was graded using a 5 point scale with 1 been not at all satisfied and 5 been completely satisfied. Any complications, if present were also noted. Results Among the 242 patients, 224 were underwent scalp transplantation, 3 underwent beard, 12 underwent moustache and 3 underwent moustache transplantation. Hair growth was observed in all cases between 2 to 6 months post surgery. Although initially not an uniform result to begin with, complete result was observed at 10 to 12 months. Most patients (n=190) were completely satisfied, 34 were very satisfied, 10 were quite satisfied while 8 were barely satisfied with the surgical outcome. No major complications were noted. The scars in the donor area were visually imperceptible after 7–10 days. Conclusions From the maxillofacial perspective, Alopecia of the maxillofacial regions can be effectively managed using FUE technique of hair restoration. The technique offers the advantages of been a minimally invasive procedure which is not only scarless but also naturally pain free in the post operative period. References/Bibliography Dua A, Dua K. Follicular unit extraction hair transplant. J Cutan Aesthet Surg 2010; 3: 76–81. Rajput R. Post burns hair restoration of eyebrow, eyelash, moustache, beard and scalp areas. Indian J BUrns 2015; 23: 26–31.

ABS00533 Efficacy of Autogenous Grafts Versus Alloplastic Grafts in Nasal Augmentation Procedures: A Comparative Study Siddharth Dhanaraj, M.V. Sainath, Kamal Kannadasan SRM University, Chennai, India Abstract Background/Introduction An esthetically balanced eye, ear, nose and mouth is always appreciated. The dilemma when arises about introducing foreign or autologous materials for augmenting columella, dorsum and bridge the septal cartilage, the autologous materials proved the best. In our study we have used iliac crest and alloplastic porous poly ethylene material (Biopore) and compared three characters like stability, acceptance, shape and contours of the graft. Objectives The purpose of this study is to compare the efficacy of autogenous (Iliac crest) and alloplastic (Porous Polyethylene - Biopore) in rhinoplasty. Methods This study was done at SRM Dental College, Ramapuram in department of Oral and Maxillofacial Surgery on 10 patients with deformed nose. Their age ranging from 18 to 25 years (mean=21.5 years). In our study 6 males and 4 females were taken in which 8

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 cases were cleft nasal deformities and 2 patients were treated for cosmetic reasons In our study we have used iliac crest and alloplastic porous poly ethylene material (Biopore). Results The efficacy of the material were analysed both intra operatively and post operatively in terms of contour, shape, stability and graft acceptance. All the patients were followed for a period of six months and results were made. The 10 patients were divided into Group I who received autogenous iliac grafts for nasal augmentation and Group II who received alloplastic Biopore grafts. Conclusions Based on our study we conclude that Biopore alloplastic nasal implant has shown to be superior compared to autogenous iliac grafting as it avoids problems related to donor site morbidity, graft size and biocompatibility. References/Bibliography 1. Julie Karnes, Porous High-density polyethylene implants (medpor) for Nasal dorsum Augmentation, Aesthetic Surgery JournalJanuary/February 2000. 2. Michael J. Brenner, Grafting in Rhinoplasty Review Article, Facial Plastic Surgery Clinics of North America, Volume 17, Issue 1, February 2009, Pages 91–113.

ABS00727 Microtia Reconstruction with Porous High Density Polyethylene Ear Implant: A Prospective Evaluation Dr. Shiva Mani- Senior Lecturer Department of Oral and Maxillofacial Surgery at Saraswati Dental College and Hospital, Lucknow, Uttar Pradesh, India Abstract Background/Introduction Microtia is a condition characterized by deficient external ear with/ without associated internal ear malformations, rehabilitation of which is always a challenge to surgeon. Autologous costal cartilage, Porous High Density Polyethylene (PHDPE), Titanium dowel based ear reconstruction are the common modalities of microtia rehabilitation. Objectives To evaluate the versatile role of PHDPE implants and document any post-operative complications when used for auricular reconstruction. Methods A prospective study comprising of 7 non-syndromic patients with unilateral grade III microtia was conducted. Parameters evaluated were duration of surgery; pain score (using Visual Analog Scale [VAS]), drain collection and duration for which it was in situ, wound dehiscence upto 2 weeks postoperatively. Other long term parameters evaluated were implant exposure, mobility, deviation, infection at surgical site, need and number of secondary surgeries and complications at Temporo Parietal Fascia (TPF) fascia harvest site. Results Wound dehiscence due to TPF ischemic necrosis was seen in 1 out of 7 patients necessitating removal of implant leading to exclusion of the case from the study. Post operatively, significant reduction in VAS scores was seen from day 1 to day 5 for all patients. In the remaining 6 cases, complications encountered were late infection, implant exposure and hypertrophic scar with alopecia in one case each. Conclusions PHDPE ear implant with all its inherent advantages, being completely inert and biocompatible has a promising future and proves to be a

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 good alternative for conventional autologous costal cartilage in auricular reconstruction.

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ABS00833 Sculpting the Face with Biopore

References/Bibliography 1. Romo T, Presti PM, Yalamanchili HR. Medpor Alternative for Microtia Repair. Facial Plast Surg Clin North Am 2006; 14:129–36.

ABS00824 Computer Assisted Surgical Planning in CranioMaxillofacial Surgery Dr. Usha Asnani Mahatma Gandhi Mission’s Dental College and Hospital, Kamothe, Navi Mumbai Abstract Background/Introduction In cranio-maxillofacial surgery, surgeons are often faced with the reconstruction of massively destroyed or radically resected tissue, structures. Corrections of malunited fractures up to the complete remodeling of facial regions in cases of complex congenital malformations are common tasks of maxillofacial and reconstructive surgeons. With regard to the individual anatomy and physiology, such procedures have to be planned and executed thoroughly in order to achieve the best functional as well as an optimal aesthetic rehabilitation. The application of the CAD/CAM technology, together with the emerging 3D images based virtual surgical planning (VSP) technology; to cranio-maxillofacial reconstruction has been gaining attention to reconstructive surgeons. Conclusions Computer-assisted modeling, planning and simulation approach allows for pre-operative assessment of different therapeutic strategies on the basis of three-dimensional patient models and improve the predictability of planning and outcome while improving efficiency preoperatively as well as intraoperatively.

Dr. Ketaki Joglekar, Dr. Shashwat Magarkar, Dr. Kavita Sahu, Dr. Vyankatesh Sahu Email: [email protected], Contact details: 9975635634, Postal Address: 115, Reshimbagh Godavari Nagpur-440009 Abstract Background/Introduction Facial skeletal augmentation is an important clinical procedure for surgeons performing cosmetic and reconstructive facial surgery. Highdensity porous polyethylene (BioporeTM) has gained wide acceptance as an implant for facial skeletal augmentation in the last decade. Objectives To study the versatility of high density porous polyethylene for the correction of various maxillofacial defects and deformities. To evaluate the post-operative esthetic outcome and complications following its use. Methods All the patients of traumatic/congenital/iatrogenic maxillofacial defects and deformities were included. Patients were evaluated pre operatively on the basis of clinical examination (Site and size of the defect/deformity), radiographs, CT scan and at intervals of 7 days, 1, 3, 6, and 12 months post-operatively for Aesthetics, Symmetry, Allergic reactions, Infection, Exposure and other complications. Pain, numbness, satisfaction with treatment proceedings, and outcome were evaluated by the patient on a four-point scale. The remaining criteria were evaluated by the treating doctor on a four-point scale. Results High Density Porous Polyethylene implants - Biopore TM – have worked well in at least 13 patients out of 15 who underwent implant surgery. Only the patient, in whom Orbital Sheet and Plumper were used, showed an unsatisfactory outcome of the implant surgery. Conclusions High density porous polyethylene implant is a versatile material for the reconstruction of maxillofacial defects and deformities. It also gives good esthetics and is biocompatible.

References/Bibliography C.P. Kasaven et al.: Accuracy of both virtual and printed 3-dimensional models for volumetric measurement of alveolar clefts before grafting with alveolar bone compared with a validated algorithm: a preliminary investigation British Journal of Oral and Maxillofacial Surgery xxx (2016). Y. Y. Wang, H. Q. Zhang, S. Fan, D. M. Zhang, Z. Q. Huang, W. L. Chen, J. T. Ye, J. S. Li: Mandibular reconstruction with the vascularized fibula flap: comparison of virtual planning surgery and conventional surgery. Int. J. Oral Maxillofac. Surg. 2016. Stefan Zachow, Hans-Christian Hege, Peter Deuflhard ComputerAssisted Planning in Cranio-Maxillofacial Surgery Journal of Computing and Information Technology - CIT 14, 2006, 1, 53–64.

Section: Maxillofacial Implant ABS00218 Maxillary Sinus Floor Elevation Using Osteotome With Immediate Placement of Implant in Atrophic Maxilla Without Graft Material: A Clinical Study Dr. Shibaliik Mukherjee, Dr. Zodin Liana The Oxford Dental College Abstract Background/Introduction Implant restorations in the posterior maxilla pose significant challenges to the clinician because of the location of maxillary sinus and softness of the alveolar bone in this area. Minimally invasive sinus augmentation is an effective solution for this problem. Objectives The aim of this study was to investigate amount of sinus lift achieved by the cheapest and less time consuming procedure osteotome

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S32 mediated maxillary indirect sinus lift technique with simultaneously implant placement without using grafting material. Methods The study was conducted on 16 patients males and females. Indirect sinus lift was done with osteotome of gradual diameters and 8–10 mm long implants placed simultaneously. Preoperative & postoperative bone height and sinus lift respectively was measured in OPG using caliper. 4 months later endosinus bone gain was recorded in OPG. Results All implants achieved primary stability and were successfully loaded 4 months after healing. The mean sinus lift was 3.19 mm. Highest sinus lift achieved was 4.8 mm in 1 of the patient. In all the patients the implants were completely embedded in the newly formed bone and the sinus floor had been relocated apical to its previous demarcation. Conclusions The findings from these 16 cases suggest that the osteotome sinus floor procedure without grafting material, and immediate implant placement, can be applied in situations for which previously only direct sinus lift by lateral approach and indirect sinus lift with other methods except osteotome were applied. More patient and longer follow-up are warranted to investigate how reliable this technique can be when applied to atrophic maxilla.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Results The patients in study group had lesser postoperative pain, swelling and required lesser analgesic consumption as compared to the patients in control group with statistically significant difference. Less operating time was also statistically significant for study group. There was no implant failure reported in any group and the difference between the peri-implant bone losses in both the groups after 6 months postloading was statistically insignificant. Conclusions Both techniques were successful for implant placement, but single drill required less surgical time and the postoperative morbidity was minimal. References/Bibliography Guazzi P, Grandi T, Grandi G. Implant site preparation using a single bur versus multiple drilling steps: 4-month post-loading results of a multicenter randomised controlled trial. Eur J Oral Implantol. 2015 Autumn; 8(3):283–90. Bettach R, Taschieri S, Boukhris G, Del Fabbro M. Implant survival after preparation of the implant site using a single bur: a case series. Clin Implant Dent Relat Res. 2015 Feb;17(1):13–21.

References/Bibliography Toffler M. Osteotome mediated sinus floor elevation: Int J Oral Maxillofac Implants 2004; 19:266–73. Nedir R, Nurdin N, Szmukler-Moncler S, Bischof M. Osteotome sinus floor elevation technique without grafting material and immediate implant placement in atrophic posterior maxilla. J Oral Maxillofac Surg 2009; 67:1098–103.

ABS00376 Role of Custom Fabricated Titanium Implants in Maxillofacial Reconstruction: Experience of 2 Cases 1) Dr. Raghav Agrawal, Senior Resident, 2) Dr. Biju Pappachan Professor Govt. Medical College, Rajnandgaon; Govt. Dental College Raipur

ABS00311 Single Drill Versus Multiple Sequential Drills in Dental Implant Site Preparation: A Randomized Controlled Trial Anuj Jain, Anshul Rai All India Institute of Medical Sciences, Bhopal Abstract Background/Introduction Dental Implants have become an increasingly opted treatment modality for the rehabilitation of edentulousness. The placement of dental implant requires preparation of recipient site using multiple sequential drills resulting in various complications like post-operative pain, swelling, peri-implant crestal bone loss and sometimes implants failure. Objectives This prospective trial was performed to compare the clinical outcomes between the use of single drill and conventional multiple sequential drills for implant site preparation. Methods Fifty patients reporting to our institute requiring dental implant rehabilitation and having residual bone with height of minimum 10 mm and width of minimum 5 mm were enrolled in the study. These patients were randomly allotted to either of the two groups, Study group (single drill group) or control group (multiple sequential drills). After three months these implants were loaded with a metal ceramic crown. The parameters studied and statistically analyzed were operation time, postoperative pain, swelling, analgesic consumption and peri-implant bone loss. Follow up period was up to 6 months from implant loading.

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Abstract Background/Introduction Craniofacial defects also have complex anatomical shapes that is hard to achieve intraoperatively by carving harvested bone from the donor site. Use of auto grafts is limited by the availability of suitable donor site especially for large defects, additional expensive surgeries, tissue harvesting problems, donor site morbidity with an additional patient discomfort, chances of infection at both the recipient and donor sites, increased surgical time, resorption of the graft requiring secondary surgeries and the need for additionally skilled surgical team, which has led to the search of alloplastic material that would be suitable without the inherent problems. Objectives To access the role of custom fabricated titanium implants in improving precise adaptation to the region of implantation, reducing surgical times, leading to lesser chances for infection, faster recovery and better cosmesis in craniofacial surgery. Methods A case of frontal bone defect caused after primary healing of gun shot injury was reconstructed through hemicoronal flap using CFTI. In another case defect in the malar region after improper reduction of zygoma and zygomatic arch fracture was reconstructed via hemicoronal approach using CFTI. Results CAD/CAM systems have enabled us the ability to design and manufacture custom implants at an acceptable cost in a reasonable time. CFTI have an advantage of preventing donor site morbidity and giving predictable results in maxillofacial reconstruction. Conclusions CFTI if becomes economical and easily accessible to maxillofacial surgeons we can definitely avoid donor site surgeries with better

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 aesthetic and stable outcome. A team effort is mandatory for better outcome.

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ABS00560 The Socket Shield Technique: Bilaspur Experience

References/Bibliography 1. Jayanthi Parthasarathy 3D modeling, custom implants and its future perspectives in craniofacial surgery Ann Maxillofac Surg. 2014 Jan-Jun; 4(1): 9–18. doi:10.4103/2231-0746.133065.

ABS00490 Immediate Vs Delayed Placement of Implants Following Split Crest Procedure to Augment Narrow Alveolar Ridges: A Pilot Study 1. Dr. Himanshu Chauhan, MDS Senior Lecturer Co-Authors: 2. Dr. Shubha Lakshmi, MDS Professor, 3. Dr Puneet Wadhwani Professor Dept of Oral & Maxillofacial Surgery Saraswati Dental College, Lucknow (UP); Dept of Oral & Maxillofacial Surgery College of Dental Sciences, Davangere (Karnataka); Dept of Oral & Maxillofacial Surgery Saraswati Dental College, Lucknow (UP) Abstract Background/Introduction Narrow ridges pose a serious challenge for successful placement of endosseous implants. Alveolar ridge widening procedures is indicated in cases of crest thickness of = 4.0mm. Objectives Evaluate and compare between immediate and delayed implant placement using split crest procedure to augment atrophic narrow alveolar ridges. Methods Ten patients were randomly divided into two groups of five (Immediate) and (Delayed). Implants were placed simultaneously following split crest procedure in immediate technique and after 3–4 weeks of healing in delayed technique, Loading was done at the end of 6 months and patients were called for periodic follow ups. Both the techniques were evaluated for amount of augmentation achieved and implant success and survival rates. Results Statistically significant (p = 0.000) difference was observed for implant stability at intra-op, 4 months between the two groups, There was no statistically significant difference in the amount of augmentation achieved between the two groups. 100 % success and survival rate was achieved using both the techniques. High positive correlation (R = 0.845) was noted between the amount of augmentation achieved and the length of edentulous span. Conclusions We observed that both the techniques were comparable on the basis of augmentation achieved and implant success and survival rates, whereas implant stability was significantly higher in delayed technique group. Although Periotest values of all the implants were within range of good stability range we felt the need to use bone grafts in two case of immediate technique group. References/Bibliography 1. Enislidis G, Wittwer G, Ewers R. Preliminary report on a staged ridge splitting technique for implant placement in the mandible: a technical note. Int J Oral Maxillofac Implants. 2006 MayJun;21(3):445–9. 2. IE Zakhary et al. Oral Surg Oral Med Oral Pathol Oral Radiol 114 (5 Suppl), S179–S189. 2012 May 12.

Sandeep Prakash, Ketaki Kinikar, Prakash Khare, Bhupendra Kashyap Chhattisgarh Institute of Medical Sciences, Bilaspur Abstract Background/Introduction Anterior esthetic implant placement requires exact three dimensional placement of implant fixture so that the hard n soft tissues maintain their position. Extraction of a tooth invariably leads to loss of hard tissue dimensions. There have been numerous methods for the maintenance of facial bone, ranging from immediate implant placement to socket preservation with GBR, but these have not been very predictable. In-lieu of surgical procedures to prevent collapse of hard tissue, the socket-shield technique offers a promising solution. Objectives To analyse the efficacy of socket shield technique in preventing loss of facial bone and gingivae after immediate implant placement. Methods Seven patients were selected for the study requiring immediate replacement of eight teeth. Six implants were placed in anterior region and two in premolar region using socket shield technique. Results In the eight cases where the socket shield technique was carried out, the results of the cases were followed up till 1 year post-treatment. Except for the one shield, the rest seven shields showed very encouraging results. Conclusions It is to be concluded that this technique is a highly promising addition to aesthetic implant dentistry, further reaffirming the hypothesis that the retention of a prepared tooth root section as a socket-shield prevents the recession of tissues buccofacial to an immediately placed implant. References/Bibliography rst histological, clinical, and volumetrical observations after separation of the buccal tooth segment – a pilot study. Clin Implant Dent Relat Res 2015; 17: 71–82 Hurzeler MB, Zuhr O, Schupbach P, Rebele SF, Emmanouilidis N, Fickl S. The socket-shield technique: a proof of principle report. J Clin Periodontol 2010; 37: 855–62. Ba¨umer D1, Zuhr O, Rebele S, Schneider D, Schupbach P, Hu¨rzeler M. The socket-shield technique.

ABS00566 Design and Development of Silicon Based Cartilage Like Ear, Nose, Eye, Orbital Implants for Craniofacial Reconstruction Dr. Biswajit Kumar Biswas Avinash Dental Laboratory and Research Institute Pvt. Ltd, Kolkata, West Bengal, India Abstract Background/Introduction In twenty first century, composite materials gained a lot of interest not only in material sciences but also it showed a wide range of use in medical sciences. Composite materials or simply composites are those materials made from two or more constituent materials with significantly different physical or chemical properties. The property of new composite may include stronger, lighter and/or less expensive when

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S34 compared to traditional materials. Composite materials are used widely in dentistry for a long time. Objectives In the present study, we are trying to develop silicon based cartilage like bio-active implantable composite bio-materials to reconstruct the loss facial tissue with minimum morbidity. The ideal outcome expected of an artificial implantable material is bio-integration. It should not induce any deleterious /harmful effects or reaction such as chronic inflammatory response or formation of unusual tissues barrier. Hence, it is of paramount importance to find outbiomaterials in such a way, so that the graft materials or an implant produces such an environment, where body tissue reacts favorably tissue in-growths towards the implanted materials. Biologically active materials are the choice today instead of biologically inert material. Methods Different bio-materials are added to the silicon in different permutation and combination process and finally characterization for the new composites done. Results Results are highly satisfactory in terms of bio-compatibility with animal trails. Conclusions There is an absolute need of cartilage like biomaterials which are not available at present in the world market, in the field of reconstructive surgery. We have understood the bio-physics of the implant problem and try to find out the alternative means to solve these problems. Hope these new material can shows new hope in the field of cartilaginous alloplastic bio -materials. References/Bibliography 1. Physicians at Massachusetts General Hospital in Charlestown, using magnetic resonance imaging, found that a significant amount of free silicone had migrated from an implant (not noticeably ruptured) into the liver and spleen of a woman. (Magnetic Resonance Medicine 36:3 [September 1996], 498–501. Researchers also found that silicone in the liver could be detected in the first three to four years after a woman received her implant. (Magnetic Resonance Medicine 33:1[January 1995], 8–17.).

ABS00603 Clinical Outcome of Immediate Verses Delayed Dental Implants: A Prospective Study Dr. Rushit Patel, Narsinhbahai Patel Dental College and Hospital Visnagar, Gujarat, India Abstract Background/Introduction The implant surgical protocol proposed by Bran mark et al involves open flap access, stepwise osteotomy of the bony ridge, and implant placement followed by good primary closure. Objectives To compare the radiographic marginal bone loss, pocket depth and along with that clinical outcome associated with immediate and delayed implants, and success rates two years after the placement of implants. Methods Total 62 Dental implants were placed in 42 patients, they were randomly selected to the Immediate or Delayed group. In that 30 were immediate implants and 32 were delayed implants. The width and depth of marginal bone defects around the implants were measured

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 clinically just after placement and 3 months later at the abutment surgery. Bone healing and marginal bone changes were evaluated radiographically and clinical parameters evaluated were pocket depth, local infection, altered sensation, soft tissue dehiscence, pus discharge, implant mobility and patient’s satisfaction. Results The results revealed that there was a significant difference in pocket depth and crestal bone loss in both groups. Mean pocket depth in immediate group was 3.285 mm and in delayed group mean pocket depth was 3.523mm at 1 year respectively. There were minimal crestal bone loss in immediate group as compared to delayed implant group at 1 year follow up. Also there were reduced complication like local infection, altered sensation, soft tissue dehiscence, pus discharge in immediate implant placement group. And resulted in patient’s satisfaction. Conclusions We conclude that the immediate dental implant placement is significantly superior over the delayed implant placement. References/Bibliography Immediate Versus Delayed Loading of Dental Implants Placed in Fresh Extraction Sockets in the Maxillary Esthetic Zone: A Clinical Comparative Study.

ABS00650 Ridge Preservation Techniques in the Anterior Aesthetic Zone for Implant Placement Dr. Sheetal Kelkar YMT Dental College and Hospital Abstract Background/Introduction Extraction of a tooth sets in progress a number of changes that lead to loss bone and soft tissue support. The bone width loss in the highly aesthetic zone of the premaxilla is primarily from the facial region because the labial plate is very thin compared with the palatal plate and facial undercuts are often found over the roots of the teeth. Hence this region often requires both hard tissue and soft tissue restoration before placement of an implant. However it is advantageous to preserve the dimension of the post-extraction ridge instead of reconstructing it thereafter, thus maintaining its ideal vertical and horizontal dimensions and decreasing patient morbidity. Objectives The aim of this study is to discuss and evaluate various techniques of ridge preservation of the aesthetic anterior region. Methods Various techniques of ridge preservation including the socket seal (grafting), soft tissue grafting, socket shield technique, root submergence technique etc. are discussed and evaluated. Results The preservation of ridge after extraction helped in optimal placement of implant and avoiding the complicated grafting procedures at the time of implant placement. Conclusions Ridge preservation procedures are effective in limiting horizontal and vertical ridge alterations in post extraction sites. Also the maturation and mineralization of the newly formed bone in the extraction socket is accelerated or improved by ridge preservation. This facilitates the placement of an implant in a correct 3-dimensional position optimizing its aesthetic and functional outcome.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 References/Bibliography 1. Brandom L, Malmstrom H, Jawed F etc. Ridge Preservation Techniques in the Anterior Esthetic Zone. Implant. Dent. 2015; 24(6): 699–712. 2. Darby I, Chen S, Buser D. Int J Oral Maxillofac Implants. 2009; 24: 260–71.

ABS00676 Use of PRF as the Sole Grafting Material After Sinus Membrane Elevation and Immediate Implant Placement in the Posterior Maxillary Region

S35 tissue healing. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101:e56–e60. Lundgren S, Cricchio G, Palma VC, et al. Sinus membrane elevation and simultaneous insertion of dental implants: A new surgical technique in maxillary sinus floor augmentation. Periodontol 2000. 2008; 47:193–205.

ABS00797 A Systematic Evaluation of Membranes Used in Guided Bone Regeneration Procedures in Oral Implantology Dr. Nitin Verma

Dr Sachin Rasal, Senior Resident, Dr Anshul Rai, Assistant Professor

Government Dental College and Hospital Amritsar

All India Institute of Medical Sciences, Bhopal

Abstract Background/Introduction Membranes have been used extensively in advance cases of oral implantology. Most commercially available resorbable membranes used are made of collagen which is cross linked barrier. Whereas non resorbable membranes are made up of Titanium PTFE. Since they dont get dissolved with saliva or blood, they have high predictability in bone reveneration. Objectives To evaluate resorbable and non resorbable membranes in terms of membrane exposure, graft resorption, height gained or reduced, aesthetic results and patient satisfaction. Methods The study was done on 10 patients who required bone augmentation with Immediate and or delayed implant placement using resorbable vs non resorbable membrane. Results It was found that in terms of Membrane exposure, less grafy resorption bone height gained was remarkably more with non resorbable. But patient satisfaction was same in both groups. Conclusions Non resorbable is definitely more predictable with bone regeneration in implant dentistry with unavoidable problems of 2nd surgery and costly availability.

Abstract Background/Introduction Conventionally, autogenous bone graft was considered the gold standard in the maxillary sinus floor grafting procedures. However, following research and advances in the field of implant dentistry, many substitutes were devised. These included synthetic graft materials which avoided the common complications associated with autogenous graft materials. Later, certain growth factors were discovered which enhanced and accelerated the bone formation process and was initially used only in conjunction with graft materials. However, later many studies were conducted to decisively prove that growth factors alone were required for the bone forming process irrespective of the use of graft materials. Objectives To assess the increase in alveolar bone height after sinus membrane elevation & implant placement without bone graft and use of PRF. To assess the implant survival in the posterior maxilla with the direct technique of sinus membrane elevation procedure and implant placement without bone graft and use of PRF. Methods 10 sinus elevations with simultaneous implantation were performed on 10 patients with Choukroun’s PRF as the sole filling biomaterial. For each patient, a presurgical exam and a 1, 4 and 6-month postsurgical radiologic exam were performed with a panoramic x-ray and three-dimensional CBCT to evaluate the sub-sinus residual bone height and the final bone gain around the implants. Results In this study, 21 implants from different systems with different screw designs were placed. All implants were inserted in residual bone height between 1.5 and 6 mm (mean ± SD: 2.9 ± 0.9 mm). The final bone gain was always very significant (between 7 and 13 mm [mean ± SD: 10.1 ± 0.9 mm]). No implant was lost. After radiologic analyses, the position of the final sinus floor was always in the continuation of the end of the implant. Conclusions From a radiologic point of view at 6 months after surgery, the use of PRF as the sole filling material during a simultaneous sinus lift and implantation stabilized a high volume of natural regenerated bone in the subsinus cavity up to the tip of the implants. Choukroun’s PRF is a simple and inexpensive biomaterial, and its systematic use during a sinus lift seems a relevant option, particularly for the protection of the Schneiderian membrane. References/Bibliography Choukroun J, Diss A, Simonpieri A, et al. Platelet-rich fibrin (PRF): A second generation platelet concentrate. Part IV: Clinical effects on

References/Bibliography Long-term outcome of implants placed with guided bone regeneration (GBR) using resorbable and non-resorbable membranes after 12–14 years.

ABS00842 The Bone Formation at the Maxillary Sinus Floor Following Simultaneous Intra Alveolar Elevation of the Mucosal Lining and Implant Installation Without Graft Material: Prospective Clinical Evaluation Dr Mrs Varsha S Manekar, MDS & PhD Scholar Associate Professor Oral & Maxillofacial Surgery, GDCH, Nagpur Abstract Background/Introduction In the posterior maxillary quadrant, insertion of implants of desired length and diameter is often limited by the dimensional alterations of

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S36 the residual ridge as well as the pneumatization of the maxillary sinus occurring after tooth loss. Intra alveolar sinus floor elevation represents a surgical option to vertically enhance the available bone in the posterior maxillary quadrant through an access created in the edentulous bone crest. Restoration of this condition has for last two decades been successfully treated with various sinus augmentation techniques and installation of dental implants. The use of graft material is anticipated to be necessary. However recent studies have demonstrated that the mere lifting of the sinus mucosal lining and simultaneous placement of implants results in bone formation. This study is conducted to evaluate the intra alveolar sinus lift and simultaneous implant placement without graft. PICO-problem is reduced subantral bone in the posterior maxilla, in patients (Population) indicated for implant supported prosthesis, intervention is intra alveolar hydrolic sinus lift; expected outcome is increase in subantral bone resulting in use of adequate length of implant indicated and success of implant. Objectives Primary objective is to evaluate bone formation at the maxillary sinus floor (subantral bone) following simultaneous intra alveolar elevation of the mucosal lining and implant installation without graft material Secondary objectives are –1. primary stability of implant at the time of first stage surgery 2. success of implant. Methods Study design is prospective clinical study. The dependant variable is sub antral bone height and independent variable is sinus lift procedure. A prospective study is carried out in patients with inclusion criteria of subantral bone 4mm–7mm with adequate alveolar width and indicated for implant prosthesis. A sample size of 15 patients underwent implant placement simultaneously with sinus lift procedure. The sinus lift procedure is intra alveolar with sequential drilling. The sinus lining is lifted with hydrolic pressure. The implant is placed in the osteotomy directly without any graft placement. The cover screw is placed and sutured. The healing period for osseointegration is 6 months. Then the implant is loaded with prosthesis and brought into function. The post-operative x-rays shows the tenting of the sinus membrane above the end of implant. The follow up x-rays and CBCT shows bone formation here. Results There is mean increase of 3mm, with range of 3–6mm, subantral bone. All the implants were successful according to criteria of Buser et al. The sinus lining remained intact in all cases and the primary stability ranging from 20 to 30 nm was achieved. The CBCT imaging shows that sparse bone is formed above the implant although good quality bone is seen around the implant in tented sinus floor. In cases of more than one implants there is continuous increase in bone formation. Conclusions The bone formation at the maxillary sinus floor following simultaneous intra alveolar elevation of the mucosal lining and implant installation without graft material is a successful technique. It is less invasive and more acceptable to the patients. References/Bibliography 1. He LL, Chang X, Liu Y. Sinus floor elevation using osteotome technique without grafting materials: a 2-year retrospective study. Clin. Oral Impl. Res. 24 (Suppl. A100), 2013, 63–67 doi: 10.1111/j.1600-0501.2011.02376.x. 2. Seyed Amir Danesh-Sani, Petre M Loomer, Stephen S Wallace; A comprehensive clinical review of the maxillary sinus floor elevation: anatomy, technique, biomaterials and complications.

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Section: Oral Precancer and Cancer ABS0085 To Evaluate Factors Involved in Delayed Presentation of Oral Cancerous Lesion in Rural Areas Dr. Harish Saluja Reader Dept of OMFS, RDC, LONI-413736 Abstract Background/Introduction In India the incidence of oral cancer is very high. The tumor size has been classified according to their sizes from T1 to T4. At our institute more than 70% of the cases encountered are of T3, T4 size. Many of the times tumor reported to us become nonoperable. There are evidences that early detection of oral cancer in its early stages has a great positive influence on the prognosis of the disease, treatment results and it may also improve significantly the person’s quality of life (Allison et al. 1998; Baykul et al. 2010). Tumor size influences therapy and prognosis of oral cancer. Patients with oral cancer often present late to the doctor making treatment difficult, expensive and sometimes unsuccessful. There is huge difference between staging at which patient reports to rural and urban centers. So we decided to find out the reasons behind such delayed presentation of oral cancer patients. Objectives The aim of the study was to find out the % of tumor size reporting to our rural institute and reasons behind reporting of patient at such a late stage. Methods Study included 300 oral cancer patients and tumor size was noted. A questionnaire was prepared to find out the reason behind such late presentation. Time lapse was also noted between first presentation of any sign/symptom or first notification by the patient till patient reported to our department. Results Self negligence, reluctant attitude towards health and negative attitude of relatives towards cancer patient was big reason for late reporting. Even misguidance/inability to diagnose lesion by local doctors was another big reasons for late referral to onco centers. Conclusions Awareness is required in rural areas for issues related to health. Even health professionals of rural areas require training to screen out suspected cancerous lesions. References/Bibliography Kademani D, Bell RB, Bagheri S, et al.: Prognostic factors in intraoral squamous cell carcinoma: the influence of histologic grade. J Oral Maxillofac Surg 2005; 63: 1599–1605.

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ABS00124 Predictability of Depth of Tumor Invasion, Tumor Budding & Worst Pattern of Invasion as Risk Factor for Nodal Metastasis Dr Vijaykumar J Girhe DR HSRSM Dengan College Hingoli

S37 Methods Series of five cases done with one year follow up. Results Modified nasolabial biwinged flap is advantageous than conventional one MIcrostomia is minimal Reach of flap from retromolar region to commisure is adequate. Conclusions Modified biwinged naso labial flap is comfortable than conventional flap in advanced cases. References/Bibliography

Abstract Background/Introduction Oral squamous cell carcinoma is characterized by highly variable prognosis even in early stage disease. Nodal metastasis is amongst most important prognostic factor. Objectives To verify the predictability of depth of tumor invasion, tumor budding & worst pattern of invasion as risk factor for nodal metastasis. Methods Depth of tumor invasion, Tumor budding & worst pattern of invasion were studied in 20 cases of T1/T2 N0M0. Oral squamous cell carcinoma managed in our hospital were reviewed histologically. Results Tumour budding and depth of invasion were associated with poor prognosis in patients with early oral squamous cell carcinoma. The worst pattern of tumour invasion was also found to be an independent prognostic factor. Conclusions Depth of tumor invasion, Tumor budding & worst pattern of invasion are reliable risk factors for nodal metastasis in early oral squamous cell carcinoma. References/Bibliography 1. Ganly I, Patel S, Shah J. Early stage squamous cell cancer of the oral tongue—clinicopathologic features affecting outcome. Cancer 2012;118: 101–111. 2. Ho CM, Lam KH, Wei WI, Lau SK, Lam LK. Occult lymph node metastasis in small oral tongue cancers. Head Neck 1992;14:359–363. 3. Kellermann MG, Sobral LM, da Silva SD, et al. Myofibroblasts in the stroma of oral squamous cell carcinoma are associated with poor prognosis. Histopathology 2007;51:849–853.

ABS00205 Bi Winged Nasolabial Flap: A Modified Reconstruction Approach for Submucous Fibrosis Dr. R. Murugan MDS Fiboms Rajah Muthiah Dental College and Hospital Abstract Background/Introduction Surgical management of submucous fibrosis includes various flaps and grafts. Amongst all nasolabial flap is the most accepted and gold standard reconstructive option till followed. But conventional nasolabial flap has its own merits and limitations in advanced cases. So we have done a series of cases with bi winged flap in our centre. Objectives To give adequate access of flap till commisure after releasing circum oral bands to prevent post Operative microstomia.

Extended nasolabial flap in the management of oral sub mucous fibrosis -BJOMS 2009 382–385 RM Borle, PV Nimonkar, R. Rajan.

ABS00221 Surgical Margin in Oral Cancer: How Close can We Get? Dr Praveen Satish Kumar, Dr Omkar Shetye, Dr Rakshit Khandeparkar Goa Dental College and Hospital, Goa, India Abstract Background/Introduction The ideal width of the surgical margin for oral cancer has always been an issue of debate. Microscopic tumor at the inked resection margin increases the chance of local recurrence by a factor of 2. The most widely accepted definition of a close margin is tumor within 5 mm of the inked resection margin. This an arbitrary designation and when recurrence rates are specifically cited for close margins, they are generally less than the rate observed for patients with tumor at the inked resection margin. Patients with clear but close margins are often considered from a clinical standpoint to have positive or inadequate margins. The precise definition of the clear or adequate surgical margin is an important prognostic consideration with clinical implications in the selection of patients for adjunctive treatment. Objectives The aim of this review is to evaluate the definition of close margin in head and neck squamous cell carcinoma and its possible prognostic significance. Methods A scopus /PubMed search was done to retrieve articles discussing adequate surgical margin in HNSCC. A double cross-check was performed on citations and full-text articles. Results This systematic evaluation of surgical margins suggests that an adequate resection in oral cancer should provide a margin of greater than 3 mm on permanent pathology section. Conclusions Pathology reports should designate the distance in millimeters of tumor from the inked mucosal and deep resection margin to facilitate ongoing evaluation. Intraoperative assessment of margin status needs to be refocused to examine the proximity of tumor to, as well as involvement, of the deep surgical margin. References/Bibliography What is the adequate margin of surgical resection in oral cancer? doi.org/10.1016/j.tripleo.2008.11.013.

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ABS00282 Evaluate the Efficacy of an Absorbable Bilayer Collagen Membrane in Cases of Oral Submucous Fibrosis

ABS00398 Does Adjuvant Therapies Improve Outcomes in pT1-3 Oral Cavity Cancer with Tumor-Free Margins and Perineural Invasion?

Dr Pragya Harsh Ex Resident, 2 Dr Dk Gupta Ex-HOD, 3 Dr Ashutosh Harsh Assistant Professor General Dentistry

Dr. Ashish Sharma Kothiwal Dental College and Research Centre, Moradabad

Dr SN Medical College; Government Dental College Jaipur; Dr SN Medical College Jodhpur Abstract Background/Introduction Oral Submucous fibrosis (OSMF) is a chronic, complex, irreversible, highly potent pre-cancerous condition that affects the entire oral cavity which predominantly affects the people of southeast Asia. It characterized mainly by two symptoms, burning sensation in the mouth while eating spicy food in early stages of the disease and trismus in the late stages of the disease. Numerous non-surgical and surgical methods have been employed for treatment of this disease. In our cases we use an absorbable bilayer collagen membrane. After fibrotomy for replacement. Objectives The aim of our study, to assess the efficacy and usefulness of a commercially available absorbable bilayer collagen membrane in surgical management of Oral submucous fibrosis. Methods Xenogenous collagen membrane supplied by EUCARE pharmaceuticals private limited; Chennai will use for the study. Procedure would include resection of fibrous bands, intra operative forced mouth opening, followed by covering the raw mucosal defect with a commercially available absorbable bilayer collagen membrane. Collagen membrane will thoroughly washed in sterile saline solution and will cut by scissors in slight excess of the wound size and sutured to the edges of the wound by the use of vicryl sutures. They will be instructed to quit the habit completely. Patients will be required to continue with postoperative physiotherapy along with nutritional supplements. Results The collagen membrane used to cover the buccal defects after fibrotic bands release had excellent results in total thirty cases we have gain good results take less suturing time so less operating time, good interincisal opening, good postoperative healing, less post pain, less Contracture. Patient have preoperative interincisal distance of 0–15 mm and post operative interincisal distance of 25–35 mm. Conclusions We concluded that the advantages of using bilayer collagen membrane to cover the defect of oral mucosa are easily availability, simplicity of procedure, good tolerance of membrane by oral tissue, no need to perform a second operation for obtaining a graft or detachment of the pedicle, no morbidities as associated with various other grafts and no problems associated with donor site healing. References/Bibliography 1. Comparative Clinical Evaluation of Buccal Fat Pad and Collagen in Surgical Management of Oral Submucous Fibrosis. Nataraj S, Guruprasad Y, Shetty JN. Archives of Dental Sciences 2011; 2: 1 15–22. 2. The Efficacy of Collagen Membrane as a Biodegradable Wound Dressing Material for Surgical Defects of Oral Mucosa: A Prospective Study. Rastogi S, Modi M, Sathian B. J Oral Maxillofacial Surg 2009;67:1600–160.

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Abstract Background/Introduction The criteria for administration of adjuvant therapies in oral cavity squamous cell carcinoma (OSCC) remain controversial, and it is unclear whether patients with pT1-3N0 disease benefit from adjuvant chemo-radiation or radiation in the presence of free margins and perineural invasion. Objectives The goal of this report was to determine whether the groups would benefit from adjuvant radiation or chemoradiation therapy in terms of 5-year local control rate and overall survival rate. Methods We retrospectively reviewed our case records from January 2006 to May 2017. In all, 180 cases of pT1-3N0 OSCC patients had tumorfree margins, of whom 24 had perineural invasion. Postoperative adjuvant RT and postoperative concomitant chemo-radiation therapy were used for patients. Local control and overall survival rates were plotted by Kaplan-Meier analysis for the three groups that is only surgery, surgery with RT and surgery with concomitant chemoradiation. Results The results revealed that local control and survival were insignificant among the three groups and the addition of adjuvant radiotherapy and chemotherapy did not significantly alter the 5-year local control rate (p \0.05) or the overall survival rate (p \ 0.05) in patients with perinural spread. Conclusions Altogether, these data seem to indicate that radical surgical resection alone should be considered a sufficient treatment for OSCC patients with pT1-3N0 disease, even in the presence of perineural invasion. References/Bibliography 1. Ballantyne AJ, McCarten AB, Ibanez ML. The extension of cancer of the head and neck through peripheral nerves. Am J Surg 1963;106: 651–667. 2. Batsakis JG. Nerves and neurotropic carcinomas. Ann Otol Rhinol Laryngol 1985;94:426–427.

ABS00466 Impact of Depth of Invasion, Perineural Invasion and Lymph Node Involvement on Disease Free Survival in Head and Neck Cancer Patients Dr Mayank N Patil HCG Manavata Cancer Centre, Nashik Abstract Background/Introduction Head and neck cancers are the most common type of cancers worldwide. Cervical lymph node metastasis is one the known

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 prognostic factor which lowers the survival rate by 50%. Recent data suggest that Depth of invasion is better predictive parameter than tumor thickness and is a significant predictor of nodal metastasis. Objectives 1) to determine the role of depth of invasion in predicting disease free survival 2) to evaluate the role of nodal staging on disease free survival 3) to check the impact of nodal positivity on disease free survival. Methods It is a retrospective study which was conducted in HCG Mnavata Cancer Centre, Nashik. In this study we included 100 patients who had undergone surgery for Head and neck cancers. The depth of invasion and pathologic nodal status was noted and its effect on disease free survival was monitored. Results It was found that patients with primary tumor having depth of invasion more than 5mm and positive lymph node had disease free survival ranging from 4–6months. Conclusions It is concluded from the study that the patient with depth of invasion more than 5mm and positive lymph node have greater chance of recurrence. References/Bibliography 1. Head and Neck Cancers—Major Changes in the American Joint Committee on Cancer Eighth Edition Cancer Staging Manual. William M. Lydiatt CA Cancer J Clin 2017;67:122–137. 2. The Indian scenario of head and neck oncology – Challenging the dogmas Vidisha Tuljapurkar, South Asian Journal of Cancer July-September 2016 Volume 5 Issue 3.

ABS00479 Post Operative Assessment of Spinal Accessary Nerve Function of Patients Undergoing Neck Dissection for Oral Cancer: A Prospective Study Dr. Vinod Krishna, K, Dr. Mathan Mohan, Dr. B. Bala Guhan, Dr. G. R. Karthikeyan Oral Cancer Foundation, Head & Neck Services, Karpaga Vinayaga Inst. of Medical & Dental Sciences, Madhurantakam, Tamil Nadu 603 319 Abstract Background/Introduction The eleventh cranial nerve, otherwise termed as spinal accessory nerve (SAN) which innervates the trapezius and sternocleidomastoid muscle. Trapezius muscle acts as a stabilizer for scapula and makes it to rotate, elevate and also to retract. Head and neck cancer tops at the sixth level of all cancer in the worldwide. One of the prognostic factor of squamous carcinoma mainly depend on the involvement of the level of cervical lymph nodes. For many years addressing the cervical group of lymph nodes surgically by radical neck dissection (RND) was a golden standard technique for head and neck squamous cell carcinoma which sacrifices SAN, sternocleidomastoid and internal jugular vein. Sacrificing SAN leads to denervation and atrophy of the trapezius muscle with onset of shoulder disability showing limited range of motion, pain, muscle weakness and drooping. In order to reduce these functional morbidities modified radical neck dissection (MRND), selective neck dissection (SND) were preferred recently.

S39 Many studies have reported iatrogenic SAN injury are seen in 60–80% of patients who undergo RND, 1.68% in patients who undergo MRND and in 30 % of patients who undergo SND which includes the cervical lymph node level II–IV. We present a study of evaluation of SAN of patients who had underwent exclusively selective neck dissection for squamous cell carcinoma involving head and neck region over a period of 5 years prospectively. Objectives The Aim of the study is to describe the function of spinal accessory nerve (SAN) postoperatively after performing neck dissection due to oral cancer and also to describe the modalities of trauma to the SAN while doing different type of neck dissection. Methods This study was done Between 2012–2017, Patients reported (male 305 female - 245) with mean age of 54 years with a range of 39–69 years receiving all SND performed by a single surgeon who belongs to the department of Head & Neck Oncology services, Karpaga Vinayaga Institute of Medical & Dental Sciences, Kanchipuram district, Tamilnadu were studied. None of the patients had metabolic disorders, muscle disease, concomitant rheumatological disorders, with no history of previous trauma and no history of any surgery related to the neck. We identified the SAN in all SND done patients by dissecting the sternocleidomastoid muscle and retracting it posteriorly to identify the entry point of SAN nerve at the junction of upper third and middle third of posterior border of sternocleidomastoid muscle. Identified SAN were retracted with use of vessel loop to prevent it from injury during surgery. It was then meticulous dissection were carried out to clear level IIa and IIb group of lymph nodes. All patients shoulder function was assessed pre operatively and post operatively by the arm abduction test. Based on the abduction of arm resulting in a value from 1 (abduction \ 90 degree) to value 5 (abduction [180 degree). Results Arm Abduction test after performing neck dissection were carried for all the patients in the frequency of I week, III week, I month, III month & VI Post-operatively (Includes after radiation therapy). Based on the abduction of arm resulting in a value from 1 (abduction \ 90 degree) to value 5 (abduction [180 degree) the results were tabulated as follows: Totally 550 patients, in which 426 patients were satisfied the study up to the follow up of 6th month post -operatively, remaining patients were not able to follow up to the institution due to various reason. Conclusions Shoulder dysfunction after neck dissection gives a consideration about the spinal accessory nerve (SAN) while performing neck dissection in Sub level IIB. Even we preserve the SAN clinically (intra operatively), we suggest that prevention of SAN from thermal injury during dissection from cautery, careful retraction of Sternocleidomastoid muscle, shoulder exercise physiotherapy even after radiation therapy must be educated for the patients post operatively to maintain the function of the shoulders. References/Bibliography 1. Shoulder complaints after nerve sparing neck dissections, van Wilgen CP1, Dijkstra PU, van der Laan BF, Plukker JT, Roodenburg JL., Int J Oral Maxillofac Surg. 2004 Apr;33(3):253–7. 2. Shoulder disability after different selective neck dissections (levels II–IV versus levels II–V): a comparative study. Cappiello J, Piazza C, Giudice M, De Maria G, Nicolai P. Laryngoscope. 2005 Feb; 115(2):259–63.

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ABS00512 Treatment Algorithm in Oral Submucous Fibrosis Based on OSMF Scoring Index: A Prospective Study Dr Pawan Dawane; Assistant Professor RRK Dental College & Hospital, Akola Abstract Background/Introduction Oral submucous fibrosis is poorly understood and unsatisfactorily treated disease with obscure etiology. Objectives We have classified the disease in different groups according to the OSMF scoring Index and treated them according to the stage of disease. Methods 93 patients of oral submucous fibrosis and classified them into three groups based on OSMF scoring Index and given specific treatment for each group. Group A (n=31) patients treated with medicines, Group B (n=31) treated with intra lesional injections and Group C (n=31) treated with surgical therapy and followed them up for 2 years regularly. Results Almost all patients got symptomatic relief from the disease. Patient’s interincisal mouth opening increased significantly. All patients can take regular diet. Progressive malignant transformation can be diagnosed earlier to avoid future morbidity and mortality. Conclusions Oral submucous fibrosis (OSMF) scoring index is reliable method to decide the severity of disease and progress. Based on this scoring and grouping, we can give definite prompt treatment to the patients with satisfactory results. References/Bibliography 1. Pindborg JJ, Sirsat SM (1966) Oral submucous fibrosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 22:764–779.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 further sub grouped into =70years and [70years groups. The association of these groups with various factors like co-morbidities, type of reconstruction, tumour factors –peri-neural invasion, extra-capsular spread and adjuvant therapy was assessed. Uni and multi-variate analysis of factors affecting overall survival (OS) and disease free survival (DFS) was done. Results Male to female ratio was 2:1. Median follow was 48 months. There was no difference in association of Clinico-pathological factors, reconstruction choice, adjuvant therapy completion, OS and DFS between the =70 and [70 years sub-group (p[0.005). The OS of the entire cohort was 46.1months while DFS was 37.5months. On multivariate analysis, tumour thickness, adjuvant received, extracapsular spread, nodal involvement were found to be significantly affecting both OS &DFS (p\0.005). Of the patients advised adjuvant therapy, 93.6% of them could complete it. Conclusions There is no difference in tumor biology, association with different clinico-pathological factors and survival in patients=70 and [70years of age. Majority of patients could complete the adjuvant therapy advised to them thus indicating no requirement of de-escalating treatment in them in view of the age. References/Bibliography 1. Kowalski LP, Alcantara PS, Magrin J et al. A case-control study on complications and survival in elderly patients undergoing major head and neck surgery. Am J Surg 1994;168:485–490. 2. Huisman MG, et al., Delivering tailored surgery to older cancer patients: Preoperative geriatric assessment domains and screening tools e A systematic review of systematic reviews, Eur J Surg Oncol (2016), http://dx.doi.org/10.1016/j.ejso.2016.06.003.

ABS00607 Use of Buccal Fat Pad for Treatment of Oral Submucous Fibrosis Col MK Rath

ABS00586 Treatment Outcome of Geriatric Patients with Oral Squamous Cell Carcinoma (OSCC): Rationale in Indian Scenario Prashant Chopda, Akshat Malik, Aseem Mishra, Pankaj Chaturvedi, Prathamesh Pai Dept. of Head & Neck Oncology, Tata Memorial Centre (TMC), Mumbai Abstract Background/Introduction Geriatric patients ([65 years) constitute a significant number of oral cancer patients. They are a special group of patients who have unique issues like multiple co-morbidities, poor performance status or poor social support. Objectives There is a need to separately evaluate the tumour characteristics, behaviour and outcomes in these patients. Methods This was a retrospective analysis of prospectively collected data of 140 geriatric OSCC patients operated from 2012 to 2013. They were

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AFDC, New Delhi Abstract Background/Introduction The buccal fat pad (BFP) is a supple and lobulated mass, easily accessible and mobilized. It is a well accepted graft for defects after incision of fibrotic bands in the surgical management of oral submucous fibrosis (OSMF). Objectives The aim of this study was to clinically evaluate the application of pedicled BFP in the surgical management of stage III and IV OSMF. Methods Twenty-eight cases of clinically and histologically diagnosed cases of OSMF were divided into 2 groups: group I (n=15) and group II (n=13), corresponding to clinical stage III and stage IV, respectively. All the patients underwent incision of fibrotic bands and coverage of the buccal defect with a pedicled BFP flap. Both groups were analyzed separately for mouth opening (interincisal distance in millimeters) preoperatively and 1 year postoperatively, time taken for epithelialization of BFP, time taken for establishment of normal contour, and changes in symptoms (painful ulcerations, burning sensation, and intolerance to spices) 1 year after grafting.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Results The mean preoperative mouth opening was 19.6 mm (SD, 2.43) in group I and 12.92 mm (SD, 1.21) in group II. The mean postoperative mouth opening after 1 year was 35 mm in group I (SD, 1.96) and 31.76 mm in group II (SD, 1.97). The time taken for epithelialization of BFP was 4 weeks in group I and 5 weeks in group II. The mean time taken for establishment of normal contour after grafting was 12.25 weeks (SD, 1.42) in group I and 15.07 weeks (SD, 1.26) in group II. In 2 cases in group II, there was remission of painful ulcerations, burning sensation, and intolerance to spices. Conclusions BFP is reliable for the treatment of OSMF. References/Bibliography Rohit Sharma, G. K. Thapliyal, Ramen Sinha, P. Suresh Menon, J Oral Maxillofac Surg 70:228–232, 2012.

ABS00633 Study of Retro Auricular Endoscope Assisted Selective Neck Dissection for Early Oral Cavity Cancers 1) Dr Sagar Shridhar Vaishampayan, Consultant Maxillofacial & Oral Cancer Surgeon, 2) Dr Prashant V Pawar, Consultant Head Neck & Skull Base Surgeon

S41 aesthetic outcome as the scar is hidden in the hairline. No serious adverse outcomes were observed in any patients. Conclusions In a resource poor setting where Robotic surgery system is not available, endoscope assisted retro-auricular neck dissection gives us good cosmetic outcomes without compromising oncological safety in early oral cavity cancers. References/Bibliography 1. Robotic-assisted selective and modified radical neck dissection in head and neck cancer patients; Nikolaus Mo¨ckelmann et al.; International journal of Surgery, January 2016, Volume 25, Pages 24–30. 2. Approaches of robot-assisted neck dissection for head and neck cancer: a review; Shanghui Zhou, Chen ping Zhang, Daqing Li; Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 121, Issue 4, April 2016, Pages 353–359.

ABS00640 Primary Intra-Osseous Squamous Cell Carcinoma in Mandible: Tumor Size [ 4cm Significantly Reduces Loco-Regional Control and Survival Dr Sandhya Gokavarapu. MDS, Consultant Head and Neck Oncologist, YiMing Chen, Resident

1) Apollo Hospital, Navi Mumbai; 2) Fortis Hospital, Mumbai KIMS Hospitals Hyderabad; Shanghai Ninth People Hospital Abstract Background/Introduction Conventional operation for oral cavity squamous cell carcinoma includes resection of primary tumour and neck dissection. This in most cases results in a grossly visible scar leading to stigma of a visible scar with fibrotic band formation. Recently numerous surgical approaches have been developed in conjunction with a Robot in order to avoid these complications. The Robot is an expensive equipment and not affordable for resource poor settings. We therefore explored the efficacy of a Retro auricular Endoscope assisted selective neck dissection in early oral cavity squamous cell carcinoma. The aim of our study was to observe surgical outcomes of Retro auricular Endoscope assisted selective neck dissection. Objectives Conventional operation for oral cavity squamous cell carcinoma includes resection of primary tumour and neck dissection. This in most cases results in a grossly visible scar leading to stigma of a visible scar with fibrotic band formation. Recently numerous surgical approaches have been developed in conjunction with a Robot in order to avoid these complications. The Robot is an expensive equipment and not affordable for resource poor settings. We therefore explored the efficacy of a Retro auricular Endoscope assisted selective neck dissection in early oral cavity squamous cell carcinoma. The aim of our study was to observe surgical outcomes of Retro auricular Endoscope assisted selective neck dissection. Methods From August 2016 to July 2017, 21 patients of early oral cavity cancer (c T1/T2 N0) were enrolled into this observational study. Total duration of surgery was recorded. Patients were then observed for other factors such as intra-operative and postoperative complications & pathological factors especially the lymph node yield. Results Mean total operative time of endoscopic assisted technique was 130 minutes. Patients with retro auricular neck dissection have better

Abstract Background/Introduction Primary intra-osseous squamous cell carcinoma (PIOSCC) is the subgroup of oral cancer that is by default staged as stage IV by UICC or AJCC because of bony involvement irrespective of size, since; this is a special rare scenario; staging is ambiguous and needs scrutiny. The clinical and pathological features of are not well understood since the literature is sparse with few clinical papers that either reported a small series or a single case report. We analyzed the cases of PIOSCC from a single institute database of a tertiary referral hospital to find the prognostic factors. Objectives To find the prognostic factors of primary intra-osseous Squamous cell carcinoma. Methods A retrospective study for primary intra-osseous squamous cell carcinoma patients treated in a head and neck department of tertiary hospital from 2010 to 2015 was executed. The clinical, radiological, pathological, treatment information was collected. Statistical analysis was performed for the data collected. Results There were a total number of 36 patients treated in the given time period, among which 34 had followed up, the minimum period of follow up was 12.00 months. 28 patients received postoperative radiotherapy. 9 patients died by the end of the study period. We observed significantly lower loco-regional control and survival among patients with tumors[4cm (p\0.01) in size, 100% of patients with =4 tumor size were alive while 30.7% of patients with [4cm were alive, the result was consistent in multivariate analysis, further; patients with positive lymph node had lower survival (P\0.01). Conclusions Neck metastasis and tumor size [ 4cm significantly reduces locoregional control and survival in PIOSCC. tumor staging for this entity need evaluation.

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S42 References/Bibliography 1. To EH, Brown JS, Avery BS, et al. Primary intraosseous carcinoma of the jaws. Three new cases and a review of the literature.[J]. British Journal of Oral & Maxillofacial Surgery, 1991, 29(1):19–25. 2. Cavalcante AS, Carvalho YR, Cabral LA. Tender mandibular swelling of short duration.[J]. Oral Surgery Oral Medicine Oral Pathology Oral Radiology & Endodontics, 2002, 93(93):167–170.

ABS00660 Management of the N1 Neck in Buccal Carcinoma: A Continual Conundrum Dr Deepika Kenkere Professor & HOD, Co-Author: Dr Azeem Mohiyuddin S M Professor & HOD Department of Dentistry Sri Devaraj Urs Medical College Tamaka, Kolar 563101 Karnataka, India Email id: [email protected], Mobile Number: 98455 46746, Landline Number: 080 22216703/080 22211042; Department of Otorhinolaryngology, Head & Neck Surgery Sri Devaraj Urs Medical College Tamaka, Kolar 563101 Karnataka India Abstract Background/Introduction Buccal mucosa is the most common site for malignancy in South East Asia, accounting for 40% of the oral cancers. A majority of these (80%) are at Stage III or IV at the time of presentation. The anatomy and physiology of the muscle predispose to an early invasion and cervical metastasis of buccal carcinoma. Cervical metastasis is the single most important prognostic factor. Studies have quoted that of all the buccal mucosa cases, 55% present with cervical lymphadenopathy but the incidence of clinical false positivity is as high as 45%, whereas that of false negativity is only 3%. 1 It is described that 49% have occult metastasis in cervical lymph nodes in patients presenting with buccal carcinoma, Level I being the most common site for nodal metastasis (100%), followed by Level II (32%), Level III (16%) and Level IV (8%). 2 In view of the above reports, deciding on the type of neck dissection that should be performed for a N? neck is a longstanding topic of debate. Various neck dissections have been advocated taking into consideration the natural progression of the disease, the T and N status and adverse tumor and nodal factors. This presentation is a literature review of the different types of neck dissection that have been performed for carcinoma of the buccal mucosa, and an attempt is made to arrive at a rational approach in the management of a N? neck. Objectives Objectives. Methods Methods. Results Results. Conclusions Conclusions. References/Bibliography 1. Pradhan SA. Surgery for Cancer of the Buccal Mucosa. Seminars in Surgical Oncology 1989; 5:318–321. 2. Harald Essig, Riaz Warraich, Gulraiz Zulfiqar et al. Assessment of cervical lymph node metastasis for therapeutic decisionmaking in squamous cell carcinoma of buccal mucosa: a prospective clinical analysis. World J Surg Oncol 2012;10:253.

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ABS00685 Predictable Results in OSMF with the Use of Nasolabial Flap Dr. Shweta Bhatnagar, Associate Professor Bundelkhand Medical College, Sagar, MP Abstract Background/Introduction Oral submucous fibrosis is a precancerous and potentially malignant condition characterized by juxtaepithelial fibrosis of the oral cavity. The condition is multifactorial in origin with a high incidence in people who chew arecanut (1). Objectives The objective of this study was to evaluate the role of nasolabial flap in the surgical treatment of OSMF. The nasolabial island flap is a full thickness flap which is not native to the oral cavity. Hence, the chances of developing OSMF in nasolabial flap is very less (2). Methods Five patients with mouth opening of less than 15 mm were included in this study. The fibrotomy done along with the inset of nasolabial island flap. The malposed third molars were removed. The patients were evaluated for six months postoperatively. Results In all five patients adequate mouth opening of 30–35 mm was maintained. There was no incidence of flap necrosis or flap loss. All patients had acceptable aesthetics. Conclusions As the nasolabial flap is not native to oral cavity and therefore there are less chances of it to get involved by disease subsequently. References/Bibliography 1. G. Arakeri, P. A Brennan. Oral submucous fibrosis: An overview of the aetiology, pathogenesis, classification and principles of management. British journal of oral and maxillofacial surgery. 51:587,2013. 2. Shah and Tauro. Clinical and histological basis for the use of nasolabial tissues in the surgical management of OSMF. J Oral Maxillofacial Surgeon 73:2251.e1, 2015.

ABS00718 Oral Trauma as a Risk Factor in Oral Cancer Dr Srishti Deshpande, 1st MDS Department of Oral and Maxillofacial Surgery, KLE VK Institute of Dental Sciences, Belgaum, Karnataka Abstract Background/Introduction Oral cancer is among the commonly seen cancers in the world. It leads to about 145,000 deaths annually. These cancers are associated with the use of tobacco, betel nut, areca nut, smoking and alcohol consumption. In addition to these, long standing irritation has been postulated as a risk factor as well. Chronic irritation may result from poor oral hygiene, poor dentition, missing teeth and ill fitting dentures. However, the role of these conditions in developing oral cancer has been debatable. Objectives We therefore decided to conduct a review of literature to evaluate the role of chronic irritation resulting in these conditions in causing oral cancer.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Methods A systematic search of the databases MEDLINE, PubMed, Cochrane Database of Systematic Reviews, Web of Science was done. Relevant articles were identified. The search terms used were ‘‘dental trauma,’’ ‘‘mucosal trauma,’’ ‘‘oral cancer,’’ ‘‘squamous cell carcinoma,’’ ‘‘risk factor,’’ ‘‘potentially malignant lesion,’’ ‘‘dental factor,’’ ‘‘mechanical irritation,’’ ‘‘dental irritation,’’ and ‘‘cancer.’’ These were searched as text word and as subject headings individually as well as in different combinations. The reference lists of relevant articles were also searched for appropriate studies. No language restrictions were used in either the search or study selection. This search yielded 788 articles. Articles were excluded from the review if they failed to describe the factors of interest for the study. Among these articles, only 22 articles described chronic mucosal trauma as risk factors for oral cancers and were considered in this review. Results From the literature we came across, several studies showed an association of ill fitting or defective dentures with the development of oral cancer. Some studies further went on to stress that poor oral hygiene can be a strong factor associated with oral cancer. Conclusions Thus, from this review, we can conclude that chronic mucosal irritation resulting from ill fitting dentures, poor oral hygiene etc can be factors associated with development of oral cancer. No association has been proven, however, between duration of denture use and cancer formation. No definitive relation has been seen between broken/ sharp teeth, dental implants, nature of dental materials and oral cancer formation. References/Bibliography Franco EL, Kowalski LP, Oliveira BV, Curado MP, Pereira RN, Silva ME, et al. Risk factors for oral cancer in Brazil: A case-control study.

ABS00723 Should We Treat Oral Cancer Patients With OSMF and Without OSMF With Same Protocol? Dr Gaurav Singh, Associate Professor

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ABS00783 Postoperative Oral Health-Related Quality of Life (OHRQoL) in Oral Cancer Patients at Karpagavinayaga Institute of Dental Sciences, Tamilnadu: A Cross-Sectional Study 1. Dr. G.R. Karthikeyan, Reader, 2. Dr. A. Mathanmohan, 3. Dr. B. Balaguhan, Professor, 4. Dr. Meera Tinakaran, Professor & HOD Department of Oral and Maxillo Facial Surgery, Karpaga Vinayaga Institute of Dental Sciences, Tamilnadu Abstract Background/Introduction Treating oral cancer produces important changes in the oral cavity which impairs normal functions such as speech, swallowing, chewing, and salivation. The patient’s QOL can also be significantly impaired by these functions. Hence, there is need to evaluate final outcome following the different combination of treatment modalities available to make better therapeutic treatment decisions. Objectives To assess Oral health related quality of life (OHRQoL) in 120 patients with oral cancer who had undergone single or multi-modality treatments. Methods Participants were grouped based on the treatment they had undergone into Group I - Surgery alone, Group II - Surgery and Radiotherapy, Group III- Surgery, chemotherapy and radiotherapy and assessed for OHRQoL using the shorter version of Oral health impact profile-14 (OHIP-14) questionnaire. Results Among the 120 participants, Upper lower class and lower class people were around 81.6 %. Buccal mucosa (58.9%) was found to be the most frequent site. Among the clinical staging, Stage II (33.33%) oral cancer was more prevalent. Among the Three groups the Functional limitation domain was significantly different. Conclusions Oral cancer patients who had been undergone surgical treatment in the earlier stage alone had better Quality of life when compared to the other combined treatment modalities. References/Bibliography

Super Specialty Cancer Institute, Lucknow Abstract Background/Introduction In Indian subcontinent arecanut chewing is more prevalent leading to OSMF and subsequently oral cancer. Objectives To evaluate and compare neck metastasis in Oral Cancer patients with OSMF and without OSMF. Methods A total of 102 patients were taken with oral cancer with or without OSMF. All patients were undergone surgery and histopathologic reports were evaluated and compared. Results Significantly low neck metastasis was found in OSMF group. Conclusions Further evaluation is needed to establish newer protocol for oral cancer patients with OSMF. References/Bibliography J Oral Pathol Med. 2017 Jul;46(6):448–453. doi:10.1111/jop.12553. Epub 2017 Feb 28.

1. Barrios R, Tsakos G, Garcı´a-Medina B, Martı´nez-Lara I, Bravo M. Oral health-related quality of life and malnutrition in patients treated for oral cancer. Support Care Cancer 2014;22:2927–33. 2. 2. Varshitha A. Prevalence of oral cancer in India. J Pharm Sci Res 2015;7:845–8.

ABS00786 Salivary Duct Carcinoma: Report of Two Cases V Deepak, Gr Karthikeyan, B Balaguhan, A Mathanmohan Abstract Background/Introduction Salivary duct carcinoma (SDC) is an aggressive rare malignant tumour with a propensity for invasive growth, resulting in early regional and distant metastases. SCD accounts for 1% to 3% of all malignant salivary gland tumours. A few cases been reported in literature resulting in limited data about its biologic and immunohistochemical characteristics.

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S44 Objectives The authors report two cases of SDC presented to their department one with the extraoral swelling confined to the parotid gland and other with intra oral swelling confined to the posterior part of left side of the palate. Methods SDC of Parotid gland was operated with aggressive resection, Selective Neck Dissection along with Split Skin Grafting as the tumour had cutaneous involvement. Other SDC was operated with primary tumour resection along with left maxillectomy and Selective Neck Dissection Both SDC’s received postoperative radiotherapy. Results Aggressive resection with adequate marginal clearance, neck dissection and postoperative radiotherapy ensured patient disease free without any loco-regional metastases. Conclusions SDC is a rare and aggressive salivary gland malignancy for which treatment is surgical resection and neck dissection, with adjuvant radiation therapy reserved for the more advanced forms. Post-operative radiation therapy is mandatory in advanced cases of SDC, whereas chemoradiotherapy is generally reserved for metastatic forms of the tumor. The prognosis may be improved in tumors measuring \2 cm, however, the five-year recurrence-free survival rate remains at 30%.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Audiometry and Impedance Audiometry, and correlated with various stages of OSMF. Results Hearing impairment and ETD was found to be statistically significant in OSMF patients as compared to normal patients. Severity of Hearing Impairment was found more in advanced stage of fibrosis i.e. Clinical Stage III & Functional stage C. Mild to Moderate type of Hearing loss was seen more in Stage IIIC. ETD was also predominantly present in Stage IIIC OSMF patients. Correlation of age with various clinical & functional stages was found to be positive. Correlation of different clinical & functional stages of OSMF with Hearing Loss after Pure Tone Audiometry, ETD after Impedance Audiometry was found to be positive. Conclusions From the present study it is evident that that with advancing stages of OSMF conductive hearing impairment increases as well as ETD. References/Bibliography Gupta SC, Singh M, Khanna S, Jain S. Oral submocous fibrosis with its possible effect on Eustachian tube functions: a tympanometric study. Ind J Otolaryngol Head Neck Surg. 2004;56:183–5. Shah M, Katarkar A, Shah P, Alam N, Modh D. Tympanometric study of Eustachian tube function in oral submucous fibrosis. Indian J Otol. 2011;17:80–2.

References/Bibliography Intraoral salivary duct carcinoma: A case report and a brief review. Acharya S, Padmini S, Koneru A, Krishnapillai R. J Oral Maxillofac Pathol. 2014 Sep;18(Suppl 1):S121-7 Salivary duct carcinoma of the parotid gland: A case report and review of the literature. Xie S, Yang H, Bredell M, Shen S, Yang H, Jin L, Zhang S. Oncol Lett. 2015 Jan;9(1):371–374. Epub 2014 Oct 31.

ABS00805 Does Advancing Stages of OSMF Affect Degree of Hearing Impairment and Eustachian Tube Function? Dr. Apoorva Mishra, Dr. Rajanikanth, Dr. Rajiv Borle, Dr. Nitin Bhola, Dr. Anendd Jadhav, Dr. Bhushan Mundada Datta Meghe Institute of Medical Sciences, Sawangi (Meghe), Wardha Abstract Background/Introduction Literature is available regarding the involvement of muscles of soft palate in OSMF [2–4], and literature for associated ETD and hearing impairment is deplete [6–8]. However there are no studies available on assessing the degree of hearing impairment, presence of ETD and its correlation with clinical stages of OSMF, and its association with increase or decrease in the severity of the disease. We hypothesize that with increasing severity of the disease, hearing impairment and ETD increases. Objectives Assessment of degree of hearing impairment and Eustachian tube dysfunction (ETD) along with its correlation with various stages of Oral Submucous Fibrosis (OSMF). Methods Present study was conducted on 102 individuals including 51 OSMF patients (102 ears) and 51 healthy controls (102 ears). All were evaluated for hearing impairment and ET function by Pure Tone

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ABS00806 Effect of Clinical, Demographic and Pathological Factors on Disease Free Survival Rate of Patients Having Oral Squamous Cell Carcinoma with Oral Submucous Fibrosis: A Retrospective Study Dr. Prachet N Dakshinkar Datta Meghe Institute of Medical Sciences, Wardha Abstract Background/Introduction More than 90% of all oral cancers are squamous cell carcinoma (SCC). One of the most important risk factors for oral SCC is the use of tobacco (in all forms) or betel quid which also serves as a causative factor for oral submucous fibrosis (OSMF). There has been increased incidence of concomitant association of OSCC & OSMF in recent times. Objectives The aim of this study was to evaluate the effect of individual variables on disease free survival in patients having OSCC along with OSMF. Methods A retrospective observational study was carried out in which records of patients were retrieved from 2011 to 2014. A total of 78 patients having OSCC with OSMF were taken up for the study. Patient‘s present clinical information was obtained through telephone call. Patients were evaluated on demographic, clinical and pathological fronts and its effect on disease free survival was studied. Results Overall disease free survival was found to be 84.62%. Patients with negative margins had substantially low recurrence as compared to those who had positive surgical margins. In regards to the present study recurrence was present in 12 cases, which was found to be the sole factor having profound impact on survival. Rest all variables had no significant impact on disease free survival.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Conclusions Good survival rate can be obtained with primary surgical treatment. Pre operative assessment of factors such as stage of lesion, cervical lymph node metastasis, extra capsular spread, staging of OSCC, grading of OSMF play a crucial role in predicting recurrence postoperatively. Thus to improve survival rate, recurrence has to be minimized which in turn is controlled by above factors.

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ABS00823 Noninvasive Early Diagnosis of Oral Mucosal Precancerous and Cancerous Lesions Using Fluorescence Spectroscopy Pranav Ingole*, P. Chaturvedi, D Nair, S Nair, S Dutta

References/Bibliography Seyed Hosiin Tabatabaei, Mahmood Tafti, Ali Hossini. Evaluation of clinical, demographic, pathological and molecular factors with survival rate of patients with Oral squamous cell carcinoma in Yazd city during 1998–2008. Camisasca DR, Silami MA, Honorato J et al. Oral squamous cell carcinoma clinicopathological features in patients with and without recurrence. ORL J Otorhinolaryngol Relat Spec.2011:73:170–176.

ABS00815 Efficacy of Botox in Reducing Silocele: A Sequel of Oral Squamous Cell Carcinoma Surgery Dr Bhushan Mundada, Dr Nitin Bhola, Dr Rajiv Borle, Dr Anendd Jadhav Abstract Background/Introduction Salivary fistulas are a well-known sequel of parotidectomy, and successful treatment with botulinum toxin has been demonstrated in individual cases. Objectives Squamous cell carcinoma of buccal mucosa and gingivobuccal sulcus is an aggressive form of oral carcinoma with a high recurrence rate. Injury to the parotid duct is often unavoidable when surgically treating mentioned sites because of the intimate anatomic relation among the buccal mucosa, Stensen duct, and parotid gland. It is often difficult to achieve negative margins and preserve the integrity of the parotid duct. Sialocele formation is a frequent and untoward complication owing to extravasation of saliva into the surgical defect, which delays healing, creates fistulas, and produces painful facial swelling. Currently, no consensus exists regarding the management of a parotid sialocele. Multiple investigators have described different modalities of treatment. Methods With approval from the institutional ethical committee, 15 cases of oral squamous cell carcinoma warranting injury to parotid duct, gland or parotidectomy (tail of parotid) as a part of treatment included in study. Botox injected at the time surgery in parotid gland at four anatomical sites (anterior, posterior, superior and inferior) and observed for any sign of silocele for period of 1 month. Results There was significant reduction in salivary flow in all cases. No significant side effect seen with use of botox. Conclusions In summary, botulinum toxin injections into the parotid tissue at the time of surgery appear to be an effective preventive treatment for salivary fistulas following surgeries in head and neck region.

*V.S.P.M Dental College & Research Centre, Nagpur Head & Neck Surgical Oncology, Tata Memorial Hospital, Mumbai, India Abstract Background/Introduction Squamous cell carcinoma of the oral cavity is usually preceded by changes in the oral mucosa in the form of leukoplakia, erythroplakia, submucosal fibrosis etc. These lesions carry risks of varying degree for malignant transformation. We report the results of a clinical in vivo study to evaluate the potential of fluorescence spectroscopy for differential diagnosis of oral mucosal malignant and potentially malignant lesions. Objectives Non-invasive screening of these lesions may help in early detection of malignancy. We report here the results of an in vivo clinical study showing clinical applicability of fluorescence spectroscopy for discriminating potentially malignant lesions from the healthy squamous tissues of human oral cavity. Methods The in vivo study was conducted at the Tata Memorial Hospital (TMH), Mumbai. A compact and portable spectroscopic system was used. The system utilizes a sealed-off, high-pressure nitrogen laser, as the excitation source for inducing tissue fluorescence. Light delivery to and collection from tissue is achieved with a fiber-optic probe consisting of seven 400 micron core diameter fibers. The fluorescence emission collected by the fiber-optic probe. The in vivo fluorescence spectra were recorded in the 375–700 nm spectral range. Results Figure 1 shows the mean fluorescence spectra for OSMF (n=83), LP (n=90), and normal squamous (n=283) tissues. The most prominent of these are seen in the wavelength region below 500nm particularly in the 390nm and 460nm spectral bands. The 390nm spectral band is the most intense in OSMF tissues while the intensity of the 460nm band is the highest in the spectra from normal squamous tissues. A probability based multivariate statistical diagnostic algorithm was developed to analyze the oral tissue fluorescence spectra. Fluorescence spectroscopy was able to distinguish potentially malignant from normal oral tissues with a predictive accuracy of [90% with respect to histology as the gold standard. Conclusions The results of this pilot study demonstrate the potential of fluorescence spectroscopy in distinguishing potentially malignant lesions from the normal mucosa of the oral cavity in a clinical setting. References/Bibliography 1. De Veld DC, Witjes MJ, Sterenborg HJ, Roodenburg JL. The status of in vivo autofluorescence spectroscopy and imaging for oral oncology. Oral Oncol 2005;41:356–64. 2. Majumder SK, Gupta A, Gupta S, Ghosh N, Gupta PK. Multiclass classification algorithm for optical diagnosis of oral cancer. J Photochem Photobiol B 2006;85:109–17. 3. Majumder SK, Gupta A, Gupta S. Non-linear multi-class pattern recognition for laser-induced fluorescence diagnosis of oral cavity cancer. Photo/Electrochemistry and Photobiology in the Environment, Energy and Fuel. In: Kaneco SB, Katsumata V, Katsumata H, editors. Research Signpost, 2009. p. 95–114.

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S46 4. Majumder SK, Gebhart S, Johnson MD, Thompson R, Lin WC, Mahadevan-Jansen A. A probability-based spectroscopic diagnostic algorithm for simultaneous discrimination of brain tumor and tumor margins from normal brain tissue. Appl Spectrosc 2007;61:548–57.

ABS00826 Oral Squamous Cell Carcinoma Metastasis to Submandibular Gland: It’s Removal A Questionable Necessity Dr Anendd Jadhav, Dr Nitin Bhola and Dr Rajiv Borle Department of Oral and Maxillofacial Surgery Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences, Sawangi (M), Wardha Maharashtra 442002, [email protected], Contact No: 9766599911, 9623399911, and 7767811911 Abstract Background/Introduction The submandibular gland is routinely removed during neck dissection involving level IB. Its removal however reduces basal salivary secretion resulting in increased symptoms of subjective xerostomia. Objectives The present study was deliberated to assess whether submandibular gland preservation is a viable option in oral squamous cell carcinoma (OSCC). Methods This was a prospective study conducted between Sept 2014 and June 2017. A consecutive 153 histologically established OSCC treated primarily by surgery with a curative intent were included in the study. The fibrofatty tissue surrounding the SMG was divided into 6 parts depending upon its location with the submandibular gland. These, along with SMG were separately sent for histopathological analysis. Metastasis pattern in level IB was noted. Results 1.30% (2/153) glands showed involvement by the tumour, 10.45% (16/153) gland showed chronic sialadenitic changes. The two involved gland showed extra capsular spread from level IB nodes. Evidence of metastasis was not seen in any of the glands. Conclusions Metastatic involvement of SMG is extremely rare. SMG can safely be spared during neck dissection in OSCC. Patients with OSCC will benefit from preservation of ipsilateral SMG. References/Bibliography Panda NK, Patro SK, Bakshi J, Verma RK, Das A, Chatterjee D. Metastasis to submandibular glands in oral cavity cancers: Can we preserve the gland safely? Auris Nasus Larynx. 2015 Aug;42(4):322–5. Chen TC, Lou PJ, Ko JY, Yang TL, Lo WC, Hu YL, Wang CP. Feasibility of preservation of the submandibular gland during neck dissection in patients with early-stage oral cancer. Ann Surg Oncol. 2011 Feb;18(2):497–504.

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Section: Reconstruction ABS0011 Use of Superficial Temporal Fascia Flap for Treatment of Post Radiation Trismus: An Innovation Dr Tushar Deshmukh, Dr Rohit Sharma Armed Forces Abstract Background/Introduction Post radiation trismus severely reduces the quality of life. Radiation causes fibrosis of muscles of mastication resulting in severe restriction of mouth opening. Objectives To check new modality in reconstruction. Methods Use of superficial temporal fascia to cover the defect. Results Following the release of fibrosis secondary to radiation, superficial temporal fascia (STF) was used to cover the defect with excellent results and no recurrence after a year of follow up. Conclusions Superficial temporal fascia (STF) can be used to cover the defect with excellent results and no recurrence after a year of follow up. References/Bibliography Borle RM, Borle SR. Management of oral submucous fibrosis: a conservative approach. J Oral Maxillofac Surg 1991; 49: 788–91.

ABS00129 Comparative Evaluation Between Use of Different Pedicled Grafts and Prosthesis Vs Maxillofacial Obturators After Unilateral Maxillectomy Dr. Syed Ansar Ahmad Jamia Millia Islamia, New Delhi Abstract Background/Introduction If any pathology occurs in facial skeleton, pathology has to be removed and defect reconstructed. For unilateral maxillectomy cases debate is between use of surgical reconstruction or prosthetic rehabilitation. Objectives To utilise the pedicled flaps for reconstruction of the defects following unilateral maxillectomy and to compare, corroborate and analyse with similar defects where maxillofacial obturators have been used. Methods Patients treated by pedicled grafts were taken and were compared by patients treated by maxillofacial obturators after unilateral maxillectomy. Results were taken on different parameters. Results Most of the patient with pedicled grafts had satisfying results.

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Conclusions Aesthetically and functionally most of the pedicled flaps were better except in those patients where periodic check up of the site is required.

ABS00156 Pectoralis Major Myocutaneous Flap: A Boon for Maxillofacial Reconstruction

References/Bibliography

Geetha N.T, Sunil S. Byadgi, Kirthikumar Rai

A. Ali, M.J. Fardy, D.W. Palton. Maxillextomy to reconstruct or obturate? Results of a Uk survey of oral and maxillofacial surgery. British Journal of Oral and Maxillofacial Surgery 1995, volume 33, 207–210.

ABS00139 Soft Tissue Coverage in the Aged Patient: Challenges and Pitfalls: A Report of Two Cases Major Rahul P Menon Command Military Dental Centre (SWC) Abstract Background/Introduction Soft tissue coverage, whether intraoral or extraoral has always been a challenge. This becomes even more apparent in advanced age. Objectives This paper aims to highlight the challenges faced by the surgeon in the coverage of such defects by reporting two cases in male patients, both aged above the 5th decade of life. Objective: To highlight some of the pitfalls and technique sensitivity of the two flaps used to cover the defects and the ensuing complications that were age, surgical technique and post op care related. Methods Case 1: A 58 year old man reported with extensive alveolar tissue loss in the parasymphysis region secondary to panfacial trauma. He was taken up for secondary closure of the defect using an anteriorly based buccinator myomucosal flap to cover the defect. Case 2: A 69 year old man reported with an ulcer of 3x3.5cm diameter as a complication of neglectful post op follow up and treatment of a submandibular space infection. The defect was repaired using a platysma and skin paddle flap. Results Case 1: Initial 2 week follow up was promising but it deteriorated after sectioning of the pedicle leading to only 90% recovery in coverage. Case 2: This however failed in 3 weeks due to a cutaneous salivary fistula but regained about 80% of the defect coverage. Conclusions Although both flaps seemed to yield promising results at the beginning, the end results were less than ideal and this paper hopes to highlight some of the complications of the technique, surgery and post op care.

Bapuji Dental College and Hospital, Davangere, Karnataka Abstract Background/Introduction Head and neck cancer is the sixth most common cancer worldwide. Oral and oropharyngeal carcinoma are the third most common in males and fourth most common in females in developing countries. Surgery remains the mainstay for treating these cancers. So reconstructing major ablative defects following their resection remains a challenge for surgeons as it requires both restoration of form and function. Soft tissue defects mostly demand both skin cover and oral lining. The use of free flaps has become the state of the art for reconstruction of oral and maxillofacial defects in the present era. But free flap transfer cannot be used for all patients at every institute since it requires special techniques and equipments as in the case of microsurgery. So locoregional flaps play a crucial role in many of the oncological cases. Conventional flap like pectoralis major remains versatile and reliable flap for primary and secondary reconstruction. Many qualities of this flap such as its proximity to the head and neck region, the reliability of its pedicle and short learning curve, have contributed to the widespread use of this flap and its overall good success rates. Complication rates in this flap vary from 13% to 65%. This flap is now popularized in developing countries with limited medical resources. It seems that the role of PMMC in head and neck reconstruction has shifted from a ‘‘workhorse flap’’ to a ‘‘salvage flap’’ in the era of free flaps. Furthermore, technique modifications of flap harvesting not only ensure its reliability but also decreases the donor site functional impairment. In this paper we would like to share our experience in using this flap as both a workhorse as well as a salvage flap mainly emphasizing on the different harvesting techniques and complications. Objectives Not applicable. Methods Not applicable. Results Not applicable. Conclusions Not applicable. References/Bibliography 1. Ashutosh Gupta, Gunjan Agrawal, Santanu Tiwari, Kshitij Verma, Rajesh Agrawal, Vivek Choudhary. Pectoralis major myocutaneous flap in head and neck reconstruction: an interesting experience from central India regional cancer center. Int J Res Med Sci. 2015;11:3065–3068.

References/Bibliography 1. Amin Rahpeymaa and Saeedeh khajehahmadib. Inferiorly based buccinator myomucosal island flap in oral and pharyngeal reconstruction. Four techniques to increase its application. International Journal of Surgery Case Reports 14 (2015) 58–62.

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ABS00193 Lip Reconstruction: Why? When? & How? A Comprehensive Review of Various Techniques Dr. Anuj S. Dadhich Dept of Maxillofacial & Reconstructive Surgery, Rural Dental College, Loni, Maharashtra Abstract Background/Introduction The lips have important functional and aesthetic role in daily living, they are focal point of lower face and make an important aesthetic unit. The role of lips in aesthetic balance, speech, facial expression and deglutination can not be replicated by any other tissue substitute. The primary goal of reconstruction is restoration of function and aesthetics. Objectives The objective of the study is to evaluate different techniques of lip reconstruction & to evaluate the advantages and disadvantages of each & provide guidelines to surgeons about application of these techniques in various clinical scenarios. Methods Patients who underwent lip reconstruction in dept. of Maxillofacial and reconstructive surgery, RDC Loni were included in the study. All patients were evaluated for oral continence, lip mobility, amount of mouth opening, symmetry of lips. Results There is no single technique which can be used for reconstruction of all defects of lips. Different techniques have there own indications, pros and cons and these should be critically evaluated before surgery. Conclusions The best surgical outcome in lip reconstruction can be achieved by re positioning of the remaining lip element and mobilisation adjacent soft tissue. Reconstruction of very large defects often require free flap but that provides only static support of lip and does not restore the dynamic function. References/Bibliography Lip reconstruction: Donald Baumann, Geoffrey Robb, Seminars in plastic surgery, 2008 Nov; Vol 22(4):269–280.

ABS00271 Role of Rapid Prototyping (RPT) Models in Midface Reconstruction Dr. Ravi Veeraraghavan, Dr. Krishnakumar T Abstract Background/Introduction The reconstruction of midface following ablative surgery is a challenging task. The objectives of reconstruction are to separate oral and nasal cavities, to provide support to the eye, to aid in dental rehabilitation and to recraft the lost aesthesis. This has been attempted with bone grafts, alloplastic materials, pedicled flaps and free flaps. RPT models have been used for quite some time for mandibular reconstruction. Their use in midface reconstruction has not been detailed well. The potential advantage it offers is in proper positioning of (i) alveolus (so as to aid in dental rehabilitation), (ii) orbital floor and rim and (iii) zygomatic prominence. Objectives To assess the effectiveness of rapid prototyping models as an aid to maxillary reconstruction using free flaps.

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Methods Cases of midface reconstruction following tumour ablation over eighteen months were reviewed. RPT models were used in 7 of those cases. The adequacy of reconstruction was assessed with subjective and objective means. The assessment was done separately for (i) anatomic structure - Flap/graft bulk, fistula, vestibular depth, orbital rim), (ii) facial aesthetics (zygomatic prominence, lip support, scleral show, scar resolution, dystopia/enophthalmos) and (iii) function (speech (hypernasality), swallowing and dental rehabilitation). Results Of the seven cases, only three involved orbital floor/rim resection. In all patients except one, the position of the alveolus was deemed correct and was amenable for dental rehabilitation. 3 of these patients underwent implant-based dental restoration. The orbital floor was reconstructed, where required by a titanium mesh, and was supported by a fibular strut in one patient. The zygomatic prominence was a factor only in two patients, and the RPT models seem to have made little impact on it. Conclusions RPT models are good cost-effective aids to help placement of the alveolus and orbital floor. Their use in achieving the optimal contour of zygoma and orbital rim could not be established. References/Bibliography 1. Maxillary reconstruction: current concepts and controversies. S Iyer and K Thankappan. Indian J Plast Surg. 2014 Jan-Apr; 47(1): 8–19. 2. Rapid prototyping-assisted maxillofacial reconstruction. Q Peng, Z Tang, O Liu and Z Peng. Ann Med. 2015; 47(3):186–208.

ABS00278 Natural Bio Ceramics-Changing Perspective in the Reconstruction of Maxillofacial Skeleton: Our Experience 1- Vivekanand Kattimani, Reader & Research Scholar, 2- Krishna Prasad L, Prof and Head, Dean, 3- Dr. Girija E K- Asst. Prof. 1. Dept. Oral and Maxillofacial Surgery, SIBAR Institute of Dental Sciences, Guntur, India, [email protected]. Mb09492473628; 2. Dept. Oral and Maxillofacial Surgery, and Dean, SIBAR Institute of dental sciences, Guntur; 3. Department of Physics, Periyar University, Salem 636 011, Tamil Nadu, Salem, India Abstract Background/Introduction Bioceramics is an advancing front in the reconstruction of defects of maxillofacial skeleton. Advancing technology for production of synthetic graft materials made the surgeon to dream for artificial bone regeneration. Various bone graft substitute materials are used to enhance the bone regeneration.[1] In recent past Egg shell derived Hydroxyapatite (EHA) is introduced as synthetic bone graft substitute;[2] which has changed the face of regenerative science. Objectives To assess bone regeneration using EHA in cystic and/or apicectomy defects of mandible and maxilla using digital radiographs/CBCT. Methods Twenty patients of either gender requiring grafting after cystectomy and/or apicectomy were enrolled in the study protocol-CTRI/2014/12/ 005340. The defects were grafted with EHA. The patients were followed up over a period of 24 weeks post surgically with intervals of 4,8,12 weeks to assess the amount of osseous fill using digital

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 radiographs and CBCT. Statistical analysis was carried out using Mann–Whitney U–test, Wilcoxon matched pairs test. Results Significant changes were observed in the formation of bone and merging of material and surgical site margin at 1st week to 1st month in all the patients (age range 15–50 years). Bone formation was seen in grafted sites by the end of 8 weeks with significant P value and trabecular pattern was seen by the end of 12 weeks with uneventful wound healing. Conclusions EHA showed enhancement of bone formation and was complete by the end of 12 weeks. The study showed necessity of the grafting for early bone formation. EHA is cost effective and production is go green way with no disease transfer risks. So Natural bio ceramics will play an important role in the reduction of cost involved for grafting.

S49 References/Bibliography 1. Ross DA, Chow JY, Shin J, Restifo R, Joe JK, Sasaki CT, Ariyal S (2005) arterial coupling for microvascular free tissue transfer in head and neck reconstruction. Arch Otolaryngol head neck surgery 131:891. 2. Douglas AR, Ariyan S, Restifo R (2003) use of the operating microscope and loupes for Head and Neck free Micro-Vascular tissue transfer. Arch Otolaryngol Head and Neck Surgery 5:129.

ABS00446 Bone-Anchored Titanium Implants for Auricular Rehabilitation: Case Report

References/Bibliography 1. Kattimani VS, Chakravarthi PS, Prasad LK. Biograft Block Hydroxyapatite: A Ray of Hope in the Reconstruction of Maxillofacial Defects. J Craniofac Surg. 2016 Jan;27(1):247–52. 2. Kattimani V, Lingamaneni KP, Chakravarthi PS, Kumar TS, Siddharthan A. Eggshell-Derived Hydroxyapatite: A New Era in Bone Regeneration. J Craniofac Surg. 2016 Jan;27(1):112–7.

ABS00395 Various Methods of Micro-Vascular Anastomosis: A Prospective Study on Conventional Suturing with Fibrin Glue, Couplers, Lasers and Staplers Dr. R. Balaji Srikanth, MDS, Dr. Senthil Murgan, MDS Sri Venkateshwara Dental College, Chennai; SRM Dental College, Chennai Abstract Background/Introduction Microvascular anastomosis remains a technically sensitive and critical determinant of success in free tissue transfer. microvascular anastomosis coupling device is an elegant friction fit ring pin device becoming more wide used techniques than other techniques. Objectives To evaluate the Successful outcome of free flap surgery predominantly depends upon proper anastomosis of blood vessels by using various techniques. Methods Despite the tremendous advancements in the field of anastomosis, the conventional way of suturing the blood vessels is still in practice. However, the other methods like coupling and stapling the vessels are gaining popularity in recent years. On the other hand application of diode lasers in performing anastomosis by the way of welding the vessels is the most recent method. paper based on various method of anastomosis in 125 patients in 12 years of time. Results Total 125 patients performed in to various techniques, 25 patients coupler 25 patients stapler, 25 patients laser, 25 patients suturing, 25 patients fibrin glue application. success rate is better in couplers than any other techniques. thrombosis rate is less by using coupler. study done in single centre and operated by the same surgeon. Conclusions Flap survival and revision free application of the micro-vascular coupler occurred in more than 99% of cases survival. That substantial time savings with coupler device.

Deepak Agrawal Govt. College of Dentistry, Indore Abstract Background/Introduction Osseointegrated implants have acquired an important role in the prosthetic rehabilitation of patients with craniofacial defects. Objectives This paper presents a clinical case and discusses indications and advantages of the osseointegrated implant technique for retention of auricular prostheses. Methods Two endo-osseous root-form implant with customized bar is used to retain silicon ear prosthesis. Results Prostheses made of silicone are state-of-the-art. The clinical parameters evaluated showed good postoperative healing, healthy periimplant tissue, good hygiene and no loss of implants. Conclusions The surgical technique for rehabilitation using implant-retained auricular prostheses seems to be simple. It is associated with low rates of adverse skin reactions and long-term complications. References/Bibliography Bone-anchored titanium implants for auricular rehabilitation: case report and review of literature. Gumieiro EH1, Dib LL, Jahn RS, Santos Junior JF, Nannmark U, Granstro¨m G, Abraha˜o M.

ABS00498 Rehabilitation & Reconstruction of Hemimandibulectomy Defect Using Free Fibula Endosseous Implants Abhishek Akare, Abhay Datarkar Govt Dental College Nagpur Abstract Background/Introduction Mandibular reconstruction with microvascular free fibula is an elegant solution to restore the anatomic arch, oral function and facial esthetic, vestibular groove and the fragility of the soft tissue complicated dental prosthetic stabalization.

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S50 Objectives To evaluate the clinical outcome and the aesthetic and functional results of implant rehabilitation of fibula free flap reconstructed mandibles. Methods Five patients having pathology were constructed in this study were free fibula was harvested and immediate implants were placed, prosthetic rehabilitation achieved after 6 month. the study was done at dept of oral and maxillofacial surgery, govt dental college and hospital Nagpur. Observation studied 1) Ossetiointegration of implants 2) immediate implant placement 3) prosthetic rehabilitation 4) esthetic. Results Ameloblastoma was the pathology and treated with immediate reconstruction and placement of implant. a total 10 implants were placed, an loading was done after 6 month. postoperatively. the implants were stable functionally and improvement in function and aesthetics was reported by the patients. Conclusions In our series of cases through different factors were believed to be associated with a poorer prognosis mainly because of the improperly formed periimplant gingival cuff. In both our patient we preserved the attached gingiva at the time of resection of the defect, this has help for the proper formation of gingival cuff with the minimal periimplant complication.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Results All the 10 patients who underwent the procedure had successful graft incorporation. No complications were encountered and were successfully rehabilitated with Bicortical basal Implants with immediate Loading. No incidence of Implant Loosening or Failure were encountered. Conclusions Our technique presented here is simple, effective, reliable, less time consuming treatment strategy which has a short learning curve and hence can be carried out in tertiary care centres also. References/Bibliography Iliac Crest Grafting for Mandibular Reconstruction; Kademani, Deepak et al. Atlas of the Oral and Maxillofacial Surgery Clinics of North America, Volume 14, Issue 2, 161–170.

ABS00548 Rapid Prototyping Technique in Primary Reconstruction of Segmental Mandibular Defects Dr. Manoj Kumar KP, Professor & Head

References/Bibliography 1. Brauner E, Cassoni A, Battisti A, Bartoli D, Valentini V. Prosthetic rehabilitation in post-oncological patients: Report of two cases. Annali di Stomatologia. 2010;1(1):19–25.

ABS00525 From Reconstruction to Rehabilitation: A Novel Protocol for Segmental Mandibular Defects in Benign Pathologies with Non Vascularised Iliac Bone Graft Dr. Kaushik Pai S H., Dr. Paul C Salins, Dr. Samarth R Shetty Mazumdar Shaw Medical Centre Abstract Background/Introduction The reconstruction of the mandible is a complex procedure because various cosmetic as well as functional challenges must be addressed, including mastication and oral competence. The restoration of mandibular bone defects depends on the diagnosis, anatomical site, extent of the defect, and the patient’s age, as well as the surgeon’s experience. Many surgical techniques have been described to address these challenges, including nonvascularized bone grafts, vascularized bone grafts, distraction osteogenesis and approaches related to tissue engineering. The ultimate goal is restoration of both form and function, necessitating the evaluation of appearance, mastication, deglutition, speech, and oral competence. Objectives To Introduce a simple reliable and effective protocol for functional reconstruction of segmental mandibular defects which enables quick rehabilitation with less morbidity. Methods 10 cases of segmental mandibular defects due to benign pathology were reconstructed using non vascularised iliac bone grafts and rehabilitated using Bicortical Basal Implants with Immediate Loading.

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Dept. of Oral & Maxillofacial Surgery KMCT Dental College, Kozhikode, Kerala Abstract Background/Introduction Reconstruction of mandibular defects after tumor ablative surgery remains a challenge for the oral and maxillofacial surgeon, in achieving the best functional and aesthetic results. The widely studied Rapid Prototyping techniques include stereolithography apparatus (SLA), selective laser sintering, three-dimensional printing, fused deposition modeling, 3D plotting, solid ground curing, multiphase jet solidification, and laminated object manufacturing. 3D printing has been applied in medicine since the early 2000s, when the technology was first used to make dental implants and custom prosthetics. Stereolithography is a rapid manufacturing and prototyping technology for producing high accuracy and good surface finish. We present our experience in primary mandibular reconstruction using Rapid Prototyping technology. Objectives To evaluate the efficacy of Rapid prototyping technique in primary reconstruction of mandibular defects. Methods Case 1 A 55 year old male was diagnosed with ameloblastoma who underwent segmental resection of anterior mandible –Reconstruction was performed using rapid prototyping technology with SLA model. A virtual surgery was performed in the 3D model and a surgical guide was used to assist the resection procedure. A customized titanium replica of the resected segment was fixed to the defect. Case 2 A 48 year old male patient diagnosed with an extensive Keratocystic odontogenic tumor (KCOT) involving the mandible- Segmental resection was performed in between symphysis and sub condylar region. Rapid prototyping technology was utilised for primary reconstruction of the defect. The customized titanium replica of the resected mandible was contoured to resemble a hollow perforated crib, simulating the inner and outer cortices of mandible. The perforated hollow was filled with small chips of cortico cancellous bone from ileac crest. Results This procedure has significantly reduced operating time and has provided an excellent functional and aesthetic outcome.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Conclusions In our experience, the use of SLA models has significantly contributed to advanced treatment planning, decreased operating room time, more precise and accurate surgical procedures resulting in improved reconstruction of form and function. References/Bibliography 1. Advanced Applications of Rapid Prototyping Technology in Modern Engineering Edited by Dr. M. Hoque ISBN 978-953307-698-0. 2. Cardoso CL, Munhoz EA de, Ribeiro ED, Souza Neto JB de, Sant’Ana E, Ferreira Ju´nior O. Application of stereolithography in mandibular reconstruction following resection of ameloblastoma: case report. Rev Clı´n Pesq Odontol. 2008;4(2):101–105. 3. Mehra P, Miner J, D’Innocenzo R, Nadershah M Use of 3-D Stereolithographic Models in Oral and Maxillofacial Surgery. J Maxillofac Oral Surg. 2011 Mar; 10(1): 6–13.

ABS00600 Calvarial Tuberculosis: A Rare Entity in Craniofacial Region Dr. Sreeram. M.P. MDS (Oral and Maxillofacial Surgery) Surgical Registrar, Co Authors – 1) Dr. B.S. Srinath. Ms, FRCS, FRCS Head of the Department, 2) Dr. Praveen K.S. Dnb, Mch. 3) Dr. Vishnu Kurpad. Ms, Mch. Consultant Department of Surgical Oncology, Sri Shankara Cancer Hospital and Research Centre Besavangudy, Banglore – 560004 Email – [email protected] Phone - ?919940489041; Surgical Oncology Sri Shankara Cancer Hospital and Research Centre Besavangudy, Banglore – 560004; Department of Neuro Oncology, Sri Shankara Cancer Hospital and Research Centre, Besavangudy, Banglore – 560004; Department of Surgical Oncology Sri Shankara Cancer Hospital and Research Centre, Besavangudy, Banglore – 560004 Abstract Background/Introduction Tuberculosis is a common disease in developing countries such as India, posing a major public health problem. Tuberculosis of the calvaria is a rare entity accounting for 0.2–1.3% of all cases of skeletal tuberculosis. Its capacity to affect every other organ, and atypical presentations make it an important part of the differential diagnosis. Objectives To discuss the case, review the incidence, etiology, pathogenesis, clinical/radiological features of calvarial tuberculosis. Methods An old aged lady who is known case of carcinoma left breast operated 12 years back, presented with soft and fluctuant swelling on her frontal scalp with 4 months duration. Swelling is painless and measured about 6 x 6 cm in dimension with no evidence of pus discharge. FNAC yielded yellowish purulent exudates which was reported as dermoid cyst. The CT scan of the head revealed bony erosion of the inner/outer table of frontal bone of the skull. The soft tissue mass was overlying the bony lesion with no intra dural extension. She underwent cyst excision and titanium mesh cranioplasty. Postoperative HPE was reported as Calvarial tuberculosis. She recovered well and was started on Anti tuberculous treatment.

S51 Results Tuberculosis of the skull should be included in the differential diagnosis of scalp swellings even though it is a rare entity. Conclusions A soft tissue, cystic, swelling on the scalp is associated with a variety of clinical differentials such as sebaceous cyst, lipoma, adenexal tumor, solitary myeloma of the bone, secondary metastasis. Thus, a high index of suspicion is required for prompt diagnosis of this condition. References/Bibliography 1. Sridharan S, Balasubramanian D. Primary calvarial tuberculosis. Surgical Neurology Int 2017;8:126. 2. Abhijith et al AJNR American Journal Neuroradiology 25:409–414, March 2004.

ABS00705 Lip Reconstruction with Platelet Rich Fibrin (PRF): A Case Report DR. Deepak S. Singh, Observer in Head and Neck Oncology, Dr. (Mrs.) Uma Mahindra, Consultant Oral and Maxillofacial Surgeon, Private Practitioner; Dr. Roohi Syed, Consultant Oral and Maxillofacial Surgeon, Private Practitioner Tata Memorial Hospital, Mumbai Abstract Background/Introduction Healing of wound whatever may be the etiology is the main concern for the surgeons. Growth factors release following clot formation and degranulation of platelets in the 1st stage in wound repair. Growth factors released from platelets are biologically active products that accelerates chemotaxis, cell proliferation, angiogenesis, extracellular matrix deposition and reodelling. This case report describes the application of Platelet Rich Fibrin (PRF) gel in reconstruction of lip tissue loss due to trauma with minimal scarring. Objectives The objective was to assess soft tissue healing and scarring. Methods PRF was prepared as per Choukroun’s technique. Blood sample collected and centrifuged at 3000 RPM for 10 minutes. PRF gel was separated from the test tube and applied on the tissue defect and stabilised with sutures and dressing was given. Results Subsequent follow ups showed complete reconstruction of the lip, with no comparable difference between the repaired vermillion border and white line with adjacent normal area and minimal scarring and aesthetic wound healing. Conclusions Use of PRF showed satisfactory aesthetic results, and thus have presented as an excellent healing agent. References/Bibliography 1. Choukroun J, Diss A, Simonpieri A, Girard MO, Schoeffler C, Dohan SL, et al. Platelet Rich Fibrib (PRF): A second generation platelet concentrate. Part IV: Clinical effects on tissue healing. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101:e56–60. 2. Rozman P, Bolta Z. Use of platelet growth factors in treating wound and soft tissue injuries. Acta Dermatoven APA. 2007;16(4):156–165.

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ABS00809 Mandibular Reconstruction with Free Fibula Flap: Comparison of ‘‘Jugaad Technique’’, Virtual Surgical Planning and Conventional Surgery - An Institutional Experience Amit Dhawan, Ramandeep Bhullar, Vikas Kakar SGRD Dental College, Amritsar, India Abstract Background/Introduction Free osteomyocutaneous fibular free flap has become one of the primary options for mandibular reconstruction. Proper preoperative planning is necessary to give near normal anatomical and functional form to the patient. Objectives Present study evaluated the accuracy of mandibular reconstruction with free fibula flap and assessed clinical outcomes in planning done with ‘‘ jugged technique’’ (inverse denture planning), Virtual surgical planning (computer assisted) and conventional surgery (using K wire template). Methods 34 patients divided in 3 groups (I-22, II-7, III 5) were retrospectively evaluated for outcome measures including operative time, facial appearance, occlusal function and quality of life (QOL) assessment scores. Group -I included 22 patients in which reconstruction was done conventionally, Group-II included 7 patients in which planning was done with Jugaad technique and Group III included 5 patients in which software planning was done which resulted in prefabricated models and cutting guides through virtual planning. Results High precision with the use of cutting guides and templates were found for both the fibula and mandible, and a good fit was noted among the pre-bent plates, mandible and fibula segments in virtual planning group. QOL scores were significantly improved (p\0.005) in virtual planning group as compared to conventional surgery and jugged technique. Conclusions The use of prefabricated cutting guides and pre bent plates makes fibula flap placement accurately, minimizes operating time, improves clinical outcomes and QOL scores. Cost constraint is the only limiting factor. References/Bibliography YY Wang et al, IJOMS, 45, 11, 2016: 1400–1405.

Section: TMJ Surgery ABS008 Reconstruction of RCU in TMJ Ankylosis Indranil Deb Roy Command Military Dental Centre (SC) Abstract Background/Introduction Management of TMJ ankylosis is a surgical challenge. Early release of the ankylosis with reconstruction of the RCU is the only treatment

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 option. Reconstruction is a challenge because of its unique anatomical structure and its functional requirement. Objectives To device an optimum procedure for reconstruction of the RCU following release of TMJ ankylosis. Methods In 11 patients with unilateral TMJ ankylosis (Type III- 5, Type IV - 6) CCG was used for reconstruction of the RCU. In 07 patients (Type III-3, Type IV - 4) RCU was reconstructed by distraction osteogenesis. Results Normal range of motion and function was observed in all cases with satisfactory restoration of the ramal condylar unit. Conclusions Long term studies with larger sample size is required to evaluate the superiority of one modality over the other. References/Bibliography 1. Perrot DH, Umeda H, Kaban LB. Costochondral graft construction/reconstruction of the ramus/condyle unit: long term follow up. Int J Oral Maxillofac Surg 1994;23:321–8.

ABS0010 Comparative Histomorphometric Evaluation of Healthy and Ankylosed Mandibular Condylar Process Dr. NK Sahoo (Prof & HOD), Dr. Dibyajyoti Boruah (Scientist-‘D’), Dr. Ankur Thakral (Oral & Maxillofacial Surgeon), Dr. Rahul Kumar (Oral & Maxillofacial Surgeon), Dr. ID Roy (Prof) Dept of Oral & Maxillofacial Surgery, CMDC Lucknow; Dept of Pathology, AFMC Pune; Corps Dental Unit, Bhopal; CMDC (NC); Dept of Oral & Maxillofacial Surgery, CMDC Pune Abstract Background/Introduction Temporomandibular joint (TMJ) ankylosis is one of the most disruptive maladies afflicting the masticatory system. The characteristic feature is the formation of bony mass bridging condyle with glenoid fossa. The exact pathogenesis is however not completely understood. Quantitative histomorphometry is a tool that allows tissue level assessment of bone turnover and bone mineralization. Objectives To investigate and compare histomorphometric features of ankylosed condylar specimen with normal condylar process. Methods Group I included 17 post-traumatic unilateral TMJ ankylosis patients managed by excision of ankylosed mass and interpositional arthroplasty. Group II included 13 dicapitular condylar head fracture patients more than 8 weeks old and not responding to conservative treatment managed by surgical debridement. The bony specimens of both the groups were subjected to histomorphometric examination for assessment of percentage of bone in trabeculae area (%BONE), osteocyte cell density (OSTCD), presence of inflammation and fibrosis. Results The mean %BONE, OSTCD, % inflammation, % fibrosis was 60.4%, 340.9 mm2, 52.9% and 58.8% in group I and 29.6%, 202.6 mm2, 31% and 0% in group II. %BONE, OSTCD and fibrosis in cases of TMJ ankylosis were significantly higher than the controls while no significant difference was observed in presence of inflammation.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Conclusions The present article emphasizes that dicapitular fracture of condylar head more than 8 weeks old and not responding to conservative treatment may be considered for surgical debridement as the inflammatory condition of joint space following condylar head fracture did not get resolved in majority of the patients and the persistence of joint inflammation eventually leads to ankylosis of the joint.

S53 References/Bibliography Dimitroulis G: A new surgical classification for temporomandibular joint disorders. Int J Oral Maxillofac Surg 42(2): 218e222, 2013. Dimitroulis G: Outcomes of temporomandibular joint arthroscopy in patients with painful but otherwise normal joints. J Craniomaxillofac Surg 43(6): 940e943, 2015.

References/Bibliography 1. Miyamoto H, Kurita K, Ogi N, Ishimaru JI, Goss AN. The effect of an intra articular bone fragment in the genesis of temporomandibular joint ankylosis. Int J Oral Maxillofac Surg 2000;29:290–5. 2. Dempster DW, Shane ES. Bone quantification and dynamics of bone turnover by histomorphometric analysis. In: Becker KL, editor. Principles and practice of endocrinology and metabolism, 3rd ed. Lippincott Williams and Wilkins; 2001. p. 541–48.

ABS0086 Viscosupplementation-The Concept in Alleviating Symptoms of Temporomandibular Joint Osteoarthritis. A Clinical Study Dr P G Antony, Dr Bobby John Govt Dental College Kottayam

ABS0016 Outcomes of Temporomandibular Joint (TMJ) Arthroscopic Lysis and Lavage: What is the Rate of Progression to Open Surgery? Vishakha N. Devrukhkar M.G.M. Dental College and Hospital, Kamothe, Navi Mumbai, India Abstract Background/Introduction Arthroscopic lysis and lavage has been shown to be effective in the management of a variety of TMJ diseases. Objectives The purpose of this study was to evaluate the medium to long-term outcomes of TMJ arthroscopic lysis and lavage and determine factors associated with progression to open surgery. Methods Materials and methods A retrospective cohort study of a single operator series was performed over a 6-year period from 2006–2012. The variables of gender, age and category (Dimitroulis classification) were compared to evaluate factors associated with success of arthroscopy and progression to open surgery. Results Results A total of 167 patients and 216 joints underwent arthroscopy. Overall 77.7% of joints had a successful result and required no further surgery. There was no gender difference with respect to progression to surgery. Males underwent open surgery after a mean of 6.2 months from arthroscopy and Females after a mean of 15.6 months from arthroscopy (p \0.005). The highest failure rate between age groups was in the 21–30 year age group (p\0.04). There was a statistically significant rate of progression to open surgery depending on the classification at the time of arthroscopy, with all patients with category 4 and 5 disease progressing to open surgery (p\ 0.0001). Conclusions Conclusion Arthroscopic lysis and lavage of the TMJ is a reliable and effective operation for patients with early stage (i.e., Categories 1, 2 and 3) disorders of the TMJ. Patients with more advanced joint disease (i.e. Categories 4 & 5) gain only temporary relief from TMJ arthroscopy and often progress to open TMJ surgery.

Abstract Background/Introduction Osteoarthritis is characterised by chronic degeneration of hard and soft tissue around the joint. This result in anatomical changes in the joint and joint pain due to alterations in the central and peripheral pain processing mechanism. Osteoarthritis affect the temporomandibular joint leading to more complex symptoms like joint dysfunction, locking and excruciating pain due to the series of bio mechanical changes in the joint. Immune cells trigger inflammatory responses leading to the release of various mediators of inflammation. Treatment of TMJ arthritis should be directed at suppressing the active inflammatory process, preserving the function, preventing further damage to the joint and alleviating the pain. This study aims to evaluate the efficiency of Hyaluronic acid injected directly into the joint to restore the function and to improve the joint rheology and viscoelastic properties and thereby assessing the anti inflammatory and analgesic properties of Hyaluronic acid in the treatment of TMJ osteoarthritis. Objectives The aim of the present study was to evaluate the efficacy of hyaluronidase injection in the treatment of temporomandibular joint osteoarthritis. Methods Patients with symptoms of unilateral temporomandibular joint osteoarthritis, non-responsive to conservative measures such as pharmacotherapy, splint therapy and arthrocentesis were treated with injections of 150 TRU of hyaluronidase. The outcome variables were maximum voluntary mouth opening, deviation on mouth opening, pain-visual analog scale, joint sounds (crepitations/clicking). Results 54 patients, including 28 females and 26 males were studied. The age group was 25 to 40 years. Patients received 3 injections of hyaluronic acid at 10 days interval according to their symptoms. 38 patients showed a significant reduction in symptoms after the first injection. With the third injection all patients obtained complete relief and were symptom free during the follow up period. Conclusions Intra articular injection of Hyaluronic acid is a highly effective treatment modality in patients with TMJ OA, non-responsive to other conservative measures. References/Bibliography Clegg TE, Caborn D, Mauffrey C. Viscosupplementation with hyaluronic acid in the treatment for cartilage lesions: a review of current evidence and future directions. Eur J Orthop Surg Traumatol. 2013.

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ABS00110 Efficacy of Dermal Fat Graft in the Management of TMJ Ankylosis

ABS00113 Comprehensive Management of Temporomandibular Joint Ankylosis

Dr Sajjad Abdur Rahman (Presenting Author), Dr G S Hashmi (CoAuthor), Dr Kalim Ansari (Co-Author)

Dr. Lt Col K Kamalpathey Army Dental Centre (Research & Referral)

Z A Dental College, AMU, Aligarh, UP, India Abstract Background/Introduction TMJ ankylosis is a common debilitating disease affecting a large number of patients particularly affecting young growing children (1). The most common cause leading to TMJ ankylosis has been attributed to childhood trauma to mandible (1). The main modality of treatment is interpositional arthroplasty. There are number of interpositional material utilized for the treatment including temporalis muscle, temporalis fascia, skin, costocondral graft, fat and even alloplastic material etc. The main problem in the management of the disease has been recurrence of the problem if proper post operative physiotherapy is not followed by patients. Post operative physiotherapy is affected by many factors especially pain at surgical site postoperatively. Dermal fat has been successfully utilized as an interpositional material in the long run (2). Objectives This study was planned to assess the success of dermal fat as interpositional material in maintaining adequate pain free post surgical mouth opening and the eventual fate of dermal fat graft at the grafted site. Methods Inclusion criteria: 1. All TMJ ankylosis patients reporting to Dept of OMFS irrespective of age and sex. Exclusion criteria: 1. Patients refusing the surgery. 2. Any medical and surgical condition contraindicating the harvest of graft. 3. Pregnant patients. Method: Preauricular incision for removal of ankylotic mass, creating a gap of at least 1.0 cm intraoperatively, achieving intraoperative mouth opening of atleast 3.5cm, contralateral coronoidectomy if required, filling the gap with abdominal dermis fat. Assessing pain at 1 week and 30 days postoperatively by Visual Analogue scale. Results Total 15 patients and 18 joints were operated. 3 patient had bilateral and 12 had unilateral ankylosis. Mean age of patients was 12.6 years (6–30 yrs). Average follow up of patients is 13.2 months (6–24 months). Average preoperative mouth opening was 5.1 mm (0–17mm) and postoperative interincisal mouth opening is 3.0 cm (0–4cm). Postoperative pain after 1 week was recorded as mild and remained below 1 after 1 month. Conclusions It can be interpreted from the study that because of lack of postsurgical pain the compliance for physiotherapy was good in majority of patients leading to good maintenance of mouth opening. In our opinion abdominal dermas fat is a reliable material for interposition in TMJ ankylotic surgery. References/Bibliography 1. Vinay Kumar Gupta et al. an epidemiological study of temporomandibular joint ankylosis. Natl J Maxillofac Surg. 2012;3(1):25–30. 2. Dimitroulis G. The interpositinal dermis-fat graft in the management of temporomandibular joint ankylosis. Int J Oral Maxillofac Surg. 2004; 33(8):755–60.

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Abstract Background/Introduction Temporomandibular joint (TMJ) ankylosis is a morbid condition that not only results in hypomobility of the joint but also cause considerable facial asymmetry and obstructive sleep apnoea (OSA). Patients with longstanding unilateral temporomandibular joint ankylosis usually present with restricted mouth opening, facial asymmetry and upper airway obstruction in the form of OSA. Objectives The purpose of this article is to discuss the comprehensive management ankylosis with a holistic approach to achieve good function and satisfactory form. Methods Five cases of unilateral ankylosis with gross facial asymmetry was managed in our institution between the period Jun 2015 to Jun 2017. Multidisciplinary approach was contemplated with surgical and orthodontic interventions. Treatment was planned in five stages with stage - 1 comprising of release of ankylosis, restore of function in terms of satisfactory mouth opening, follow up, prevention of reankylosis. Stage - 2 comprised of orthodontics with fixed mechanotherapy for correction of malocclusion and orthodontic decompensation. Stage - 3 comprised of orthognathic surgical procedure with distraction osteogenesis (DO). Stage - 4 comprised of post orthodontic treatment for callus moulding, consolidation and final settling of occlusion. Stage - 5 was follow up phase and prevention of relapse. Results Release of TMJ ankylosis with osteoarthrectomy with interpostional temporalis fascia was done in 4 cases and dermis fat graft in 1 case respectively. Mouth opening at one year follow up showed average mouth opening of 35 mm. Correction of canting and facial asymmetry with orthognathic surgery and distraction osteogenesis was done in all 5 cases. Bilateral mandibular body distraction was done in 4 cases and ramal condylar unit (RCU) DO was done in 1 case. All cases showed satisfactory results without any complication and relapse. Conclusions The management of a facial asymmetry secondary to TMJ ankylosis requires a combined surgical and orthodontic approach. Treatment should optimize symmetry, while minimizing morbidity and treatment duration and maximizing long-term predictability. Osteoarthrectomy with interpositional material and postoperative aggressive mouth opening exercises plays an important role in prevention of relapse. Distraction osteogenesis is an excellent tool in management of facial asymmetry and yields desired results. References/Bibliography H. Yu et al. Gap arthroplasty combined with distraction osteogenesis in the treatment of unilateral ankylosis of the temporomandibular joint and micrognathia. British Journal of Oral and Maxillofacial Surgery 47 (2009) 200–204.

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ABS00158 Simultaneous Mandibular Distraction and Gap Arthroplasty for Correction of Facial Deformity in Temporomandibular Joint Ankylosis Dr G. Harsha MDS, MOMS’RCPS (Glasg), Professor & HOD, Department of Oral & Maxillofacial Surgery, MNR Dental College,& Hospital, Sangareddy, Telangana – 502294 Abstract Background/Introduction Temperomandibular Joint Ankylosis is a debilitating disease mainly affecting children. It is characterised by progressive restriction of mouth opening and maxillomandibular developmental deformities. Distraction Osteogenesis had developed as one of the surgical procedures for correction craniofacial deformities. The purpose of this study was to assess simultaneous Mandibular Distraction and Gap Arthroplasty in correction of Facial Deformity in Temporomandibular Joint Ankylosis patients. Objectives The purpose of this study was to assess simultaneous Mandibular Distraction and Gap Arthroplasty in correction of Facial Deformity in Temporomandibular Joint Ankylosis patients. Methods This prospective randomized study included 10 unilateral TMJ Ankylosis patients associated with facial deformity and restricted mouth opening. In all 10 patients simultaneous Distraction osteogenesis and Gap arthroplasty were performed. Treatment outcomes were analysed in terms of mouth opening, Facial asymmetry correction. Results Among 10 patients treated with simultaneous Distraction osteogenesis and Gap arthroplasty, 8 patients had good correction of facial esthetics and adequate mouth opening, 1 patient had reankylosis, 1 patient had infection and loosening of distractor. Conclusions Simultaneous Distraction Osteogenesis and Gap arthroplasty is very effective in correcting of post ankylotic deformity and improving function and also eliminates the need for second surgery.

S55 Objectives 1. Correlate radiographic changes with TMJ pain/complaint. 2. Obtain specific guidelines for diagnosis & management of TMDs from the scientific literature. Methods 642 consecutive digital OPGs were analyzed for condylar changes and were correlated with patients’ complaints. A literature search was also done for specific guide lines regarding diagnosis & treatment of these changes/complaints. Results A sizable proportion of the OPGs showed ‘‘condylar changes’’ but the % of patients who complained of TMJ problems was minimal. Uniformity was lacking in the ‘‘scientific guidelines’’ for diagnosis & management of these problems. Conclusions Our study showed that there is no correlation between radiographic changes of the mandibular condyle and TMJ pain/complaints. It also showed that there is a woeful lack of well-conducted studies regarding TMJ problems and most treatments were done using a ‘‘blunderbuss’’ approach. References/Bibliography 1. Wieckiewicz M, Boening K, Wiland P, Shiau YY, ParadowskaStolarz A. Reported concepts for the treatment modalities and pain management of temporomandibular disorders. J Headache Pain. 2015;16:106. 2. Acupuncture therapy in the management of the clinical outcomes for temporomandibular disorders: A PRISMA-compliant metaanalysis. 3. Wu JY, Zhang C, Xu YP, Yu YY, Peng L, Leng WD, Niu YM, Deng MH. Medicine (Baltimore). 2017 Mar;96(9):e6064.

ABS00233 ‘‘Auricular Cartilage Fixation in Treatment of TMJ Ankylosis’’ Case Series 1. Dr Ashutosh Harsh Assistant Professor General Dentistry, 2. Dr D.K Gupta Ex-HOD, 3 Dr. Pragya Harsh Ex-Senior Resident

References/Bibliography Simultaneous gap arthroplasty and intraoral distraction and secondary contouring surgery for unilateral temporomandibular joint ankylosis Journal of Maxillofacial Plastic and Reconstructive surgery (2016)38:12.

ABS00217 TMJ Disorders: Are We Getting it Right? Mohan Alexander MAHSA University, Jalan SP2, Jenjarom, 42610, Saujana Putra, Malaysia Abstract Background/Introduction Diagnosis as well as management of patients reporting with TMJ problems is part of the maxillofacial surgeon’s repertoire. But the variety of methods for evaluating and managing TMDs that have been proposed can be quite confusing for most of us.

1. Dr SN Medical College Jodhpur; 2. Government Dental College Jaipur; 3. Dr SN Medical College Jodhpur Abstract Background/Introduction Temporomandibular joint ankylosis is a condition in which there is immobility of joint, it is characterized by formation of an osseous fibrous or fibroosseous mass fused on the base of skull. Trauma is the most common etiology Different autogenous and alloplastic interposition materials have been used after the resection of the ankylotic bone to achieve desirable and long lasting results. The recurrence of disease is most distressing for both patients and surgeon. This study demonstrated that autogenous auricular cartilage fixed with condyle with suture is a suitable material for interpositional arthroplasty in adults. Objectives The objective of this study is to evaluate the clinical efficacy of use of autogenous auricular cartilage graft as an interposition material fixed to condyle after arthroplasty of the TMJ ankylosis. The use of an interposition material with less volume and proper fixation covering all the raw bone joint space prevents reunion of bone; fixation of the cartilage prevents its movement and thus extrusion of interpositional graft and prevents reankylosis.

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Methods All the patients will undergo gap arthroplasty followed by placement of auricular cartilage graft as interpositional material. The technique of using auricular cartilage covering whole of the joint space fixed with non-absorbable silk 3-0 suture to the condyle was employed in all patients. Results Twenty patients of temporomandibular joint ankylosis were selected. In all patients’ treatment of tempromandibular joint ankylosis was done using auricular cartilage fixation. The pre-operative interincisal mouth opening ranged from 5 to 15 mm. The intra-operative interincisal mouth opening ranged from 25 to 45 mm. There was no extrusion of the auricular cartilage in follow-up period. Conclusions Use of auricular cartilage with less volume and proper fixation covering the joint space, prevents reunion of bone; fixation of the auricular cartilage prevents its movement and extrusion. There was no verticle height shortening of mandible.

References/Bibliography

References/Bibliography

PGIDS, Rohtak, Haryana

1. Yazdani J, Ghavimi MA, Pourshahidi S, Ebrahimi H.Comparison of Clinical Efficacy of Temporalis Myofascial Flap and Dermal Graft as Interpositional Material in Treatment of Temporomandibular Joint Ankylosis. J Craniofac Surg.2010; 21: 1218–1220. 2. Kalra.G.S. (2011)8 et al did the study of temporomandibular joint ankylosis fixation technique with ultra thin silicon sheet Indian J Plast Surg. 2011 Sep-Dec; 44(3): 432–438.

Abstract Background/Introduction A patient with bilateral TMJ ankylosis was operated for two times and patient developed the ankylosis for the this time providing the history of first operation 14 years back. CT evaluation confirmed the type IV TMJ ankylosis. Patient was planned for surgical treatment of ankylosis first and following with orthodontic treatment and advancement of chin. Current case reports only about the surgical treatment for ankylosis and is under treatment for further procedures including orthodontic treatment. Objectives To achieve the sufficient mouth opening for the functional movements of TMJ. Methods Gap Arthroplasty. Results Satisfactory mouth opening achieved. Conclusions Old recurrent cases of TMJ Ankylosis should be managed by efficient planning along with the high patient cooperation to achieve the satisfactory results.

10. ABS00367 Discectomy as the Primary Surgical Option for Painful Internal Derangement of the Temporomandibular Joint: A 3 Year Clinical Follow Up Study Dr Sandeep Mehta Military Dental Centre Abstract Background/Introduction A 3 year prospective study to assess the surgical management of unilateral internal derangement of TMJ. Objectives The goal of this prospective study was to evaluate outcomes and compare the pre-operative and post-operative status of the patients who underwent unilateral temporomandibular joint discectomy without replacement as the primary treatment for internal derangement after failure of nonsurgical therapy. Methods Thirteen patients with TMJ internal derangement without reduction were managed with discectomy from 2014 to 2016 at Bathinda Military Dental centre. Patients were selected for surgery depending on their clinical as well as MRI TM joint findings. No patient was lost in the follow up and average follow up was carried out at least 18 months. Results All 13 patients showed improvement in mandibular mobility, mouth opening, joint function, as well as reduction in TMJ and muscular facial pain. One patient required contralateral surgery during the follow up period. Conclusions Discectomy of the TMJ as a primary surgical option significantly reduces pain and improves joint functions who show no improvement with prior non-surgical treatment.

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1. Brown WA: Internal derangement of the temporomandibular joint. Review of 214 patients following meniscectomy. Can J Surg 23:30, 1980. 2. Holmlund A, Axelsson S: Diskectomy in treatment of disk derangement. A one and three year follow-up. Swed Dent J 14:213, 1990.

ABS00427 Surgical Treatment of 14 Years Old Case of Bilateral Recurrent Ankylosis of TMJ Dr. Ravinder Solanki, Associate Professor

ABS00759 Efficacy of Abdominal Dermis Fat Graft and Temporalis Myofascial Flap as an Interpositional Material in the Management of Temporomandibular Joint Ankylosis: A Comparative Analysis Dr. Surendra N. Daware, Assistant Professor, Government Dental College and Hospital, Nagpur and Dr. Abhay N. Datarkar, Professor & Hod Government Dental College and Hospital, Nagpur Abstract Background/Introduction Temporomandibular joint (TMJ) ankylosis is characterized by the formation of a bony or fibrous mass that replaces the normal articulation, particularly hindering mouth opening, as well as anterior and lateral movement. The treatment for TMJ ankylosis aims at complete removal of ankylotic block and a more normal range of jaw motion.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Management of ankylosis occurs through surgical intervention; several authors agree that it is necessary to use an interpositional material to prevent re-ankylosis after gap arthroplasty. The primary function of the interpositional material is to prevent the reankylosis by eliminating contact between bone surfaces. Appropriate interpositional material include: 1-autogenous tissue: meniscus, muscle, fascia, skin, cartilage, fat or combination of these tissues; 2: allogeneic tissues; cartilage and dura; 3; alloplastic: silastic materials like acrylic, proplast, and silicon; 4: xenograft tissues: usually of bovine origin (collagen and cartilage). Objectives This paper aims at comparative evaluation of two inter positional materials like abdominal dermis fat graft and temporalis myofascial flap in the management of Temporo-mandibular joint (TMJ) ankylosis. Methods Total 10 cases (6 female and 4 male) of unilateral bony ankylosis were studied for the comparative efficacy at our institute, out of which 5 were treated with abdominal dermis fat graft and 5 patients were treated with temporalis myofascial flap as an interpositional material after gap arthroplasty for the management of Temporo-mandibular joint (TMJ) ankylosis. Age of the patient was ranging from 4–20 years. Ankylotic mass removal procedure was almost same in all operated cases. For interposition purpose, Abdomen fat graft was harvested from suprapubic region whereas temporalis flap was harvested from same surgical site. Results All patients were evaluated in postoperative period at one month, three month and six month duration. Postoperative assessment was done by assessing the maximal mouth opening prior and after procedure, complication at both donor and recipient site, and prevention of re-ankylosis after interpositioning. Early vigorous postoperative physiotherapy was given in all cases. Patients operated with temporalis group were not tolerating postoperative exercises because of contracture pain during jaw movements whereas this problem was not seen in abdomen fat group. Improved range of motion was seen in abdomen fat group of patients whereas motions were limited in temporalis group. In temporalis group, depression over temporal region because of harvesting was noticed on operated side. In abdomen group, scar was well hidden in the abdomen crease. No case of reankyosis was reported in our study.

S57 Conclusions The success in the preventing Reankylosis after TMJ gap arthroplasty is related primarily to the appropriate surgical technique with adequate removal of bone, early vigorous postoperative physiotherapy, maintained for long term. Difficulty in mouth opening and vigorous post operative exercise are troublesome for the patient if Temporalis muscle is used as the interposition material due to compression of the nerves which may subsequently reduce the mouth opening. An ugly bulging in the temporal region after harvesting of that side may not be neglected. However the versatility of the Temporalis Myofacial flap technique in Interpositional material is not certain and failure may occur. The jaw movements and physiotherapy are well tolerated and maintained by patients if the gaps were filled with dermis fat grafts. The dermis fat graft minimizes the occurrence of excessive joint fibrosis and heterotopic calcification and consequently providing improved range of motion. Graft procurement is quick and easy with minimal morbidity and the wound and scar in the anatomical skin creases are accepted cosmetically. The results obtained in our study are highly satisfactory and encouraging, supporting the role of dermis fat graft as the interposition material in TMJ Ankylosis cases especially in children. However, a large sample size and a longer follow-up period are required to consolidate the findings. References/Bibliography 1. Temporalis Myofacial Flap in TMJ Ankylosis with Gap Arthroplasty: A Case Report. Yogendra Kumar Singh et al. Annals of International Medical and Dental Research, Vol (3), Issue (3). doi:10.21276/aimdr.2017.3.3.DE6. 2. Efficacy of abdominal dermis fat graft as the interpositional material in the management of Temporomandibular joint ankylosis in children- an original study. Dr. S. Gandhiraj et al. IOSR Journal of Dental and Medical Sciences (JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861. Volume 3, Issue 6 (Jan.–Feb. 2013), PP 07–11.

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Section: Craniofacial Research ABS00246 Cranioplasty: An Armed Forces Experience Sqn Ldr Jimish Desai Air Force Institute of Dental Sciences, Bengaluru Abstract Background/Introduction Cranioplasty is the surgical intervention to repair cranial defects in both cosmetic and functional ways. The history of cranioplasty dates back to 7000 B.C. In 19th century, the use of bone from different donor sites, such as ribs or tibia, gained wide population. Although many different materials and techniques had been described, there is still no consensus about the best material. Objectives Although many different materials and techniques had been described, there is still no consensus about the best material, and ongoing researches on both biologic and non biologic substitutions continue aiming to develop the ideal reconstruction materials. In this article, the principle materials and techniques of cranioplasty are reviewed. Methods Many different types of materials were used throughout the history of cranioplasty. With the evolving new biomedical technology, new materials are now available to be used by the surgeons. Results An ideal cranioplasty material must have the following features: It must fit the cranial defect and achieve complete closure Radiolucency Resistance to infections not dilated with heat Strong to biomechanical processes Easy to shape not expensive Ready to use. Conclusions Most cranioplasty materials are used with little adjustments by the surgeon. But the basic principle must not be forgotten; to choose proper material for the defect. A cranioplasty material must have low infection rates, show low heat conduction, to be non-magnetic, radiolucent, tissue acceptable, durable, shapeable, and inexpensive. Before achieving bone closure, clear bone borders should be obtained, and scalp should be dissected from dura. Dural tears should be closed in watertight manner. Bone and cranioplasty material should touch to each other with maximum capacity. To prevent the mobility of the cranioplasty flap, the material is fixed to the bone with proper plates. References/Bibliography 1. Sanan A, Haines SJ. Repairing holes in the head: A history of cranioplasty. Neurosurgery. 1997;40:588–603. 2. Blake DP. The use of synthetics in cranioplasty: A clinical review. Mil Med. 1994;159:466–9.

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ABS00808 Assessment of Involvement of Muscles of Mastication in Long Standing Cases of OSMF. Pilot Study Dr Praful Gaikwad Dmims Abstract Background/Introduction Oral submucous fibrosis (OSMF or OSF) is a chronic, complex, premalignant lesion of the oral cavity, characterized by juxta-epithelial inflammatory reaction and progressive fibrosis of the submucosal tissues (the lamina propria and deeper connective tissue). The pathogenesis of OSMF suggested that exposure to arecanut (Arecacatechu) containing products with or without tobacco currently believed to lead to OSF in individuals with genetic immunologic or nutritional predisposition to the disease. These collagen fibers are non degradable and the phagocytic activity is minimized. As the disease progresses various cardinal features established like pain on palpation in the sites where submucosal fibrotic bands are developing, trismus is caused mostly by fibrosis in the dense tissue around the ptery-gomandibular raphae but it is and it is also observed that it may be because of involvement of muscles of mastication. There are fewer evidences supporting this hypothesis. So we planned to conduct a study to evaluate involvement of muscles of mastication in OSMF using ultrasonography and subsequent Myotomy of the involved muscles to see improvement in mouth opening. Objectives To assess grading of muscle to establish regular long term follow up to perform selective sequence of muscle myotomy. Methods 10 patient with long standing OSMF were selected, and sonological conformation for assessing the hypertrophic changes in masticatory muscles were enrolled under study. The basic protocol of releasing fibrous band, coronoidectomy, Followed by reconstruction with extended Nasolabilal Flap as routine procedure and physiotherapy was decided If needed selective muscle myotomy performed in patient showing muscle restraining effect for mouth intraoperatively to achieve standard interincisal mouth opening of 35mm. Results 4 patient require myotomy. Conclusions Selective muscle myotomy, effective method to fulfill surgical protocol. References/Bibliography 11. J Oral Pathol. 1985 Oct;14(9):709–17. Ultrastructural findings of muscle degeneration in oral submucous fibrosis. el-Labban NG, Canniff JP. 12. Ma RH, Tsai CC, Shieh TY. Increased lysyl oxidase activity in fibroblasts cultured from oral submucous fibrosis associated with betel nut chewingin Taiwan. J Oral Pathol Med 1995;24:407–12. 13. Khanna JN, Andrade NN. Oral submucous fibrosis: a concept in surgical management. Int J Oral Maxillofac Surg 1995; 24: 433–9. 14. Ultrasonography in maxillofacial Imaging – a review Karthik R1,*, Mohan N2, Ravikumar PT3, Saramma Mathew Fenn4, Sabitha Gokulraj5, Cicilia.

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Section: Oral Pathology: Benign ABS0012 Consistent and Simplified Anatomical Landmarks for Safer Parotid Gland Surgery with Predictable Outcomes Kapil Tomar Naval Institute of Dental Sciences (Mumbai) Abstract Background/Introduction The facial nerve (7th cranial nerve) is intimately associated with the parotid gland and accurate understanding of its anatomy is critical for successful parotid gland surgery. Two techniques exist for identification of the facial nerve, namely the antegrade and retrograde techniques. The retrograde technique involves tracing a peripheral branch proximally towards the trunk. Several anatomical landmarks have been listed for antegrade dissection of the facial nerve trunk and its branches distally. These anatomical landmarks are the cartilaginous tragal pointer, digastric ridge, stylomastoid foramen, tympano mastoid suture line and mastoid process. We propose identification of two landmarks, the sternocleidomastoid (SCM) muscle’s mastoid insertion and the posterior belly of digastric (PBD) muscle’s mastoid insertion to serve as easy and consistent superficial landmarks to trace the main trunk of the facial nerve. Objectives To demonstrate the efficacy of utilising the sternocleidomastoid (SCM) and posterior belly of digastric (PBD) muscles as simple anatomical landmarks for consistently locating the facial nerve trunk (FNT) in parotidectomy surgeries with minimal neurologic deficit of the facial nerve branches post operatively. Methods 16 patients of unilateral parotid gland disease underwent superficial parotidectomies by the same surgical team from Jan 2015 to Dec 2016. 10 were male and 6 female. Institutional ethical committee clearance was taken for this study. Mean age of the patients was 42 years and mean duration of presentation of symptoms was 1.2 years. All patients were subjected to MRI for purpose of imaging and a fine needle aspiration cytology (FNAC) was carried out in all patients to confirm the diagnosis prior to listing the patient for surgery. 12 patients were diagnosed with benign salivary gland tumors (9 pleomorphic adenomas, 2 basal cell adenomas and 1 Warthin’s tumor) and 4 with chronic non specific sialadenitis of the parotid gland. Routine investigations were ordered and pre anesthetic check up carried out. Detailed informed consent listing out all possible complications with emphasis on facial nerve palsy was obtained from the patient. Endotracheal intubation was carried out and surgery performed under general anaesthesia. Aseptic scrubbing and draping was performed and 1;80,000 concentrated Adrenaline solution infiltrated along the proposed incision line for vasoconstriction. Modified Blair’s lazy S incision was made (Fig 1) and flap raised in a sub platysmal plane in the cervical region and along the superficial musculo aponeurotic (SMAS) layer over the parotid gland to expose the glistening white parotid fascia/capsule (Fig 2). Sharp dissection is carried out upto the depth of the parotid fascia in the preauricular area and through platysma in the cervical region. Anterior and posterior flaps are then raised along this relatively avascular plane, to expose the parotid gland anteriorly and the anterior border of the sternocleidomastoid muscle posteriorly. Great care should be taken not to raise an excessively thin flap which can cause ‘‘button-holing’’ and also

S59 increases the chances of Frey’s syndrome developing post operatively. The anterior border of the SCM which was identified is used to expose the tail of the parotid. The fascia overlying the muscle provides a safe plane to elevate the tail of the gland. Sharp dissection is carried out to separate the tail of the parotid gland off the SCM and also the cartilaginous external auditory canal. The greater auricular nerve running on the superficial surface of the SCM is identified and divided as close to the parotid gland as possible in an attempt to preserve the posterior branch if possible which may also serve as a potential nerve graft if required. Next, the skeletonised anterior border of SCM is retracted inferiorly to expose the PBD muscle which is then cleanly separated and visualised. The mastoid process is palpated and the mastoid insertions of both the SCM and the PBD dissected and exposed. The facial nerve trunk (FNT) can be found exiting the stylomastoid foramen just above the attachment of the PBD to the mastoid process (Fig 3). Thereafter, using bipolar cautery and sharp dissection, the cervicofacial and temporofacial divisions are exposed and the ‘pes anserinus’ dissected while bluntly lifting off the superficial lobe of the parotid gland from the nerve branches (Fig 4). Careful hemostasis was achieved after delivering the superficial lobe. A closed circuit suction drain was secured and layer wise closure done with 3-0 vicryl and subcuticular suturing of the skin with 3-0 prolene. Pressure dressing was applied and patient placed on broad spectrum IV antibiotics, Dexamethasone (8mg) in tapering dose and injectable Tramadol for pain relief. Results Post operatively, healing was uneventful with aesthetic scar (Fig 5). No cases had surgical wound break down or hypertrophic scar post op. Post operative complications included transient neurologic deficit of the marginal mandibular nerve in 2 cases (12.5%) and of the temporal nerve in 1 case (6.25%). All 3 cases of transient nerve deficit responded well to Tablet Methylcobalamine (1500 ugm) with tapering dose of Tablet Methyl Prednisolone (10 mg) and resolved completely in 6 weeks duration. We had no complication of Frey’s syndrome or salivary fistula post operatively. Conclusions Parotidectomy is a technique sensitive surgery requiring surgical finesse, understanding of surgical anatomy and attention to detail. Our described technique using the mastoid heads of the sternocleidomastoid and the posterior belly of digastric as anatomical landmarks to locate the facial nerve trunk is simpler and faster for the novice surgeon to perform with a broader and safer dissection field. The landmarks described are consistent, superficial, easily distinguishable and in close proximity to the facial nerve trunk, thereby allowing easier exposure of the same. In our study, we have observed and demonstrated that rather than relying on anatomical landmarks such as the tragal pointer which is inconsistent, inaccurate and vague or bony landmarks such as the tymanomastoid fissure, styloid process, mastoid tip and stylomastoid foramen which require deeper dissection and can cause inadvertent damage to the facial nerve trunk, the mastoid heads of the SCM and the PBD are relatively superficial, easy to dissect, consistent and reliable landmarks to locate the FNT with minimal post op paresis/neuropraxia. References/Bibliography 1. Sinha UK, Ng M. Surgery of the salivary glands. Otolaryngol Clin North Am 1999;32(5):887–906. 2. Scarpini M, Bonapasta SA, Ruperto M, et al. Retrograde parotidectomy for pleomorphic adenoma of the parotid gland: a conservative and effective approach. J Craniofac Surg 2009;20(3):967–9.

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ABS0017 Rare Dermoids in Maxillofacial Region AK Choudhary, NK Sahoo, Kapil Tomar Abstract Background/Introduction The dermoid cyst is an uncommon clinicopathological lesion of developmental origin. The term dermoid cyst is used to describe 3 cysts that are closely related histologically: dermoid cyst, epidermoid cyst, and teratoma. Epidermoid and dermoid cysts are benign nature, which may occur anywhere in the body, but most predominantly in the ovary and scrotal regions. Objectives To review dermoid cyst in maxillofacial region. Methods Operated on patients with dermoid cysts and reviewed all three clinicopathological lesions. Results Postoperative healing was uneventful in all patients. Conclusions Ample understanding and vigilance about this slow growing painless mass is essential not only because of the symptoms it produces but also due to its malignant potential. When dermoid cysts occur on the floor of the mouth, they may enlarge to such an extent that they can interfere with deglutition and produce respiratory obstruction. References/Bibliography De Ponte FS, Brunelli A, Marchetti E, Bottini DJ. Sublingual epidermoid cyst. J Craniofac Surg. 2002;13:308e310.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Results The cause of the mandibular lesion can be intraosseous hemorrhage, soft tissue hemorrhage with periosteal stripping and subperiosteal hematoma formation, or a combination of these factors leading to pressure necrosis phenomenon. Conclusions The differential diagnosis of masses occurring in the jaws of children is limited and since haemophilic pseudotumour is not pathognomonic in radiological findings, Haemophilic pseudotumor should be considered in the differential diagnosis when a mass presents with rapid growth, even in the absence of a prior diagnosis of hemophilia as HP may be the initial manifestation of this disease or when a patient who suffered from Haemophilia. References/Bibliography 1. Srinivasan K, Gadodia A. Mandibular Hemophilic Pseudotumor Associated With Factor IX Deficiency: Report of Case With Review of Literature. J Oral Maxillofac Surg. 2011;69:1683–1690. 2. Shi H, Wang S, Wang P, Yu Q. Haemophilic pseudotumour of the mandible. Dentomaxillofac Radiol. 2009;38:182–184.

ABS0052 Lingual Hypoglossal Nerve Reflex: An Unusual Pattern of Nerve Injury Encountered in a Series of Salivary Gland Surgeries Dr. Reena Rachel John, 2. Dr. Pathumai Murugadoss 2. Vinayaka Mission’s Sankarachariyar Dental College and Hospital, Salem, Tamilnadu

ABS0042 Haemophilic Pseudotumor of Mandible in a Patient with Severe Haemophilia B Dr (Maj) T Balasundaram, Co Author: Dr (Col) P K Chattopadhyay. Dr (Maj) T Balasundaram, Graded Specialist Armed Forces Dental Clinic, Tyagraj Marg, New Delhi-110011. Mobile No: 8826383251. Email: [email protected] Abstract Background/Introduction The Haemophilic Pseudotumour (HP) is an uncommon manifestation of haemophilia that was first reported by Starker in 1918.1 Haemophilic Pseudotumor is a rare complication seen in approximately 1–2% of cases of hemophilia. 2 It most frequently affects the femur, followed by the pelvis, tibia, bones of the feet, hands or wrist and occasionally occurring in the jaw bones. Objectives Literature review states that Haemophilic Pseudotumor though seen in Classic Haemophilia is rare in Haemophilia B. Our case report represents only the fourth case in literature wherein this tumor is presented in a patient of Haemophilia B. Our aim is to make clinicians aware of the possibility of such pseudotumors in the jaws. Methods Our case is a 7 year old boy reporting with a spontaneous extraoral swelling from mandible that was managed with transfusion of factor IX along with curettage. Histopathological examination revealed it as a case of Haemophilic Pseudotumor.

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Abstract Background/Introduction The major salivary glands in humans have anatomic proximity to several nerves of the head and neck, hence it is natural to come across nerve injuries ranging from neuropraxia to axonotmesis during salivary gland surgeries. The most common injuries in a well executed surgery is neuropraxia, the incidence of which has been reported to be 9.3% to 64.6% for parotid surgeries and 7.7%-36% for submandibular surgeries. The clinical features of such nerve injuries can range from mild paresthesia from afferent nerve injury, to paresis/paralysis due to efferent nerve injury, to aberrant regeneration resulting from cross innervation from two different nerves. eg:- Freys syndrome, lingual hypoglossal reflex. Objectives To assess the variations of nerve injury in salivary gland surgeries. Methods Out of the 11 cases of salivary gland pathologies involving major and minor salivary glands that reported to our department between 2014–2017, seven cases were from minor salivary gland and therefore not included in this series. Of the remaining 4 major salivary gland surgeries we observed the effects of nerve injury in two of the cases. Patients were followed up over a period of 5 months. Results Out of the 11 cases of salivary gland pathologies, nerve injuries were seen in two major salivary gland pathology cases. One was facial palsy following superficial parotidectomy for pleomorphic adenoma and other was exaggerated lingual hypoglossal reflex following sublingual gland excision for chronic sialadenitis. Conclusions Rare to common complications can be encountered on any surgeries. This series is interesting because of the occurrence of lingual

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 hypoglossal reflex which is only reported in feline species as per literature. References/Bibliography Distribution Pattern Of The Human Lingual Nerve Karen B. Zur, Liancai Mu, and Ira Sanders Clinical Anatomy 17:88–92 (2004) The Synaptic Basis Of A Bilateral Lingualhypoglossal Reflex in Cats.

ABS0061 Cemento Ossifying Fibroma of Maxilla: Rare Case Report Dr. Geeta Mishra Tripathi Associate Professor Dental Dept. S.S. Medical College Rewa (M.P.) Abstract Background/Introduction Ossifying fibroma is a rare, destructive, deforming, slow growing benign fibro-osseous tumor. It is usually found in the craniofacial bones with the mandible being the most common site. Less commonly the orbit, paranasal sinuses or sometimes the maxilla have been involved. It is believed to be derived from the cells of the periodontal ligament. This bone tumor consists of highly cellular, fibrous tissue that contains varying amounts of calcified tissue resembling bone, cementum, or both. They have got a female predeliction and is usually seen in the age between 35 and 40 years of age. In this report, we have described a 16-year-old female with huge swelling on lt side of maxillary region with a detailed description of clinical, radiographic, histopathologic features, and its surgical management. Objectives Not applicable. Methods Not applicable. Results Not applicable. Conclusions Not applicable. References/Bibliography 1. Khan SA, Sharma NK, Raj V, Sethi T. Ossifying fi broma of maxilla in a male child: Report of a case and review of the literature. Nat J Maxillofac Surg 2011;2:73–9. 2. MacDonald-Jankowski DS. Cemento-ossifying fi bromas in the jaws of Hong Kong Chinese. Dentomaxillofac Radiol 1998;27:298–304.

ABS0097 Facial Nerve Monitoring a Boon in Parotidectomy Dr Rajashekhar D Gadad Command Military Dental Centre (Nc) Abstract Background/Introduction Facial nerve injury is a feared complication of parotidectomy. Facial nerve paralysis can cause cosmetic and functional morbidity, ocular

S61 complications, diminished quality of life, and medical malpractice litigation. Facial nerve monitoring is an adjunctive method available to a surgeon during parotid surgery to assist with the functional preservation of the facial nerve. A diagnosed case of pleomorphic adenoma left parotid gland was operated for superficial parotidectomy with the help of electric nerve simulator with no motor loss of facial nerve function. Objectives To preserve the facial nerve and all its branches with no or minimal motor deficit post surgery and monitoring the facial nerve function of all its branches during surgery to enable in safe dissection. Methods Electric nerve stimulator used intraoperatively after elevation of skin flap and facial nerve branches identified and then the dissection carried out proximally towards the nerve trunk to identify and check the function of each of the branch during the surgery. Results Safe dissection of the nerve is difficult in cases where the nerve is involved with a tumor, which is infiltrating the gland and distorts the anatomy of the gland and the landmarks required to be identified for safe dissection of facial nerve. Continuous monitoring of the nerve intra-operatively can be safe guide for dissection and identification of the nerve. Conclusions Damage to facial nerve during parotidectomy can be devastating for the patient and can demoralize the surgeon before attempting such surgeries so its pertinent that use of nerve stimulator during the surgery can be a boon to beginners in attempting such complicated surgeries. References/Bibliography 1. David W. Eisele, MD, Steven J. Wang, MD, Lisa A. Orloff, MD. Electrophysiologic facial nerve monitoring during parotidectomy. HEAD & NECK, Mar 2010, 399–405. 2. Stephanie Flukes, Shane S. Ling, Travis Leahy, Chady Sader. Intraoperative Nerve Monitoring in Otolaryngology: A Survey of Clinical Practice Patterns. Int J of Otolaryn & H & N Surg, 2013, 2, 21–26.

ABS00286 Use of Nerve Stimulating Device in Identification of Facial Nerve in Treatment of Recurrent Parotid Tumours 1) Dr. Pranay Pardeshi- Fellow & Assistant Surgeon, 2) Dr. Ashok Mehta- Medical Director & Senior Consultant Cancer Surgeon, 3) Dr. Rajesh Valand- Professor & Senior ENT Surgeon 1. Department of Head & Neck Cancer Surgery, Brahma Kumari’s Global Hospital & Research Centre, Mumbai; 2. Department of Head & Neck Cancer Surgery, Brahma Kumari’s Global Hospital & Research Centre, Mumbai; 3. Department of Head & Neck Cancer Surgery, Brahma Kumari’s Global Hospital & Research Centre, Mumbai Abstract Background/Introduction Operating the parotid tumors requires great skills and experience to preserve the facial nerve. This task becomes even more difficult in recurrent cases where the anatomy is disturbed due to previous surgery/surgeries. The nerve stimulating device provides the surgeon accuracy to identify and preserve the facial nerve during the surgery.

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Objectives The study aims to demonstrate the effective use of nerve stimulating device to identify & preserve the facial nerve in treatment of recurrent parotid tumors. Methods 5 patients reported of recurrent pleomorphic adenoma in Department of Head & Neck Cancer at Brahma kumari’s Global Hospital & Research Centre from 1st July 2016 to 1st July 2017. Out of 5 patients 2 were males and 3 were females. The average age of patient was 29 years. Prior to anesthesia facial nerve marking was done on skin with nerve stimulating probe at low current. In most of the cases modified pre-auricular with extending submandibular incision was made. The facial nerve identification is done with nerve stimulating device and needle by checking for twitching. Results The facial nerve was identified and preserved in all cases of recurrent parotid tumors. There was no facial nerve weakness seen postoperatively. Conclusions The nerve stimulator device is readily available in operation theatres and very often used by anesthetists for nerve blocks. The device is effective in identifying and preserving the facial nerve specially in recurrent cases where normal anatomy is distorted.

osteoma of coronoid process, an extremely rare case of Masson’s Haemangioma and lastly a case of solitary Neurofibroma of mental nerve. Results Though all these cases were appear to be complex, the treatment was simple after diagnosis. Conclusions Although these pathological conditions appear complex, the treatment was simple following diagnosis. Diagnosis remains a key factor for treatment of complex pathologies.

References/Bibliography

ABS00365 Odontogenic Keratocyst: A SRU Case Series

1. Treating recurrence of parotid benign pleomorphic adenomas: Yugueros P1, Goellner JR, Petty PM, Woods JE; Ann Plast Surg. 1998 Jun;40(6):573–6. 2. Management and prognostic factors of recurrent pleomorphic adenoma of the parotid gland: personal experience and review of the literature: Luca Oscar Redaelli de Zinis, corresponding author Michela Piccioni, Antonino Roberto Antonelli, and Piero Nicolai; Eur Arch Otorhinolaryngol. 2008 Apr; 265(4): 447–452.

ABS00291 Uncommon Pathological Entities in Oral & Maxillofacial Surgery 1. Dr Shilpa S Bawane, 2. Dr Pushkar P Waknis Dr D Y Patil Vidyapeeth, Dr D Y Patil Dental College & Hospital Pimpri Pune Abstract Background/Introduction Oral & Maxillofacial surgeon commonly deals with different surgeries ranging from cleft to orthognathic surgery. In this paper, the author has included uncommon cases in clinical practice, their diagnostic methods and management. History, detail clinical examination and step by step investigation would provide the surgeon with definitive diagnosis. Objectives Objective of this paper is to report uncommon pathological entities along with diagnostic methods and management in teaching Institute. Methods Author intends to report 4 interesting cases, all of which form a different pathological entity. The cases include a suspected cyst which later on turn to be a carcinoma, a large swelling over the zygomatic region which on histopathologic examination was found to be a

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References/Bibliography 1. Y. K Chen, L-M Lin, C C Lin osteoma of mandibular coronoid process Report of a Case Int. J. Oral Maxillofac Surg 1998;27:222–223. 2. Fa´bio Andrey da Costa Arau´jo, Jimmy Charles Melo Barbalho, Orley Nunes de Farias Ju´nior, Ricardo Jose´ Holanda de Vasconcellos, Belmiro Cavalcanti do Egito Vasconcelos (2014) Pseudo-ankylosis caused by osteoma of coronoid process. Annals of Maxillofac Surg; 4: 67–69.

Dr Deepak C, MDS Reader, Co-Author 1: Prof. C. Ravindran MDS HOD Oral & Maxillofacial Surgery Faculty of Dental Sciences Sri Ramachandra University Porur, Chennai-116 Contact No: 9840261543; Oral & Maxillofacial Surgery Faculty of Dental Sciences Abstract Background/Introduction Odontogenic keratocyst is a developmental cyst, it is now referred to as keratocystic odontogenic tumor. It is cystic lesion originate from a dental lamina or from the primordial odontogenic epithelium that benign neoplasm characteristics and it has high recurrence rate. Objectives To understand the nature of Odontogenic keratocyst and the treatment modalities. Methods Case Series. Results Adequate follow up. Conclusions OKC can sometimes be treated as benign lesion, multilocular lesion have to be treated aggressively. References/Bibliography 1. Bhargava D, Deshpande A, Pogrel MA. Keratocystic odontogenic tumour (KCOT)–a cyst to a tumour. Oral Maxillofac Surg. 2012 Jun;16(2):163–70. 2. Yazdani J, Kahnamouii SS. Developmental odontogenic cysts of jaws: a clinical study of 245 cases. J Dent Res Dent Clin Dent Prospects. 2009;3(2):64–6.

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ABS00645 To Evaluate the Effectiveness of Use of Carnoy’s Solution After Enucleation in Unicystic Ameloblastoma: Report of Series of 5 Cases Dr. Hirkani Ravindra Attarde. Reader YMT Dental College and Hospital, Kharghar, Navi Mumbai Abstract Background/Introduction Unicystic ameloblastoma is a rare variant of ameloblastoma which usually occurs in younger population. They are characterised by slow growth and being relatively less aggressive as compared to multilocular ameloblastoma. Late recurrence following surgical management is been reported and is mainly related to its histological type, the site of origin and the initial treatment modalities (1). Objectives The aim and objective of our study is to evaluate the effectiveness of use of the carnoy’s solution after enucleation in the unicystic ameloblastoma with special emphasis on recurrence. Methods We treated five patients in last 3 years who were diagnosed histologically as unicystic ameloblastoma with enucleation and application of carnoy’s solution. All the patient were periodically evaluated clinically and radiologically for recurrence of lesion. Results The recurrence of lesion was not statically significant. Conclusions In our observation we may conclude that unicystic ameloblastoma often can be treated successfully with less aggressive surgery (2,3). However this observation needs to be confirmed by larger sample size and long term follow up of cases.

S63 shown that allogeneic and alloplastic materials do not integrate immediately with the surrounding bone, and therefore the strength of the mandibular segment is not significantly increased in the short term. Marsupialization (a conventional conservative method), where the cystic lining is left behind has the probability of recurrence or malignant transformation. We describe three cases of very large mandibular cyst in which enucleation of the primary lesion was done, followed by packing of the residual osseous defect, permitting the wound to heal by secondary intention. Objectives To access the feasibility of an alternative treatment modality for large cysts of mandible in achieving good functional and esthetic outcome. Methods After exposure of the pathology utilizing appropriate flap and creation of bony window, the cyst was enucleated and a strip of sterile ribbon gauze impregnated with ‘Bismuth Iodine Paraffine Paste’ (one part bismuth subnitrate, two parts iodoform, one part sterile liquid paraffin by weight) was lightly packed into the entire cavity from the open wound. The iodoform gauze pack was changed every 3 weeks. The iodoform dressings were discontinued once the cavities were small enough to be self-cleansing. Results Satisfactory healing of the resultant osseous defect was observed permitting functional and esthetic rehabilitation. Conclusions Although the healing period was relatively long with our treatment modality, the therapeutic effect was consistently achieved and well tolerated, with low morbidity and low complications risks. Apart from that the treatment provided was economical, and comfortable to the patient. References/Bibliography 1. Chacko R et al: Spontaneous Bone Regeneration After Enucleation of Large Jaw Cysts. J Clin Diagno Research 9:ZC84, 2015.

References/Bibliography 1. Case report-Unicystic ameloblastoma, Journal of Dental Science Services (2014) 9, 407–411. 2. Unicystic ameloblastoma-Use of Carnoy’s solution after enucleation. Int. J. Oral Maxillofac. Surg. 2004;33, 263–267. 3. Unicystic ameloblastoma of the mandible: A long term follow up. J Oral Maxillofac Surg 55;345–348, 1997.

ABS00764 Neck Masses: Our Experience in the Practice of Oral and Maxillofacial Surgery Md. Kalim Ansari, G.S. Hashmi, S.S. Ahmed Aligarh Muslim University

ABS00753 Secondary Healing After Primary Enucleation and Open Packing of Large Odontogenic Cysts of Mandible: A Less Invasive Treatment Modality with Good Outcome Tabishur Rahman, Ghulam Sarwar Hashmi, Sajjad Abdur Rahman Aligarh Muslim University Abstract Background/Introduction Treatment of very large cysts of jaws require aggressive treatment modality in the form of resection of involved bone and reconstruction using auto/allo grafts. The risks involved with the use of grafts are the rejection of the implants due to instability, poor blood supply, increased possibility of infection and the need to open a further operation field and resorption of the auto-transplants. Also, it has been

Abstract Background/Introduction Being an Oral and maxillofacial surgeon we frequently deal with patients having unknown neck masses. Since Hayes Martin [1] first used the technique in the 1930s, fine needle aspiration biopsy (FNAB) has become the gold standard for the histologic evaluation of a patient with a neck mass. Formulation of a differential diagnosis is essential and requires that the surgeon should have sound knowledge of surgical anatomy and skills to systematically arrive at a definitive diagnosis and ensure that the correct treatment is provided to patients. This paper highlights some of cases of Neck masses who presented to our department and were managed successfully. Objectives To share our experience in the management of neck masses treated at our department in terms of Classification, Differential diagnosis, Different lines of investigation and management. Methods Five cases of neck masses who presented to our department from June 2016 to May 2017, were investigated using USG, CT, MRI, FNAC

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S64 etc. according to their need. After making diagnosis all the cases were operated under G.A. The post-operative outcome was uneventful in all cases. Results Five cases were operated from June 2016 to May 2017 and following final diagnosis of neck masses came after histopathologic examination; 2 cases of dermoid cyst; 2 cases of chronic submandibular sialadenitis and 1 case of lymphangioma. Conclusions History and physical examination is the corner stone in the management of neck swelling. FNAB and CT are the choice of investigation for most of the neck masses. The operating surgeon should have a sound knowledge of surgical anatomy of neck to successfully manage the cases. References/Bibliography 1. Martin HE, Ellis EB. Biopsy of needle puncture and aspiration. Ann Surg 1930; 92:160–81.

Section: Oral Pathology: Malignant ABS009 Lethal Primary Oral Melanoma Maj Pramod Kumar Army Dental Corps Abstract Background/Introduction Oral melanoma melanoma (OMM) is a rare, aggressive malignant neoplasm of melanocytic origin, representing 0.2 to 8.0 percent of all melanomas. Most mucosal melanomas are painless in early stages; the diagnosis is often delayed until the disease has progressed to advanced stage. The extent & location of OMM in oral cavity often leads to compromised surgical excision. High recurrence rate is complicated with local and distant metastasis during its course resulting in poor 5 year survival rate of patient. Objectives The study deals with the role of histopathology and immunohistochemistry in early and accurate diagnosis of Oral malignant OMM. Methods Cases with histological stages I, II, III were reviewed and histopathological features compared. Also immunohistochemical tests to identify antigens related to melanoma like NKI/C-3, S-100 protein, gp100 (HMB-45), Mart-1, Vimentin & MiTF were conducted. Results Clinical differentiation of OMM with other innocuous looking pigmented & non-pigmented lesion is difficult in routine setting. Detailed histopathologic examination using Hematoylin-eosin staining technique is reliable and cost effective modality in developing countries. Other advanced immunohistochemistry techniques are costly and only HMB-45 & MiTF have shown reliable and consistent results. Conclusions OMM is one of the most life threating cancer known to mankind with unspecified etiology, difficult treatment and lethal course. Early and accurate diagnosis play an important role in treatment and subsequent survival of patient.

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 References/Bibliography 1. Prasad ML, Patel S, Hoshaw-Woodard S, Escrig M, Shah JP, Huvos AG, et al. Prognostic factors for malignant melanoma of the squamous mucosa of the head and neck. Am J Surg Pathol. 2002;26:883–92.

ABS00590 Biological and Technical Considerations of Dental Implants in Radiated Microvascular Free Fibula in Malignancy Cases Dr Anurag Yadav Sardar Patel Post Graduate Institute of Dental and Medical Sciences Abstract Background/Introduction Free fibula reconstruction of resected malignant mandible provides cosmetic results with partial functional reconstruction as fixed dental prosthesis is still not being practiced countrywide in India although having most no of cases of oral malignancies. Objectives Objective of this paper is to evaluate the biological, technical considerations along with complications associated with the rehabilitation of patients with dental implants in radiated micro vascular free fibular graft in malignancy cases. Methods Implant placement was done in radiated free fibula cases after a period of 18 to 24 months of radiation. loading was done after 4–5 months. Evaluation of all aspect was taken care pre, intra and post operatively. Evaluation of different aspects like location of implants, placement difficulty, height factor, osseointigration and infection were evaluated in all patients. Results Careful planning, selection of patients, age, psychological status of patients, surgeons expoertise are the main factors which led to successful outcome of implants in such cases. Although complications like infection and failure rate is higher in such patients. Conclusions It can be concluded that dental implant supported prosthesis can play vital role in reconstructed mandible by restoring functional occlusion, better nutrition, better oral health, better confidence of patients and psychology. References/Bibliography 1. DMD Ian et al, The mandibu Osseointegrated implants and functional prosthetic rehabilitation in microvascular fibula free flap reconstructed mandibles, The American Journal of Surgery: Volume 164, Issue 6, December 1992, Pages 677–681. 2. Efficacy of dental implants placed into fibula-free flaps for orofacial reconstruction, Franz-Josef Kramer, Rupert Dempf, Bernd Bremer, clinical oral implant research, Volume 16, Issue 1, February 2005: Pages 80–88.

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ABS00601 KCOT a Conundrum of Odontogenic Pathologies: A Rare Recurrence in Temporalis Muscle with Malignant Transformation in to Squamous Cell Carcinoma

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ABS00757 A Rare Vascular Lesion in Maxilla: A Mystery Solved After Excision. ‘‘A Challenge for Maxillofacial Surgeons’’ Dr. Mounabatti Mohapatra, Prof & Head

Dr Kanubaddy Sridhar Reddy, Associate Professor Department of Oral Maxillofacial Surgery Narayana Dental College Nellore Andhra Pradesh Abstract Background/Introduction This report describes a rare case of recurrent keratocystic odontogenic tumor (KCOT) in temporalis muscle with malignant transformation into squamous cell carcinoma in a 55-year-old woman, who presented with a painless swelling over right temporal region following hemimandiblectomy done for KCOT. Computed tomography (CT) findings did not reveal any obvious temporal bone resorption and the provisional clinical diagnosis was a cystic lesion. The entire mass was excised under general anesthesia and the pathological diagnosis was KCOT with malignant changes of cystic lining. Significantly this transformation was not evident in clinical and radiological assessment but required meticulous histopathological examination. This is the first reported case of recurrence in temporalis with malignant transformation into squamous cell carcinoma to the best of author’s knowledge. Patient remained free of recurrence in postoperative follow up for two years and her present status is unknown. Objectives To determine the factors for recurrence and malignant transformation of KCOT. Methods A single case report from Department of Oral Maxillofacial Surgery Narayana Dental College was studied for its clinical radiological and histopathology findings with recurrent KCOT. Results This report highlights the significance of meticulous histopathological examination of the deceptive epithelial lining of KCOT to find out any early changes in view of its potential neoplastic transformation. Conclusions The previous reports of malignant transformation of KCOT though few should prompt the clinicians for regular follow up of all patients who have been surgically treated for multiple recurrences as the existence of squamous cell carcinoma is usually revealed after surgical resection and as there no reliable tools to predict which cyst can transform. There is an imperative need for further research at molecular level treatment for KCOT though it is novelty at present but should influence future treatment plans as the aggressive treatment strategies at times have failed to impede the recurrences. References/Bibliography 1. Tan B, Yan TS, Shermin L, Teck KC, Yoke PC, Goh C, et al. (2013) Malignant transformation of keratocystic odontogenic tumor: two case reports. Am J Otolaryngol 34(4):357–61. 2. Worrall SF. (1992) Recurrent odontogenic keratocyst within the temporalis muscle. Br J Oral Maxillofac Surg. 30(1):59–62.

AIIMS Bhubanesar Dr Ankita Srivastava Senior Resident Maxillofacial Surgery AIIMS Bhubaneswar Abstract Background/Introduction Surgery of vascular lesions in maxillofacial region is always challenging. For few lesions, correct diagnosis before treatment is not possible. Undertaking such cases for surgery without a definitive diagnosis is still more challenging for a surgeon. Here to present one such case of slow growing, nontender, firm, swelling in right maxilla, whose initial diagnosis both on various imaging techniques like plain xray, non contrast CT Scan, USG, Angiogram and Incisional biopsy was a vascular lesion only. As the growth was increasing in size, for the benefit of patient, surgery was undertaken and challenge was accepted. Subtotal maxillectomy was done with proper precautionary measures to prevent any haemorrhagic consequences. The resected mass was send for histopathology and then mystery was revealed. Histopathology report was suggestive of composite haemangioendothelioma. Intraosseous che is a extremely rare vascular neoplasm of head and neck region seen in younger age group. Commonly involved sites are skin, long bones, striated muscles, liver and mammary glands. It is moderately malignant which might metastasize via haematogenous routes and treatment of choice is surgical resection. Histopathology is the confirmative diagnostic aid for the lesion. It has local recurrence rate of upto 50%. By presenting this case we would like to draw the attention of clinicians toward these rare challenging cases which should always be considered for differential diagnosis of intra bony lesions in maxillofacial region. Keywords: Haemangioendothelioma, Maxillectomy, Metastasis, Haematogenous spread. Objectives Objective of presenting this case in a national conference is to appraise about such rare challenging cases which should always be considered for differential diagnosis of intrabony lesion in maxillofacial region. Methods Not Applicable. Results Not Applicable. Conclusions Surgery of vascular lesions in maxillofacial region is always challenging. For few lesions, correct diagnosis before treatment is not possible. Undertaking such cases for surgery without a definitive diagnosis is still more challenging for a surgeon. References/Bibliography 1. Bhat A, ChowdAPPA V. Composite Hemangioendothelioma: Report of a Rare Case. Journal of clinical and diagnostic research: JCDR. 2016 Oct;10(10):ED01. 2. Singhal a yadav RC Haemangioendothelioma maxilla. Indian Journal of Otolaryngology 1990:40(2)73–74.

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Section: Oral Surgery ABS0025 CBCT @Maxilla Dr Vimal Kalia, Principal and Head of Department BRS Dental College, Panchkula Abstract Background/Introduction Maxillary bone can be considered the key stone of the face as all the immobile bones are connected to it. Its pertinent for a maxillofacial surgeon to understand this very important keystone. Anatomic considerations of maxilla must be understood, including the position of the nerves, sinuses and bone undercuts. The thickness and angulation of bone must be studied, and the integrity of the buccal and lingual plates clearly determined. Objectives This presentation aims to cover all the anatomical considerations of maxilla in CBCT including their clinical applications. Methods 100 CBCT scans were studied and topographic study done. Parameteres were drawn and measurements were made. Results All the measurements made were subjected to statistical analysis and distances were established for vital structures. Conclusions For this purpose, Cone beam computed tomography (CBCT) is an important tool in the hands of a clinician for diagnosis and preparation of any case. It provides with complete information on vital anatomy in the areas of consideration by producing a three-dimensional view of all of the oral structures. Scanning software allows for the fabrication of precise planning and surgical guides, which help to ensure a positive result. Communication with the patient concerning this innovative therapy reduces anxiety of an unknown procedure and increases treatment acceptance. It can help the practitioner guarantee success by alleviating most common fears prior to any surgical intervention. References/Bibliography Adibi S, Zhang W, Servos T, Neill PN. Cone beam computed tomography in dentistry: what dental educators and learners should know. Jof Dental Education 2012; 76(11):1437–42.

ABS0026 CBCT @Mandible Dr Geeta Kalra, Reader BRS Dental College, Panchkula Abstract Background/Introduction The mandible is the only bone in the entire cranium that doesn’t articulate with its adjacent skull bones via sutures. When the skull is observed purely as a bony structure, there is nothing anatomically holding the rest of the skull and the mandible together. It is also the strongest and most massive bone in the face and is the only movable

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 bone in the skull. It becomes essential for a surgeon to understand the anatomy of this bone along with understanding the placement and form of different structures passing through it. Objectives This paper aims at highlighting the use of CBCT in surgical procedures of mandible with the help of clinical case presentations. Methods 100 CBCT scans were studied. Parameters were drawn. All the distances were measured for vital structures. Results All parameters were subjected to statistical analysis and results were formulated. CBCT is capable of providing accurate, submillimeterresolution images in formats allowing 3D visualization of the complexity of the maxillofacial region. All current generations of CBCT systems provide useful diagnostic images. Conclusions CBCT allows us to create an accurate treatment plan and increases our chances for surgeries that are minimally invasive, minimally morbid and time saving and at the same time, conservative, with predictable prosthetic result. References/Bibliography Quereshy FA, Savell TA, Palomo JM. Applications of cone beam computed tomography in the practice of oral and maxillofacial surgery. J Oral Maxillofac Surg 2008;66(4):791–6.

ABS0033 Complex & Compound Odontoma Associated with Impacted Teeth (Report of 4 Rare Cases) Dr Parveen Akhter Lone Indira Gandhi Government Dental College Jammu Abstract Background/Introduction Odontomes are defined as hamartomas of odontogenic origin & are usually considered as developmental anomalies resulting from the a growth in which both epithelial cells exhibit complete differentiation of both epithelial & mesenchymal cells that give rise to both ameloblast & odontoblast. These tumours are basically formed of enamel & dentine & have variable amount of pulp issue & cementum. According to World Health Organization (WHO) classification, odontomas can be divided into three groups. • Complex odontoma: When the calcified dental tissues are simply arranged in an irregular mass bearing no morphologic similarity to rudimentary teeth. • Compound odontoma: Composed of all odontogenic tissues in an orderly pattern, which result in many teeth-like structures, but without morphologic resemblance to normal teeth. • Ameloblastic fibroodontoma: Consists of varying amounts of calcified dental tissue and dental papilla-like tissue, the later component resembling anameloblastic fibroma. The ameloblastic fibro odontoma is considered as an immature precursor of complex odontoma. We aim to report Large complex odontoma associated with impacted permanent molar in 15 years old boy (Rare case reports) Two cases of complex odontoma associated with impacted maxillary central incisors Compound odontoma with 9–10 teeth like structures associated with impacted mandibular first premolar in 24 years old female (rare case). Objectives The aim of this article was to report the very rare size complex odontome & compound odontome having 9–12 no of teeth like structures Which are rarely reported in literature as per my knowledge.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Methods Patients were referred to our department for painless swelling, with missing teeth. After clinical & radiographic examination odontomes with impacted teeth were diagnosed. Three cases were done under local anesthesia & one under general anesthesia. All the four cases were done by intra oral approach. Results All the patients were between 15–25 years of age. Two patients were male & 2 females. All the odontomes associated with impacted permanent teeth. Conclusions It is suggested that any patient in adolescent age group reporting with delayed eruption of teeth should be evaluated properly by clinical & radiographic examination of jaws. Early diagnosis & management will prevent the associated pathologies like dentigerous cyst & have better prognosis & less expansive treatment. References/Bibliography ¨ z, G., Tosun, G., Kiziloglu, D., Durmus, E. and Sener, 1. Yildirim-O Y. (2007) An Unusual Association of Odontomas with Primary Teeth. European Journal of Dentistry, 1, 45–49. 2. Singh, S., Singh, M., Singh, I. and Khandelwal, D. (2005) Compound Composite Odontoma Associated with an Unerupted Deciduous Incisor—A Rarity. Journal of the Indian Society of Pedodontics and Preventive Dentistry, 23, 146–150. http://dx.doi.org/10.4103/0970-4388.16889.

ABS0039 FESS: An Innovative Technique to Treat Chronic Maxillary Sinusitis

S67 Methods 18 patients with prominent symptoms of chronic maxillary sinusitis in the age group of 10–50 years were selected and an intervention study was carried out by treating patients with Functional Endoscopic Sinus Surgery. Results All patients were monitored post-operatively after first, third and sixth week on the basis of clinical and radiological features. The results were statistically significant after Function Endoscopic sinus surgery. Conclusions Functional Endoscopic Sinus Surgery appears to be a reliable, minimally invasive technique associated with less morbidity and lower incidence of complications. References/Bibliography 1. Stammberger H et al: Surgical treatment of chronic recurrent sinusitis–the Caldwell-Luc versus a functional endoscopic technique, HNO. 1987 Mar; 35(3): 93–105. 2. Unlu HH et al: An endoscopic and tomographic evaluation of patients with sinusitis after endoscopic sinus surgery and Caldwell-Luc operation: a comparative study, J Otolaryngol, 1994 Jun; 23(3): 197–203.

ABS0057 Use of Platelet Rich Plasma (PRP) with Hydroxyapatite in Post Surgical Jaw Defects Dr. Braj Bhushan Mall, Assistant Professor Department of Oral and Maxillofacial Surgery, Dental College RIMS Imphal, Manipur, India

Dr. Prajwalit Prakash Kende Associate Professor & HOD Government Dental College & Hospital Mumbai Abstract Background/Introduction The maxillary sinus is the largest of all other sinuses, also called as antrum of Highmore, which actually presents as a small cavity at birth, starting its development during the third fetal month and usually reaching its maximum development in early adult life about the eighteenth year. Nearly 10% to 12% of the pathological conditions involving the maxillary sinus are of dental origin. Prof. Messerklinger’s work in late 1960s and early 1970s on sinus mucosa and mucocilliary transport has proved that the pathology is not principally in the larger sinuses but is secondary to impaired drainage caused by the disease in the ethmoidal air cells blocking their natural Ostia in the middle turbinate which leads to stagnation of secretions and hence, persistent infection resulting in a vicious cycle causing mucosal swelling that can be so gross as to appear ‘‘irreversible. Thus, a revised approach to maxillary sinus should be directed towards conservative principles favoring the regeneration of the normalized mucous membrane. Objectives The Caldwell-Luc operation or the conventional procedures, which earlier aided as an equally productive intervention for chronic maxillary sinusitis has been recently criticized for its shortcomings and limitations. Thus, a revised approach, to maxillary sinus should be directed towards conservative principles favoring the regeneration of the normalized mucous membrane. Hence, an in vivo study was undertaken to clinically assess the outcome after Functional Endoscopic Sinus Surgery.

Abstract Background/Introduction ‘‘Healing is defined as restoration of original integrity of tissues.’’ Healing occurs by combination of regeneration & repair which may be of primary intension or secondary intension. Sequel of healing are initial hemorrhage, acute inflammatory response, epithelial changes & organization. Bone healing is accomplished by organized sequence of bone formation. Some of the components or compounds of bone matrix induces bone formation via interaction between pluripotential cells & morphogenetic proteins converting these cells to osteoblasts. Objectives To evaluate the effect of Platelet-rich plasma (PRP) with hydroxyapatite (HA) in healing of post surgical osseous defects clinically and radio graphically. To evaluate complications related to the grafting procedure and natural healing of bone in osseous defects. Methods After selection according to inclusion and exclusion criteria’s, 40 patients were selected. All the patients were to undergo surgical enucleation of the cystic lesion or extraction of impacted mandibular teeth, followed by placement of platelet rich plasma (PRP) and hydroxyappatite (HA) in the surgical defect. Pre operative and post operative radiographs, ultrasonography, and color doppler were utilized as diagnostic tools. Surgery was performed. After removal of the lesion/tooth the bone defect was packed with mixture of platelet rich plasma (PRP) and hydroxyappatite (HA). Closure of wound was achieved by interrupted sutures using 000 black silk with 16 mm 3/8 reverse cutting needle. The data was analyzed statistically. Results The findings of the study suggests that plate rich plasma is a feasible method to treat post treatment jaw defects with a very high success

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S68 rate and very low rate of complications such as pain, swelling and infection. Ultrasonographic evaluation proved to be beneficial in evaluation of bone formation and calcification whereas Color Doppler evaluation helped to predict the vascularization of the affected area thus showing the evidence of wound healing. Conclusions plate rich plasma is a feasible method to treat post treatment jaw defects with a very high success rate and very low rate of complications. References/Bibliography: Dean H. Whitman and Ronald L. Berry. Platelet gel- An autologous alternative to fibrin glue with application in oral and maxillofacial surgery. JOMS 1997; 55: 1294–1299. Burak Demiralp, Huseyin Gencay Keceli, Mehmet Muhtarogullarn, Ahmet Serper, Bahtiyar Demiralp and Kenan Eratalay. Treatment of periapical inflammatory lesion with the combination of platelet rich plasma and tricalcium phosphate-A case report. J. of Endodontics 2004; Vol. 30(11): 796–780.

ABS0059 Mandibular Fracture in Neonate: A Case Report Dr V Gopalakrishnan, Dr N K Sahoo, Dr Indranil Deb Roy Abstract Background/Introduction Mandibular fractures in neonate are rare. The etiological factors are traumatic delivery, accidental fall, road traffic crashes and attempted infanticide. Diagnosis is difficult due to facial edema masking the clinical features and absence of dentition. Treatment of fractures in newborn represent unique problem in terms of investigations, diagnosis, selection of anesthesia and method of fixation. We present a case of a one day old infant referred to us for management of mandibular fracture sustained due to accidental fall. During oral suction the neonatologist observed continuous blood stained secretion which raised the suspicion of trauma to oral cavity. He was diagnosed as a case of fracture mandibular symphysis with displacement. Under local anaesthesia with sedation the fracture was reduced and stabilized with the acrylic splint which was secured by circum mandibular wiring. The case was followed up for 1.5 year and the healing was satisfactory. Objectives To Treat mandibular fracture s in neonate. Methods Using conservative management. Results Only one case of neonate treated. Conclusions Mandibular fractures to be treated as early as possible irrespective of age. References/Bibliography 1. Lustmann J, Milhem I. Mandibular fracture in infants: Review of literature and report of seven cases. J Oral Maxillofacial surgery 1994: 52: 240–245. 2. Chidzonga M M. Mandibular fracture in a neonate: report of a case. J Oral Maxillofac surg 1996: 54: 1452–1454.

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ABS0066 Platelet Rich Fibrin (PRF): A Magical Healing Biomaterial Dr. Gursimrat Kaur Brar (First Author), Senior Lecturer; Dr. S. P. S. Sodhi (Second Author), Head of Department Department of Oral and Maxillofacial Surgery Dasmesh Institute of Research and Dental Sciences, Faridkot (Punjab) Abstract Background/Introduction The use of autologous platelet concentrates represents a promising and innovator tool in medicine and dentistry today. Platelet Rich Fibrin (PRF) is a fibrin matrix in which platelet cytokines, growth factors and cells are trapped and may be released after a certain time and that can serve as a resorbable membrane. Simplified processing technique not requiring biochemical blood handling makes it superior to Platelet Rich Plasma (PRP). Recent development is advanced PRF (A-PRF), prepared on the concept that leucocytes play a major role in the release of certain cytokines which aid in better wound healing. Also, the use of platelet concentrates in ‘‘liquid’’ form (i-PRF) is a new alternative to the platelet aggregate permitting incorporation of the graft forming a well agglutinated ‘‘steak for bone grafting’’. This paper presents an insight into the use of PRF and its derivatives in various defects. Objectives Use of Platelet Rich Fibrin (PRF) and its derivatives in various bony defects. Methods Platelet Rich Fibrin (PRF) preparation was done by collecting venous blood from antecubital vein of the patient into sterile vacutainer tubes without anticoagulant. These tubes were then placed in Choukroun’s centrifugal machine at 3000 rpm for 10 minutes, after which it settles into three layers. The upper layer is discarded and middle fraction is collected, which is the PRF. Results The results of Platelet Rich Fibrin (PRF) are very promising. The physiological time of healing of a bony defect is much reduced following the use of Platelet Rich Fibrin (PRF). Conclusions Platelet Rich Fibrin (PRF) represents a promising and innovator tool in medicine and dentistry today. PRF and its derivatives is a healing autologous biomaterial which accelerates and enhances the natural wound healing mechanisms of the body. References/Bibliography 1. Gupta V, Bains V. K, Singh G.P, Mathur A, Bains R. Regenerative potential of Platelet Rich Fibrin in Dentistry: Literature Review; Asian Journal of Oral Health & Allied Sciences - Vol 1, Issue 1, Jan-Mar 2011. 2. Saluja H, Dehane V, Mahindra U. Platelet-Rich Fibrin: A second generation platelet concentrate and a new friend of oral and maxillofacial surgeons. Annals of Maxillofacial Surgery; January - June 2011, Vol. 1, Issue 1.

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ABS0094 Management of Impacted Teeth: Antibiotic-Less Dr C A Ashoka Mandya Institute of Medical Sciences, Mandya Abstract Background/Introduction Management of teeth impactions forms the mainstay for an oral surgeon consultation. The use of antibiotic therapy is a well established partner in management of all surgical interventions. Is it still valid in maxillofacial region following management of wisdom teeth. Objectives objective of the study was to establish the necessity of antibiotic prophylaxis in normal healthy individuals. Methods Patients included in the study were healthy patients who presented to the department of dentistry, MIMS Mandya with wisdom teeth complaints. Total of 1000 patients was included in the study. Normal healthy individual without any documented immunocompromised status were included in the study. Study involved removal of impacted teeth using closed and open method. Results study revealed no infection in any of the patients in the post operative follow up period. Conclusions Antibiotics are not a necessity in management of impacted teeth in healthy individuals. Host immune response is adequate in promoting and controlling surgical site healing. References/Bibliography 1. Jens O. Andreasen DDS et al A Systematic Review of Prophylactic Antibiotics in the Surgical Treatment of Maxillofacial Fractures. J Oral Maxillofac Surg 64:1664–1668, 2006.

ABS00120 A Prospective Observer Blinded Randomised Clinical Study to Evaluate the Efficacy of Proteolytic Enzyme Combinations in Third Molar Surgery Dr. Paul C. Mathai, Dr. Neelam N. Andrade, Dr. Neha Aggarwal Abstract Background/Introduction The extraction of third molars is the most commonly performed surgical procedure in Oral and Maxillofacial Surgery with pain, oedema and trismus being the most common post-operative sequelae. Post-operative NSAIDS and steroids used over a long period or in high doses are associated with a multitude of side effects in certain patients. Research into more natural and safer alternatives for the management of pain and inflammation has revealed a class of drugs called Proteolytic Enzymes. Objectives To study the effectiveness of proteolytic enzymes in reducing postoperative pain, oedema and trismus. Methods 90 patients were randomly divided into 3 groups. Class II level B mesioangular and vertical mandibular third molars were selected and a single operator was assigned to maintain uniformity of surgical difficulty and surgical technique. Group A included Tab Diclofenac and Tab Tibrolin [Trypsin, Chymotrypsin and Bromelain]. Group B

S69 included Tab Diclofenac and Tab Chymoral [Trypsin and Chymotrypsin]. Group C included Tab Diclofenac alone. The parameters measured on the 2nd and 7th post-operative days were mouth opening, pain rating on VAS and anatomical facial measurements. Results There was a statistically significant [p\0.05] reduction in pain on the 2nd post-operative day in Group A. There was no difference with respect to oedema and trismus between all 3 groups. No adverse effects were noted in the 3 groups. Conclusions Proteolytic enzymes may be used in combination with NSAIDs to help add to their anti-inflammatory effect and also reduce the net dose of the NSAIDs used. References/Bibliography Inchingolo F, Tatullo M, Marrelli M, Inchingolo AM, Picciariello V, Inchingolo AD, et al. Clinical trial with bromelain in third molar exodontia. Eur Rev Med Pharmacol Sci. Italy; 2010 Sep;14(9):771–4.

ABS00173 Human Amniotic Membrane a Potential Dressing Material in Maxillofacial Region Dr Ashish J Rai, A.B. Shetty Institute of Maxillofacial Region Abstract Background/Introduction Human amniotic membrane (HAM) is known to possess distinctive property like pain reduction, wound protection, bacteriostatic and anti-inflammatory. Amniotic membrane may thus be composes of a single layer of epithelial cells that present on a basement membrane consisting of nonvascular collagenous stroma. It is also known to present HAM serves as a basement membrane that facilitates epithelial cell migration reinforcing adhesion of basal epithelial cells preventing epithelial apoptosis. It is also reported that HAM possess efficient wound healing property due to the growth factors and cytokines present. HAM application lacks a high level of clinical evidence in oral and maxillofacial surgery. Objectives The present case reports demonstrate the application of glycerol-preserved HAM in maxillofacial surgery. The two case reports validate reepithelisation with cervical necrotizing fasciitis. Necrotizing fasciitis is a soft tissue infection of odontogenic origin, chiefly a polymicrobial infection of aerobic, anaerobic, gram positive and gram negative bacteria. Methods 2 cases to demonstrate the primary closure of the defect. Results To evade the disadvantage of skin graft, glycerol-preserved HAM was advocated as grafting material. The clinical success of the two cases provides a possible use of HAM as a new biomaterial in the field of maxillofacial tissue repair. Conclusions HAM is easy to preserve, non immunogenic, economical, easily available, easy to apply and has minimum dressing requirement after application. References/Bibliography Rai M, Ramaraj P N, Sharma A: Use of Amniotic Membrane as Dressing in Cervical Necrotizing Fasciitis. J Oral Maxillofac Surg 2011; 69 page 1125–1128.

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ABS00213 Dental Extraction and Osteoradionecrosis: Current Concepts and Review Dr. Madan Mishra Reader Dept of Oral & Maxillofacial Surgery Sardar Patel PG Institute of Dental & Medical Sciences, Lucknow, UP Abstract Background/Introduction Radiotherapy causes progressive fibrosis and endarteritis which ultimately result in hypovascular, hypocellular and hypoxic jaw bones that can undergo osteoradionecrosis (ORN) on exposure to oral environment due to trauma or tooth extraction. Most of the pre and postradiation dental extractions are based on empirically designed protocols rather than evidence based studies. Many clinicians routinely prescribe prophylactic hyperbaric oxygen (HBO) therapy for prevention of ORN. Objectives This paper reviews the world English literature in an attempt to formulate guidelines for more successful and uneventful outcomes after pre or post-radiation dental extractions. Methods An extensive search of world English literature was carried out on Medline-Pubmed and Google Scholar using keywords osteoradionecrosis, dental extractions, radiotherapy, irradiated jaw, HBO therapy. Results Despite lacking in adequate methodological design, most of the existing literature suggest for meticulous history, careful case selection and atraumatic extraction techniques rather than relying more on HBO therapy. Conclusions Incorporation of multidisciplinary team approach and careful extraction selection with meticulous follow-up can lower osteoradionecrosis rates. References/Bibliography: 1. Nabil S, Samman N. Incidence and prevention of osteoradionecrosis after dental extraction in irradiated patients: a systematic review. Int J Oral Maxillofac Surg 2011;40:229–43. 2. Fritz GW, Gunsolley JC, Abubaker O, Laskin DM. Efficacy of pre- and postradiation hyperbaric oxygen therapy in the prevention of postextraction osteoradionecrosis: a systematic review. J Oral Maxillofac Surg 2010;68:2653–60.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 leading to neurologic complications. Hence localizing the accurate position of IAN is always recommended. OPG is commonly employed as a pre-operative diagnostic tool for evaluation of impacted third molars. However, it provides only 2 dimensional information of a 3 dimensional object. Where, CBCT provides three – dimensional information of the anatomical relationship between the third molar roots and adjacent vital structures. Objectives 1. To evaluate the impacted mandibular third molar using CBCT preoperatively. 2. To determine the accuracy of preoperative CBCT findings by correlating it with intra operative findings. Methods A total of 50 samples with signs or symptoms of impacted mandibular third molars and requiring the treatment of surgical removal of these teeth were included in the study. Third molars were evaluated preoperatively using CBCT and the parameters such as, proximity of third molar to IAC, number and morphology of the roots and buccal/lingual version of the tooth was assessed. Following this, surgical removal of third molar was done employing a standardized procedure. The outcomes were correlated with the preoperative CBCT findings. Results Out of 50 samples in 35 patients, root proximity/relation to the IAC was assessed preoperatively on the CBCT scan and the same was evaluated intra-operatively as the presence or absence of canal bleed following the surgical removal of the tooth. Intra-operative bleeding from the IAC was observed in 6 samples. On correlating these values with pre-operative assessment of the root proximity to the IAC, it was found that in all these samples, the root tips were within a distance of =0.5 mm from the IAC. The correlation between pre-operative and intra-operative evaluation of the roots, including the number and root morphology were 100 % accurate. Buccal/lingual version of the third molar (both crown and root) with respect to the buccal and lingual cortices was verified by the qualitative evaluation of the tooth socket intra-operatively. The intra-operative findings of this parameter in all the samples were suggestive of the pre-operative evaluation done on the CBCT. Conclusions This study showed that Cone CBCT is a very accurate tool for the preoperative evaluation of impacted teeth in terms of root proximity/relation, root morphology and pattern and buccolingo version of impacted mandibular third molar and it provides all the necessary anatomical data that helps the surgeon in its treatment planning with avoidance or reduction of treatment related complications. References/Bibliography

ABS00315 Preoperative Assessment of Impacted Mandibular Third Molar Using CBCT and Its Clinical Correlation Intraoperatively Dr Rahul Maheshwari (Consultant), Dr. Ramdas Balakrishna (Professor & HOD), Dr. G C Veena (Professor), wd jkl Dr Bhuvaneshwari Srinivasan (Senior Lecturer), Dr Kartik Tank (Consultant) K.L.E Society’s Institute of Dental Sciences, Bengaluru Abstract Background/Introduction Removal of impacted mandibular third molar is the most common performed surgical procedure and may result in injury to the IAN,

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1. Jun SH, Kim CH, Ahn JH, Padwa BL, Kwon JJ. Anatomical differences in lower third molars visualized by 2D and 3D X-ray imaging: clinical outcomes after extraction. Int. J. Oral Maxillofacial Surg 2013;42:489–496. 2. Suomalainen A, Venta¨ I, Mattila M, Turtola L, Vehmas T, Peltola JS. Reliability of CBCT and other radiographic methods in preoperative evaluation of lower third molars. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:276–284.

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ABS00325 A Comparative Evaluation of Transdermal Diclofenac Patch with Oral Diclofenac as an Analgesic Modality Following Surgical Removal of Mandibular Third Molar

S71 References/Bibliography

Dr Neha A. Harankhedkar, Assistant Professor, Dr. Ramakrishna Shenoi, Professor and Head

1. Bachalli PS et al. A comparative study of diclofenac transdermal patch against oral diclofenac for pain control following removal of mandibular impacted third molars. J Maxillofac Oral Surg 2009;8(2):167–72. 2. Bhaskar H et al. Comparison of transdermal diclofenac patch with oral diclofenac as an analgesic modality following multiple premolar extractions in orthodontic patients: A crossover efficacy trial. Contemp Clin Dent 2010;1(3):158–63.

Dept. of OMFS, Dr. D.Y. Patil Dental College, Pimpri, Pune Add - 2, Saraswati appt., 4, Ashok Nagar, Bhosale Nagar Road, Pune 411007 Mobile No. - 9823024992 Email [email protected]/[email protected]; Dept of OMFS, V.S.P.M. Dental College, Nagpur Add - 301, Abhinav Residency, B1 Lakshmi Nagar, Nagpur - 440022 Mobile No 9822220505 Email - [email protected]

ABS00402 Preoperative Intravenous Tramadol Versus Ketorolac for Preventing Postoperative Pain After Third Molar Surgery

Abstract Background/Introduction Dealing with postoperative pain remains an arena for never ending research with better formulations and modalities continuously replacing obsolete ones. Pain after third molar surgery has often been a nemesis for oral surgeons and patients alike due to the considerable degree of inflammatory response involved. Oral administration of NSAIDs, however, carries a risk of first pass metabolism with significant amount of the drug being lost before it is systemically absorbed. Oral NSAIDs are also known to cause several adverse effects, particularly gastrointestinal effects, which are dose dependant. This study of a transdermally delivered drug is a way of chasing a new path to achieve more effective management of post operative pain after third molar surgeries with minimal occurrence of adverse effects. Objectives 1. To evaluate the effect of transdermal diclofenac on pain reduction. 2. To evaluate the effect of transdermal diclofenac on trismus alleviation. 3. To evaluate the effect of transdermal diclofenac on reduction in swelling. 4. To compare the findings with those of Diclofenac tablets. Methods • Study design - Experimental study with random selection. • Sample size – Total 60 patients divided into 2 equal groups A and B. • Group A - Tablet diclofenac sodium (50 mg) orally • Group B - Diclofenac patch (100 mg) transdermally • Third molars removed surgically. • Pain, swelling and trismus were measured preoperatively and on 1st, 3rd and 7th postoperative days. • Results compared. • Data analyzed with software STATA version 13.0. Results • On both 3rd and 7th postoperative day, reduction in intensity of pain was significantly more in group B (p 1.0161 and \ 0.0001 respectively). • On 3rd postoperative day, both the therapies resulted in almost equal reduction in swelling (p 0.0836). However, on 7th postoperative day, more reduction in swelling was observed in patients of group B (p\0.001). • On 3rd postoperative day, significantly more increase in inter-incisal distance was observed in patients of group B (p 0.0123). However, on 7th postoperative day, there was no significant difference in values of both the groups (p 0.893). Conclusions Oral Diclofenac showed better pain control in the immediate postoperative period when compared to the transdermal form. However, in the following postoperative days, results of both the groups were comparable with negligible side effects from trandermally delivered drug.

Dr. Gaurav Verma, Reader Institute of Dental Sciences, Sehora, Jammu & Kashmir, India. Phone Number- ?919736565635 E Mail- [email protected] Abstract Background/Introduction The aim of preemptive analgesia is to prevent postoperative pain by administration of various therapeutic agents prior to surgery. Preemptive analgesia concept is based on the principle of prevention of peripheral and central sensitization of pain pathways by nociceptive impulses. Pain is a predictable outcome after surgery. Preemptive analgesia may prove to be a valuable tool in preventing postoperative pain. Objectives The objective of this study was to evaluate & compare the preemptive analgesia efficacy of intravenous ketorolac and intravenous tramadol in prevention of postoperative pain after surgical extractions of mandibular third molars. Methods Forty patients who required surgical extraction of mandibular third molars were divided randomly into two groups. Group-I [Tramadol Group (n=20)] patients were given 50 mg tramadol intravenously preoperatively. Group-II [Ketorolac Group (n=20)] patients were given 30 mg ketorolac intravenously preoperatively. Surgical extractions were performed under local anesthesia. The parameters under evaluation were postoperative pain intensity measurement, mean time after which rescue analgesic was taken, total analgesic consumption over 5 day recovery period, and patient’s assessment of the surgical procedure. Results The result of the study revealed that, there was no statistically significant difference between the two groups in relation to the clinical parameters under investigations except patient’s assessment of the surgical procedure. Greater percentage of patients in ketorolac group rated the procedure relatively better and less painful by giving higher scores. Conclusions Although both ketorolac and tramadol were equally efficacious as preemptive analgesics on statistical backgrounds but ketorolac seems to be more efficacious on clinical grounds. References/Bibliography Ong KS, Tan JML, ‘‘Preoperative Intravenous Tramadol Versus Ketorolac for Preventing Postoperative Pain after Third Molar Surgery’’. Int J Oral Maxillofac Surg. 2004; 33(3):274–278.

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ABS00429 Murva: A Biotic Strand for Biological Healing Dr Ashutosh Thorat (Consultant Oral & Maxillofacial Surgeon, Pune), Dr Pravin Lambade (Consultant Oral & Maxillofacial Surgeon, Nagpur) Abstract Background/Introduction The success of any surgical procedure depends upon healthy healing, which in turn depends upon the suture material used & the method employed for the closure. Many synthetic materials have replaced the natural materials, which were once used for suturing in the ancient times, and Murva is one of them. There are references of Murva (Sansevieria roxburghiana Schult. and Schult.f.) at various contexts of ‘‘Sushruta Samhita’’ where it has been used as a suture material. It is a xerophytic herbaceous plant occurring abundantly in the eastern coastal region of India. This study is carried out to compare the efficacy of murva fiber with Silk as suture material. Objectives The objective of this study is to compare the efficacy of Murva fibers with Silk as a suture material in closure of intraoral incision in third molar surgeries. Methods Fifty incisions (Wards incision) placed for the surgical removal of mandibular third molar were sutured with Murva and fifty incisions with Silk. Patients were evaluated for pain, swelling, hemostasis, infection, wound dehiscence, local tissue irritation, and bacterial colonization. Follow-up were scheduled on postoperative 1st, 2nd, 3rd, and 7th day. Results On comparing these two suture materials, in terms of post-operative pain, swelling, hemostasis, infection, wound dehiscence, local tissue irritation and bacterial colonization, the results were in favour of Murva as compared to Silk. Conclusions This study indicates that Murva can be effectively used as an alternative suture material to Silk as it is natural, economical and biocompatible with an antimicrobial activity. References/Bibliography Lambade P, Thorat A. Efficacy of murva (Sansevieria roxburghiana Schult. and Schult.f.) as a suture material in closure of incisions in third molar surgeries: A prospective study. Natl J Maxillofac Surg 2017;8:19–25.

ABS00448 Intraligamental Injection for Dental Extraction: A Prospective Randomised Clinical Study S. Rajurkar, M. Deshpande, R. Makwana, P. Ranadive, A. Nikunj, N. Kazi, S. Ingole Nair Hospital Dental College, Mumbai Abstract Background/Introduction The most common techniques used for dental anesthesia are Regional Nerve block and Local infiltration. These are standard injection techniques for securing local anaesthesia prior to minor surgical procedures on maxilla and mandible.

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Objectives Purpose of this study was to evaluate effectiveness of Intraligamental Injection technique for dental extraction in maxilla and mandible. Methods The study included 100 patients (50 patients requiring extraction of permanent mandibular molars bilaterally and 50 patients requiring extraction of maxillary anterior teeth bilaterally). 2% Lignocaine Hydrochloride with 1:80,000 adrenaline was standard anesthetic agent used. In mandible, one side was anesthetized via Pterygomandibular block (PTB) and other by Intraligamental injection. Similarly in maxilla one side was anaesthetized via Infiltration while other by Intraligamental injection. Pain was recorded on VAS scale and cardiovascular changes noted in both cases before and after injection. Results In mandible, 4 out of 50 patients (8%) and in maxilla, 6 out of 50 patients (12%) did not have objective signs of anesthesia via Intraligamental Injection and therefore extractions were carried out under anesthesia by conventional technique. Minimal fluctuations in vital parameters viz pulse rate and blood pressure was noticed with intraligamental technique. A minimal difference in pain and discomfort on injection was noted in both cases. Duration of anesthesia was longer with conventional PTB and infiltration technique, however in terms of onset of anesthesia and volume of anesthetic agent used, Intraligamental injection was superior in both cases. Conclusions It is recommended that use of Intraligamental injection be included as a necessary skill for dental graduates in the interest of patient care. References/Bibliography The periodontal ligament (PDL) injection: an alternative to inferior alveolar nerve block. Malamed SF.

ABS00465 Ascendancy of Two Flap Tracery on Swelling, Pain, Trismus, Alveolar Osteitis Following the Surgical Extraction of the Impacted Third Molar: A Prospective Study Dr. Nandini, Reader Sathyabama University Dental College & Hospital Abstract Background/Introduction Surgical removal of lower third molar teeth is a common procedure and is associated with potential postoperative complications which include pain, swelling, trismus, and alveolar osteitis. To minimize these complications clinicians have sought an optimal surgical approach and have investigated the use of various flap designs. The aim of this study is to compare the incidence and severity of postoperative complications after mandibular third molar surgery using the modified triangular flap and the envelope flap. Objectives To investigate the influence of flap tracery on postoperative pain, trismus, and swelling. Methods Twenty patients were included who has bilaterally impacted mandibular third molars in arandomized prospective split mouth study. Two flap designs were used: a buccal envelope flap and a modified triangular flap. Postoperative pain was recorded using a

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standardized visual analog scale. Postoperative swelling evaluated using measurements of facial markings of the patient’s cheek taken pre-operatively and two days postoperatively. Trismus assessed with pre-operative & post-operative mouth opening. Results There were no statistical differences between the flap designs in terms of severity of postoperative pain or trismus. A statistically significant difference was observed in postoperative swelling at 2 days, with the modified triangular flap design being associated with increased swelling. The envelope flap design was associated with a higher incidence of alveolar osteitis. Conclusions The flap designs used in this study did not adversely affect patients in terms of postoperative pain and trismus, and although greater extraoral swelling was seen with the modified triangular flap design.

measured in 3 point measure on days 1, 2, and 7 after surgery trismus was assessed using interincisal mouth opening ability. Results A total of 20 patients (10 per treatment group) were included in the study. The proportion of patients reporting no pain on the Visual Analog scale was significantly higher in the group receiving dexamethasone and Etoricoxib compared with that in the groups receiving Etoricoxib monotherapy Facial swelling was significantly less with dexamethasone and Etoricoxib. Conclusions In this study, concomitant treatment with dexamethasone and Etoricoxib provided significant relief of postsurgical pain and swelling compared with monotherapy Etoricoxib.

References/Bibliography

1. Evaluation of methylprednisolone and flurbiprofen for inhibition of the postoperative inflammatory response. Sisk AL, Bonnington Coral Surg Oral Med Oral Patho. 1985;60:137–145. 2. Pain Control with dexamethasone, etoricoxib or ibuprofen associated with arginine in impacted third molar surgery. Alessandro Hyczy et al. Rev Gaucha., Porto Alegre, v61, n.3, p. 335–340, jul./set., 2013.

1. Primary wound healing after lower third molar surgery: evaluation of two different flap designs. Jakse N et al. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;93:7–12. 2. Influence of two different flap designs on incidence of pain, swelling, trismus, and alveolar osteitis in the week following third molar surgery. D. Glenn Kirk et al. OOOE2007:104;e1–e6.

ABS00472 Comparing the Eventuality of Dexamethasone Coadministered with Etoricoxib and Etoricoxib MonoTherapy After Bi Lateral Third-Molar Extraction: A Randomized Prospective Study

References/Bibliography

ABS00488 Post Extraction Bacteremia: Prospective Study to Evaluate the Need for Prophylactic Antibiotic Coverage Aaditya S Markandey, RS Bedi, Puneet Wadhwani, Jitender Aurora, Madhumita Srivastava

Dr Anu Sudha P, Reader Saraswati Dental College, Lucknow Sathyabam University Dental College & Hospital Abstract Background/Introduction Extractions of impacted mandibular third molars generally cause patients discomfort, making it difficult for them to cope with their normal routines. The postoperative phase is characterized by signs and symptoms such as pain, oedema, restricted opening of the mouth and potential loss of function, due to the inflammatory response to the surgery. Dexamethasone is quite widely used to minimize pain, and principally oedema, after third molar extractions. Despite this, researchers have suggested further studies using Prostaglandin-endoperoxide synthase-2 (COX-2) selective inhibitors for oral surgery. Etoricoxib is a COX-2 selective inhibitor anti-inflammatory drug which has been shown to be effective in treating pain, having a rapid response and prolonged effect. Objectives The aim of this study was to compare the effects of dexamethasone 8 mg IM and Etoricoxib 60 mg PO and monotherapy with Etoricoxib 60 mg PO on postoperative pain, swelling, and trismus after surgical removal of third molars. Methods This randomized, prospective study was conducted at the Department of Oral and Maxillofacial Surgery, Sathyabama University, Chennai. Patients were randomly allocated to 1 of 2 treatment groups: concomitant treatment with dexamethasone 8 mg IM and Etoricoxib 60 mg PO or monotherapy with Etoricoxib 60 mg PO. Overall analgesic efficacy of the drug combinations was assessed for 7 days postoperatively using Visual Analog scale (1–10). Facial swelling was

Abstract Background/Introduction Bacteremia is especially common phenomenon that follows tooth extraction & other dental procedure. Objectives To estimate the prevalence & nature of bacteremia in non pathogenic or iatrogenic extractions. Methods This split mouth study included 25 patients who were divided into 3 groups – (1) group A- control group, (2) group B- receiving NS as a mouthwash with prophylactic antibiotic coverage. (3) group Creceiving chlorhexidine as a mouthwash and no antibiotic prophylaxis given. Peripheral venous blood samples were collected preoperatively, immediate, 5mins, 15mins and 30mins after extraction and inoculated in glucose broth. These then processed for aerobic and anaerobic culture and subculture by conventional microbiological techniques. Results Positive blood cultures were detected in patients after dental extractions. No relationship between the state of oral health, which was assessed using the plaque & gingival indices. Conclusions Our study concluded that routine use of chlorhexidine mouthwash before dental extraction is recommended to reduce the risk of bacteremia following tooth extraction.

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Toma’s et al, Effect of a Chlorhexidine Mouthwash on the Risk of Postextraction Bacteremia, Infect Control Hosp Epidemiol 2007; 28:577–582. II. Nicholas B. DuVall et al, The comparative efficacy of 0.12% chlorhexidine and amoxicillin to reduce the incidence and magnitude of bacteremia during third molar extractions: a prospective, blind, randomized clinical trial, Oral Surg Oral Med Oral Pathol Oral Radiol 2013;115:752–763.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 2. Saatchi M, Khademi A, Baghaei B, Noormohammadi H. Effect of sodium bicarbonate– buffered lidocaine on the success of inferior alveolar nerve block for teeth with symptomatic irreversible pulpitis: a prospective, randomized double-blind study. Journal of endodontics. 2015 Jan 31 41(1):33–5.

ABS00551 Macro and Micro Challenges in Treatment of Ameloblastoma

ABS00513 Comparison of PH Buffered Local Anesthesia Containing 8.4% Sodium Bicarbonate Solution with Standard Local Anesthesia for Infra Orbital Nerve Block

Dr. Lakshmi Shetty Associate Professor

Dr. Sapna Vadera

Abstract Background/Introduction Ameloblastoma has been an challenge being a locally aggressive tumour causing the operating oral and maxillofacial surgeon in an diagnostic and surgical dilemma. Ameloblastoma over the last two decades has changed its rate of presentation in the various clinical presentation be it unicystic variant to basal cell variant form. There is a need to systematically review with clinical evidence based approach for the treatment of this extensive odontogenic tumour in a macroscopic defect scenario and microvascular rehabilitation. Objectives To determine evidence based approach for assessment of the ameloblastoma 2. To evaluate the diagnostic protocols for assessment of the ameloblastoma 3. To determine the synchrony between clinical assessment to intraoperative assessment of ameloblastoma 4. To determine the treatment strategies for the macrodefects caused due to the extension of the lesion. Methods The evidence based approach with the assessment of all the databases of Cochrane, Pubmed, Europe Pubmed Central for systematically reviewing the articles on the objective of evaluating the various macro and micro challenges in treatment of ameloblastoma was evaluated. The various case scenarios at India in the reported literature was compared with world over protocols. The treatment modalities adapted for the surgical challenges encountered by the operating oral and maxillofacial surgeon was evaluated at various case scenarios. Results There is an enigmatic approach towards the clinical presentation of ameloblastoma. The data obtained from the various databases was evaluated depending on parameters of clinical presentation, radiographic, histopathology dilemma, intraoperative observation, treatment protocols, recurrence, macrodefects, microvascular rehabilitation, newer innovative techniques for preserving the anatomical structure. The clinical case scenarios was compared with the existing evidence based approach. The descriptive analysis of the above was done to determine evidence based protocols. Conclusions The pattern of presentation histopathologically determines the surgical approach of the ameloblastoma. The final motive is to increase the quality of life of the patient. This was achieved with the evidence based approach.

VSPMs DCRC, Nagpur Abstract Background/Introduction Fear-related behaviours have long been recognized as the most difficult aspect of patient management and can be a barrier for good care. Although short-lived, perceived pain of local anesthetic injection is extreme enough to decline further surgery under local anesthesia. The use of buffered anesthetic solutions significantly reduces pain associated with infiltration without compromising onset, extent, or duration of anesthesia achieved. Sodium bicarbonate is an alkalinizing agent most commonly used. It increases the plasma bicarbonate ion concentration, buffers the excess hydrogen ions, and leads to the rise in pH of blood, thereby reversing clinical signs of acidosis. Objectives To evaluate and compare the effect of buffered local anesthesia (2% lignocaine, 1:2,00,000 adrenaline containing 8.4% sodium bicarbonate solution) on pain on injection, onset of anesthesia & duration of action with those of standard local anesthesia. Methods A prospective, double-blind, randomized study was carried out on 100 patient (50 patients in each group) Maxillary teeth were indicated for extraction under Infra orbital nerve block category. Results Buffered lignocaine produced less pain on injection compared to conventional solution. It also provided quicker onset of anesthesia and increased duration of action. Thus, buffered local anesthesia results in better patient comfort, lessens procedural pain related anxiety, effecting positive patient attitude towards undergoing dental and oral surgical treatments under local anesthesia. Conclusions As the use of buffered lignocaine with adrenaline could serve as a boon in alleviating injection related fear and pain and also result in quicker action, it could play an important role in areas of routine patient care. References/Bibliography 1. Kashyap VM, Desai R, Reddy PB, Menon S. Effect of alkalinisation of lignocaine for intraoral nerve block on pain during injection, and speed of onset of anaesthesia. British Journal of Oral and Maxillofacial Surgery. 2011 Dec 31 49(8):e72-5.

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Department of Oral and Maxillofacial Surgery Dr. D.Y. Patil Dental College and Hospital Dr. D.Y. Patil Vidyapeeth Pune-18. Maharashtra, India. Email Address: [email protected], Phone Number: 9673006494

References/Bibliography 1. Antonoglou GN, Sandor GK. Recurrence rates of intraosseous ameloblastomas of the jaws: A systematic review of conservative

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 versus aggressive treatment approaches and meta-analysis of nonrandomized studies. J Craniomaxillofac Surg 2015;43:149–57. 2. Almeida Rde A, Andrade ES, Barbalho JC, Vajgel A, Vasconcelos BC. Recurrence rate following treatment for primary multicystic ameloblastoma: systematic review and meta-analysis. Int J Oral Maxillofac Surg 2016;45:359–67.

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ABS00662 Evaluation of Series of Secondary Chronic Osteomylitis (SCO) Dr Vandana R Gadve, Assistant Professor, Co Author Dr Varsha S Manekar, Associate Professor Govt Dental College & Hospital, Nagpur

ABS00595 Efficacy of Ozonated Water and Oil on Post Operative Sequelae Following Mandibular Third Molar Surgery: A Prospective Double Blind Study Dr Kishore Moturi; Professor and Head Dept of Oral and Maxillofacial Surgery; Vishnu Dental College; Bhimavaram Abstract Background/Introduction Researchers and Clinicians are always aiming to reduce post operative discomfort and improve the post operative healing after third molar surgery. Various methods are recommended and are being experimented towards attaining the same objective. Ozone therapy has shown promising results in this regard. In General Surgery, Ozonated Virgin Olive Oil has been recommended for better wound healing. Hence, the aim of this study was to evaluate the efficacy of Ozonated Water and Oil on the Post Operative Sequelae following Third Molar Surgery. Objectives 1. To evaluate the effect of Ozonated water and oil on post operative pain, Swelling, Trismus and Healing 2. To evaluate the amount of post operative rescue pain medication taken by the patient following third molar surgery. Methods 50 patients with bilaterally symmetrical impacted mandibular third molars were selected. Informed consent was obtained. Sides were randomly divided into - control and experimental group A single operator operated both sides at an interval of three weeks Irrigation with sterile water and plain virgin olive oil was used on the control side and ozonated water and ozonated virgin olive oil was used on the experimental side Both the Operator and Patient were blinded towards the agent being used. Results The Experimental Group showed statistically significant difference on Pain, Trismus and number analgesics required, though the swelling was similar on both the sides. Conclusions Ozonated water and oil shows a promising result on post operative sequelae after third molar surgery.

Abstract Background/Introduction Secondary chronic osteomyelitis of the jaws are common in the developing countries, where these diseases are associated with trauma, surgical procedures and previous infections, such as endodontic and periapical infections. This paper outlines 13 cases of secondary chronic osteomylitis of odontogenic origin, detailing their mode of presentation, prevalence, proper antimicrobial therapy and surgical treatment. Objectives Evaluation of series of Secondary Chronic Osteomyelitis (SCO) with odontogenic etiology in terms of prevalence, etiopathogenesis, clinical course, and Treatment. Methods 13 cases of secondary chronic osteomylitis of odontogenic origin were evaluated according to their mode of presentation, prevalence, proper antimicrobial therapy and surgical treatment. Results  Mean Age is 38.76yrs. Identified patterns on computed tomogram- Mixed pattern- one case Sclerotic pattern- nil Sequestration seen with/out other bony changes- 4 cases Most microorganisms involved in the pathogenesis of osteomyelitis of the jaws are strict anaerobes, many of them fastidious and very difficult to cultivate 7 cases underwent culture Mucormycosis- one case, Klebicella – 2 cases No growth-4 cases •Lytic pattern- 4 cases With Proper antibiotic therapy and surgical treatment (Decortication, saucerisation, curretage & extractions (4 Cases), Decortication, sequestrectomy, extn (4 cases), Debridement of necrosed bone, extn (3 cases), Sinus opening, debridement of necrosed wall & packing (2 cases) • 12 cases shows good results where as one case with alcoholism & smoking shows recurrence. Conclusions Protocol consisting of thorough surgical debridement of infected & necrotic tissue supported by proper antimicrobial therapy for 30 days can lead to predictable, good results in cases of Secondary Chronic Osteomyelitis (SCO) of jaws. References/Bibliography Elerson Gaetti-Jardim Ju´nior; Francisco Isaak Nicolas Ciesielski; Rice´lia Possagno; Chronic Osteomyelitis of the Maxilla and Mandible: Microbiological and Clinical Aspects Int. J. Odontostomat., 4(2):197–202, 2010.

References/Bibliography 1. Kazancioglu, H.O., Kurklu, E., and Ezirganli, S. Effects of ozone therapy on pain, swelling, and trismus following third molar surgery. Int J Oral Maxillofac Surg. 2014; 43: 644. 2. Sivalingam et al. Topical Ozone Therapy for Postoperative Care. J Oral Maxillofac Surg. 2017; 75: 51.e1–51.e9.

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ABS00673 A Prospective Randomized Double Blind Study to Determine the Efficacy of 2% Lignocaine with 1: 200,000 Epinephrine and 2% Lignocaine with 7ppm Dexmedetomidine in Infraorbital Nerve Block

ABS00752 The Safety and Effectiveness of Superficial Cervical Plexus Block in Oral and Maxillofacial Surgery as an Alternative to General Anesthesia in Selective Cases: A Clinical Study

Sandeep Khandaitkar, Vrinda Kolte - Professor, S.R. ShenoiProfessor & Head

Shahid Hassan Govt. Dental College, Srinagar

V.S.P.M Dental College Nagpur Abstract Background/Introduction Local anesthesia is used for various diagnostic, interventional and surgical procedure in dentistry. Adjuvants are added with peripheral nerve blocks to increase the duration of action, reduces toxicity and bleeding at the operative site. Dexmedetomidine is a selective alpha 2- aderenoreceptor agonist that have sedative analgesic, sympatholytic, antihypertensive action and also reduces the amount of anesthesia required. Objectives To evaluate and compare the effect of 2% lignocaine with 1: 200,000 epinephrine and 2% lignocaine with 7ppm dexmedetomidine in infraorbital nerve block on pain on injection, onset of action & duration of action. Methods The 60 patients were divided equally into two treatment groups: Group A and B using a computer generated random list and sealed envelope technique. The control group A (L): infraorbital nerve block: 2 ml Lignocaine 2 % with 1: 200,000 epinephrine plus 0.14 ml saline. In group B 2 ml Lignocaine 2 % plus 0.14 ml dexmedetomidine (LpD). The two groups were evaluated for pain during injection, onset of anaesthesia and duration of action. Results Pain on injection was more in group A than in Group B. Onset of action of anaesthesia was more in Group A 194(11.28) sec than in Group B 185.46(13.70) sec. Duration of action of anaesthesia was more in Group A 139.5(10.32) min than in group B 124.93(8.50) min. Rise in Heart rate, diastolic & systolic blood pressure were noted with Group A. Conclusions The addition of 7ppm dexmedetomidine to lignocaine speeds up the onset of action, prolongs the duration of action and reduces the pain on injection. References/Bibliography 1. Khandaitkar S, Kolte V, Shenoi SR, Budhraja N. A clinical study to determine the efficacy of 7ppm dexmedetomidine as an adjuvant to 2% lignocaine in infraorbital nerve block. Br J Oral Maxillofac Surg. 2016 Nov;54(9):997–1000. doi: 10.1016/j.bjoms.2016.07.011. Epub 2016 Aug 11. PubMed PMID: 27522312. 2. Bhargava D, Sreekumar K, Rastogi S, Deshpande A, Chakravorty N. A prospective randomized double-blind study to assess the latency and efficacy of twin-mix and 2% lignocaine with 1:200,000 epinephrine in surgical removal of impacted mandibular third molars: a pilot study. Oral Maxillofac Surg. 2013 Dec; 17(4):275–80. doi: 10.1007/s10006-012-0372-3. Epub 2012 Nov 10. PubMed PMID: 23143710.

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Abstract Background/Introduction Regional anesthetic block of the cervical plexus is a safe and useful alternative to general endotracheal anesthesia for surgery of the neck, upper shoulder, and occipital scalp area. The sensory component of the cervical plexus can be blocked separately and easily by a superficial cervical plexus block. Both motor and sensory block can be obtained by deep cervical plexus block. Minor transient side effects are common to deep cervical plexus blocks, but they are rarely of any consequence. Recent years have seen an increase in interest in the use of the cervical plexus block, because its popularity for surgical procedures such as carotid endarterectomies has grown. An understanding of the anatomy and principles of this anesthetic technique will enable the clinician to offer the patient and surgeon an important anesthetic option. Objectives To assess the safety and effectiveness of superficial cervical plexus (SCP) block in oral and maxillofacial surgical (OMFS) practice as an alternative to general anesthesia in selective cases. Methods The total number of patients was 10, out of which 6 were male and 4 were female patients. Five patients had incision and drainage of perimandibular space infections, two patients had enucleation of cyst in the body of mandible, one patient had open reduction and internal fixation isolated angle fracture, and two patients had submandibular lymph node biopsies. Informed & written consent were obtained from the patients after they had the procedure explained to them. Medically compromised patients and those who were excessively anxious and apprehensive, patient who did not want the procedure to be done under regional anesthesia, and patients with a history of allergy to local anesthetic were excluded. All patients had their surgical procedures under regional anesthesia (SCP block with supplemental nerve blocks) performed by the same surgeon under the supervision of anesthesiologist with continuous monitoring. Results SCP block with concomitant mandibular nerve and long buccal nerve block has a high success rate, low complication rate, and high patient acceptability as shown in the study. Conclusions Superficial cervical plexus block anesthesia is a safe and useful anesthetic technique with the low risk of accidents and complications, thus a good alternative for regional anesthesia in OMFS cases. References/Bibliography 1. Roger D (1995) Superficial and deep cervical plexus block: technical consideration. J Am Asssoc Nurse Anesth 63(3):235–243. 2. Collins VJ, ed. Principles of Anesthesiology. 2nd ed. Philadelphia, Pennsylvania: Lea & Febiger. 1978:951–955.

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ABS00814 Intraoral Autogenous Grafting Prior to Implant Placement: A Case Series Dr Deepti Vashisht Prashar, Reader (1st Author); Dr S.P.S. Sodhi, HOD (2nd Author) Department of Oral & Maxillofacial Surgery, Dasmesh Institute of Research & Dental Sciences, Faridkot, Punjab Abstract Background/Introduction The ability to augment the alveolar ridge has dramatically expanded the scope of implant dentistry. Numerous studies have been done to evaluate the efficiency of various grafts for the ridge augmentation. Autogenous bone graft from intra-oral sites remains one of the preferred methods and is gold standard too. There are various sites for intra-oral grafting such as symphyseal region, body & ramal region, coronoid process and maxillary tuberosity. This paper presents an insight into the use of symphyseal and ramal bone grafts for horizontal ridge augmentation, convenient to harvest with minimal drawbacks. Objectives To augment horizontally deficient alveolar ridge for better rehabilitation using autogenous bone from intra-oral sites. Methods Seven patients with horizontally inadequate alveolar bone ridge for implant placement were treated with autogenous bone grafts from intraoral sites. Mandibular symphyseal cortex was used in five patients whereas ramal bone graft was used in four patients. It was followed by implant placement 6 months later. Results Following the procedure, minimal resorption was observed. The postoperative morbidity is comparatively less in ramus region than the symphysis. Conclusions The findings from the present case series support the use autogenous bone graft from intraoral sites for horizontal ridge augmentation of atrophic ridges. Both mandible symphyseal and ramal region are good donor site options for intra-oral block grafting. Whereas, symphyseal graft has the advantage of better accessibility than ramal graft, the latter has better cortico-cancellous bulk and fewer complications like paraesthesia as seen in symphyseal graft. References/Bibliography 1. Clavero J, Lundregren S. Ramus or chin grafts for maxillary sinus inlay and local onlay augmentation: comparison of donor site morbidity and complications. Clin Implant Dent Related Res 2003; 5(3):154–160. 2. Adell R, Lekholm U, et all. Reconstruction of severely resorbed edentulous maxillae using osteointegrated fixtures in immediate autogenous grafts. Int J Oral Maxillofac Implants 1990; 5: 233–246.

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Section: Miscellaneous ABS003 Management of Submandibular Space Infection: Case Series Lt Col (Dr.) Ashok Kumar Army Abstract Background/Introduction Infections of orofacial and neck particularly those of odontogenic origin have been one of the most common diseases in human beings. Despite great advances in health care, these infections remain a major problem; quite often faced by oral and maxillofacial surgeons. Submandibular space infection is firm swelling in submandibular region below the inferior border of mandible. Intra orally teeth are sensitive to percussion, mobile. Patient presents with moderate trismus and dysphagia [1]. Objectives Involvement - Infection of submandibular space infection is caused by mandibular second or third molar. The pus perforates the lingual cortical plate of mandible, inferior to attachment of mylohyoid muscle and passes directly into the submandibular space. The infection from the submandibular salivary gland may pass via lymphatics to the submandibular lymph nodes. It is also involved as an extension of infection from submental lymph nodes via the lymphatics; when the node fails to contain infection within them. It is also involved by an infection originating from middle third of the tongue, posterior part of floor of mouth, maxillary teeth, cheek, maxillary sinus and palate [2]. Methods Case series – The case series consist of 05 patients in whom the cause of infection was mandibular molars, submandibular gland and submandibular lymph node. In all patients there was swelling in submandibular region below the inferior border of mandible. One patient reported with Ludwig’s Angina. He was in severe respiratory distress and looking toxic. Bilateral submandibular space and submental space were drained under local anesthesia. Patient was started on empirical antibiotics. Patient got relief from respiratory distress and toxemia immediately. In this patient, leukocyte count was increasing day by day along with episodes of fever. So, Maxillofacial and neck CT scan was taken on 3rd day. CT scan showed spread of infection to left parotid and parapharyngeal spaces with midline of respiratory tract shifted towards right side. So, on same day after tracheostomy, drainage was carried out under GA. Patient was shifted to ICU. After this, patient was started on specific antibiotics. He was put on RT feeding. He was given adequate fluids and high protein diet. Gradually patient improved and was discharged after 02 weeks. Some degree of extra oral tenderness was present in all the other patients. Overlying skin was red in 03 patients. All the patients were in pain. One patient also had fever. None of the other patients had symptoms of life threatening condition like respiratory distress, impaired vision, decreased level of consciousness, change in voice quality and restlessness due to hypoxia. One patient was edentulous, in others extraction of offending teeth was done along with I & D in three patients. I & D was done using Hilton’s method. Drain was left for 48 to 72 hrs. OPG was used as screening tool in all the patients. In one patient, infection resolves by extraction of involved teeth and I & D was not required. In one patient, moderate trismus was present. All the patients were given antibiotics, in 01 patient oral antibiotic were given; in 03 patients parenteral antibiotics were given.

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S78 Results All the patients were managed successfully. Conclusions Early recognition of orofacial infection and prompt, appropriate therapy is absolutely essential to prevent complications. References/Bibliography 1. Peterson LJ: Principles of management and prevention of odontogenic infections. In Peterson LJ, Ellis E, Hupp JR, et al, editors: Contemporary oral and maxillofacial surgery, St Louis, 1993, Mosby. 2. Chow AW, Roser SM, Brady FA: Orofacial odontogenic infections, Ann Intern Med 88: 392, 1978.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 procedure; the risk of altered sensation/numbness of lower lip and tongue, in group I, where patients were initially consented with the standard consent form, followed by the RFT consent. About 90% of the total number of patients from the study, confirmed that the request for treatment (RFT) consent process ensured a better understanding of the whole treatment process. Conclusions Request for Treatment (RFT) provides a useful and novel patientcentred method of consent, and is likely to protect against negligent consent, practically highlighting patient misunderstanding early and by providing irrefutable documentary evidence that consent has been gained. It may also provide a simple method by which Gillick competence can be assessed and documented. References/Bibliography:

ABS005 Request for Treatment (RFT); A Paradigm Shift towards an Evidence Based Approach to the Consent Process Prof. Ramakanth Reddy Dubbudu MDS, MFDSRCS (Eng), FFDRCS (Ire) Dept. of Oral & Maxillofacial Surgery SVS Institute of Dental Sciences Mahabubnagar Telangana Abstract Background/Introduction Respect for patient autonomy and the principle of informed consent is central to modern medical ethics, and the consent must be truly informed for it to be ethically valid. The fundamental difference between consent and the informed consent is the patient’s knowledge behind the consent decision, and in general, the courts of law have consistently stipulated that the burden rests with the doctor, to ensure patient’s comprehension of the information. The traditional approach to consent is paternalistic, as it places the patient in a permissive passive role. Substantial evidence also points to the fact that patients understand significantly less than we think. Request for Treatment (RFT) is a new approach to consent which aims to facilitate patient’s understanding their treatment and address some of the flaws of the current consent practice. I present our early experience with the use of Request for Treatment (RFT) consent for mandibular third molar surgical extractions. Objectives To assess and compare patient comprehension of informed consent process for mandibular third molar surgical extractions, using two different methods of consent; a standard consent form and a novel, Request for Treatment (RFT) consent form. Methods 100 patients were enrolled for the study. Patients were randomly divided into two groups I and II. The randomization process allocated 45 patients to group I and 55 patients to group II. Patients in both the groups were consented twice using the two different consent forms, but the sequence was different. Patients in group I were first consented with the standard consent form followed by the RFT consent. Group II patients were initially consented with the RFT consent, followed by the standard consent. Comprehension was assessed with a simple comprehension test questionnaire. Results Statistical analysis showed significant difference in the understanding of the most critical components of the third molar surgical extraction

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1. Shokrollahi K. Request for treatment: the evolution of consent. Ann R Coll Surg Engl 2010;92:93–100. 2. Khalique N. Informed consent: the dawning of a new era. Br J Oral Maxillofac Surg 2015;53:479–84.

ABS0043 Efficacy of Neurectomy of Peripheral Branches of the Trigeminal Nerve in Trigeminal Neuralgia: A Critical Review of Literature 1. Dr B. Krishnan, Additional Professor, 2. Dr V Yuvaraj, Professor 1. Dept of Dentistry, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Pondicherry; 2. Dept of Oral and Maxillofacial Surgery, Indira Gandhi Institute of Dental Sciences, Sri Balaji Vidyapeeth University, Pondicherry Abstract Background/Introduction Of the many chronic painful conditions, Trigeminal Neuralgia (TN) affecting the orofacial region needs the particular attention of physicians and surgeons, especially those specializing in the maxillofacial region. Treatment protocols for management of classic TN include pharmacology and surgical intervention. Oral and maxillofacial surgeons have traditionally employed the peripheral neurectomy in the surgical management of TN. Objectives This review aims to evaluate the efficacy of peripheral neurectomy in the management of TN with regards to a) the relief of symptoms in comparison with standard neurosurgical procedures and b) the duration of pain relief and complications observed compared to standard neurosurgical procedures. Methods The review of the literature was done according to PRISMA guidelines and included randomised controlled trials, reviews and prospective clinical studies involving surgical procedures for the management of TN. The primary outcomes evaluated were a) Initial relief of pain b) Duration of relief of pain c) Complications observed with ablative procedures and d) Recurrence of symptoms. A total of 43 studies fulfilled the inclusion criteria. Results In a total of 7913 patients from the 43 studies, central procedures were found to have best results for both quality and duration of pain relief. Percutaneous and peripheral procedures were associated with increased recurrence rates. The consolidated rates of complication for peripheral, percutaneous and central procedures were 39.46%,

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 65.42% and 10.41% respectively. The use of Peripheral Neurectomy alone in the management of classic TN was observed in 10 studies. Conclusions Peripheral neurectomy in Trigeminal Neuralgia is associated with lesser quality of pain relief in comparison to central neurosurgical procedures. It also provides only short to medium term pain relief. Most studies with the use of peripheral neurectomy involved only a small group of patients with short follow-up periods. Oral and Maxillofacial Surgeons must not consider the peripheral neurectomy as the first surgical option in the management of classic TN. Long term results can be achieved better with appropriate central neurosurgical procedures and pharmacotherapy. References/Bibliography 1. Akheel M, Tomar SS. Comparison of microvascular decompression and peripheral neurectomy for trigeminal neuralgia: A prospective study. J Biol Sci Opin. 2014;2(3):214–16. 2. Cerovic R, Juretic M, Gobic MB. Neurectomy of the trigeminal nerve branches: clinical evaluation of an ‘‘obsolete’’ treatment. J Craniomaxfac Surg 2009;37:388–391.

ABS0053 Assessment of Awareness of the Speciality of Maxillofacial Surgery Among Medical Practitioners Dr. Pathumai Murugadoss, Dr. Reena Rachel John Vinayaka Mission’s Sankarachariyar Dental College and Hospital, Salem, Tamilnadu, India Abstract Background/Introduction ‘‘Oral and Maxillofacial Surgery is the specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and aesthetic aspects of the hard and soft tissues of the oral and maxillofacial region.’’ It is an internationally recognized surgical specialty but the awareness of this specialty seems lacking among public including medical practitioners. Objectives This study was conducted to evaluate the perception and create an awareness of the specialty of Oral and maxillofacial surgery among the medical fraternity. Methods Survey was done among 100 medical professionals with MBBS, MS, MD, MCh & Diploma degrees in Salem, TamilNadu, India. Questionnaire to assess the awareness level of various procedures that are performed routinely by maxillofacial surgeons was personally given and collected from the medical practitioners. Appropriate statistical tests were applied to the results. Results The acceptance of managing maxillofacial trauma by maxillofacial surgeons ranged from 38 – 94 % depending on the bones fractured. With regards to salivary gland pathologies only 14 % conceded with maxillofacial surgeon’s ability. The confidence with regards to harvesting of bone grafts were higher although microvascular surgery was found to be beyond our scope according to their opinion. Conclusions The most interesting part of the survey was that the awareness of our field and our zones of surgery was high among young medical graduates with clinical experience less than 5 years than practitioners with more than 5 years of experience.

S79 References/Bibliography 1. Michael j. Hunter, Tanios Rubeiz, Lynda Rose. Recognition of the scope of Oral and Maxillofacial surgery by the public and Health care professionals. J Oral Maxillofac Surg. 54:1227–1232, 1996. 2. Ibrahim M. Haron, Mohammad Y. Sabti, Lars Andersson, Prem N. Sharma. Perception of oral and maxillofacial surgery by medical and dental health care professionals in Kuwait. Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology 25 (2013) 5–11.

ABS0064 Maxillofacial Infections in Medically Compromised Patients Group Captain (Dr) S K Kaushik Abstract Background/Introduction Dental infection is a common and potentially life threatening condition sometimes necessitating admissions for surgical treatment. In addition to localised disease, dental infections can spread regionally and haematogenously, causing serious disseminated infections, especially in patients who are medically compromised. Several epidemiological studies have linked poor oral health with cardiovascular disease, poor glycaemic control in diabetics, low birth-weight preterm babies, and a number of other conditions, including rheumatoid arthritis and osteoporosis. Oral infections are also recognized as a problem for individuals suffering from a range of chronic conditions, including cancer and infection with human immunodeficiency virus, as well as patients with ventilator-associated pneumonia. The dental management of patients with medically compromise is sometimes complex and requires a multidisciplinary and integral approach. Objectives This paper aims at bringing out the intricacies involved in the management of maxillofacial space infections in severe medically compromised patients and the need for customization of the management protocols. Methods This retrospective descriptive case study involving subjects admitted at a tertiary care armed forces health care set up between 2014–16 probes the presenting signs and symptoms and the underlying medical compromise in each case. Results A total of 24 cases of medically compromised in- patients admitted with severe facial space infections resulting from dental source were managed with custom made protocols including surgical drainage, anti-biotic cover optimization of physiologic parameters in view of underlying medical ailment. Conclusions Orofacial infections have become an increasingly common risk-factor for systemic disease, which clinicians should take into account. Clinicians should increase their knowledge of dental diseases, and maxillofacial surgeons must strengthen their understanding of general medicine, in order to avoid unnecessary risks for infection that originate in the mouth. References/Bibliography 1. Oral and Maxillofacial Infections, 3rd Edition. Topazian, RG, Goldberg, MH. WB Saunders Co. 1994. 2. Peterson’s Principles of Oral and Maxillofacial Surgery, 3rd Edition. Miloro, M, et. Al. People’s Medical Publishing House. 2012.

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ABS0099 Lefort 1 Osteotomy for Excision of Nasopharyngeal Angiofibroma; Our Experience Dr. Choubarga Naik, Assistant Professor VSS Institute of Medical Science and Research, Burla, Sambalpur, Odisha Email:[email protected] Mob: 09337237290 Abstract Background/Introduction Surgical access to the skull base is always difficult, especially because of the surrounding difficult anatomical structures. Lefort I osteotomy provides direct view to the anterior skull base, sphenoid, nasoethmoid, nasopharynx, and it also bears less morbidity when compared to other access osteotomies. Objectives To Use Lefort 1 osteotomy for excision of the Nasopharyngeal tumor. Methods Retrospectively patients were evaluated over a period of 4 years who have undergone lefort 1 osteotomy for the excision of nasopharyngeal tumor, extension; intraoperative and postoperative complications; and residual tumor and/or tumor recurrence associated with the surgical approach. Results 12 patients with nasopharyngeal angiofibroma were evaluated with a mean follow up of 24 months. There was one recurrence. Conclusions Le Fort I osteotomy approach is a useful technique for the removal of Nasopharyngeal Angiofibroma extending into pterygopalatine and infratemporal fossae. References/Bibliography

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Methods Risk is defined as the potential that chosen action or activity (including the choice of inaction) will lead to a loss or an undesirable outcome. Risk management is the identification, assessment and prioritization of risks and the application of resources to minimize, monitor, control the probability or impact of the adverse events. Effective communication skills deployed throughout the interaction with the patient, especially during the consent process are a prerequisite. Results An honest reflection by a practitioner on their competence to carry out a procedure considering their skills, equipment and support available will result in fewer medicolegal cases. Conclusions This paper explains an overview of the negligence, Indian law related to negligence and malpractice, define the risk and the elements of risk management strategies and give advice on various surgical procedures that are regularly practiced in oral & maxillofacial surgical practice. References/Bibliography 1. Goel et al TMU j.Dent vol 1: issue july 2014 2. S.J. Hendorson, Risk management in clinical practice. Part II oral surgery.

ABS00123 Full Mouth Rehabilitation with Implant Supported Fixed Prosthesis (All on Four): A Case Report 1. Dr. Abhishek Saraswat, Senior Lecturer, 2. Dr. Ayani Pandey, Senior Lecturer

1. Ying Lin, Le Fort I osteotomy for extensive juvenile nasopharyngeal angiofibroma: a retrospective study; Advances in Therapy Oct 2008.

1. Department Oral & Maxillofacial Surgery, RKDF Dental College & Research Centre, Bhopal, Madhya Pradesh; 2. RKDF Dental College & Research Centre, Bhopal, Madhya Pradesh. Address – Bhopal Dental, DK 3/1/25, Danish Kunj, Bhopal Pin – 462042 Ph. No. 9111114085, 9111114020

ABS00119 Risk Management in Oral & Maxillofacial Surgery

Abstract Background/Introduction The objective of a dental prosthesis is to replace the teeth and adjacent tissue to restore function, esthetics and speech. Oral rehabilitation of an edentulous patient is an challenge. Few patients have life long problems with their complete dentures, such as difficulties with speech and mastication. Implant supported prosthesis gives an opportunity to such patients a normal healthy life for their functional and esthetics demands. Objectives The objective of this study is to present a case report on full mouth rehabilitation with implant supported fixed prosthesis on all on four concept, for completely edentulous maxillary and mandibular arches. Methods A 50 year old female patient reported to Bhopal Dental (private dental clinic) in Bhopal (M.P, India) with chief complaint of missing teeth and wanted to be replaced by fixed prosthesis to restore esthetics and speech. After taking full case history and necessary blood investigations and radiographs implants sites were planned. Two stage surgery was planned with four implants in both arches. Two implants placed vertically in the anterior, two placed at an angle of upto 45 degree in the posterior region. Results Fixed implant supported prosthesis was given to patient when implants were osseointegerated.

Dr. Srinivas Gadipelly MDS, FDSRCS Professor Kamineni Institute of Dental Sciences, Narketpally, Nalgonda (Dt) Abstract Background/Introduction The doctor/dentist relationship has changed over the last two decades. Health professionals are increasingly viewed as providers of service for consideration. Public awareness of medical/ dental negligence in india is growing as witnessed by recent incidents of attacks on doctors and dentists. Hospital authorities are increasingly facing complaints, regarding facilities, standards of professional competence and appropriateness of therapeutic and diagnostic methods. Objectives Oral & maxillofacial surgery is often an unpleasant experience for a patient for the reason of invasive nature and if managed inadequately can be a cause for complaint or a claim in negligence. With proper for thought and planning the vexing issue can be controlled and made less anxiety producing.

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Conclusions By tilting the two posterior implants, the bone to implant contact is enhanced, providing optimal bone support even with minimum bone volume. Tilting the posterior implants also helps avoid vital structures, such as the mandibular nerve or the maxillary sinus and results in better distribution of implants along the alveolar crest which optimizes load distribution and allows for a final prosthesis with up to 12 teeth. Appropriate diagnosis and treatment planning is the key to successful full mouth rehabilitation. References/Bibliography 1. Adell R, Lekholm U, Rockler B, Branemark PL. A 15 year study of osseointegrated implant in the treatment of eduntulous jaw. Int J Oral Surgery 1981 Dec;10(6):387–416.

S81 used in large perforation which might occur during sinus lifting with the presence of an antral pseudocyst. PRF has advantages for oral surgery operation, such as no chemical additives, reduced production time, easy application, and good adaptation to the operation area. Objectives Not applicable. Methods Not applicable. Results Not applicable. Conclusions Not applicable. References/Bibliography Baslarli O, Tumer C, Ugur O, Vatankulu B. Evaluation of the osteoblastic activity in extraction sockets treated with platelet rich fibrin. Med Oral Patol Oral Cir Bucal 2015 Jan 1;20(1):e111-6.

ABS00339 Versatility of PRF and Its Biological Application in Minor Oral Surgical Procedures Dr. Fatima Hasina, Dr. Shivakumar HR, Dr. Keerthi Kumar Rai

ABS00341 Transcranial Pedicled Supero-Lateral Orbitotomy in Lacrimal Gland Adenoma

Bapuji Dental College and Hospital, Davangere Dr. Seemit Shah Abstract Background/Introduction Complex tissue remodelling requires the co-ordination of various physiological process, which involve molecular signals that are mediated primarily by cytokines and growth factors. Platelets contains various growth factors and cytokines that play a key role in inflammation and bone healing. The use of platelet concentrates has become increasingly popular during the last 15 yrs. The initial development was the fibrin adhesive in 1996, PRP is considered as the first generation autogenous fibrin adhesive and PRF is the second generation. PRF was first described by Choukran et al. in the year 2001. its not only has a workable three dimension architecture but exhibits varied potent local properties such as cell migration, cell attachment, cell proliferation and cell differentiation. it has been shown as an ideal biomaterial. To prepare PRF, 20 ml of the blood was withdrawn from the patient’s antecubital vein and centrifuged for 10 min at 3000rpm per minute. In vitro studies have proved that PRF releases autologous growth factors gradually for at least one week and upto 28 days. PRF when used in conjunction with bone grafts offers several advantages including better wound healing, bone growth and maturation, graft stabilization, wound sealing and hemostasis and improving handling properties of the graft materials. Clinical trials have suggested the combination of bone grafts and growth factors combined with PRF may be suitable for enhanced bone density. PRF can also be obtained in the form of membrane by squeezing out fluid in the fibrin clot, thus it acts as both healing and interposition biomaterial. As healing material it accelerates wound closure and mucosal healing due to fibrin bandage and growth factor release. As interposition material, it avoids therapy invagination of undesired cells, thereby behaves as a competitive barrier between desired and undesired cells. Placement of DFDBA in the extraction socket provide scaffold for bone remodelling around the tooth. PRF clot mixed with DFDBA allowed rapid healing. Radicular cysts were treated by combination of endodontic therapy followed by surgical management with PRF and bioactive glass. The results showed that its an effective modality of regenarative treatment for radicular cysts. PRF is safely

RDC Loni Abstract Background/Introduction Although various tumours usually involve the orbital lobe of the lacrimal gland, palpebral lobe involvement is seen only in 10% of cases. These palpebral lobe tumors are freely movable and do not produce proptosis or bony changes, however orbital lobe tumours can produce varied orbital sign and symptoms like pain, proptosis and bony changes. There is a continuing evolution in surgical approaches for accesses to these tumours. During the last century there have been frequent periods when a number of methods have competed as alternative surgical techniques for better outcome to the patient. Each of these approaches is associated with pros and cons and it remains to be seen whether these innovations are advantageous or not. We propose relatively newer approach and technique to accesses lacrimal gland tumours. Objectives To compare the outcome of different approaches for lacrimal gland tumors. Methods Transcranial pedicled supero lateral orbitotomy approach for lacrimal gland adenoma was done and reviewed with other existing approaches for the same. Results This newer technique was better in term of accessibility and esthetic outcomes. Conclusions The newer technique was a good options for lacrimal gland tumors and can be routinely practiced for better outcomes. References/Bibliography 1. Balihallimath L., Harkuni U., Urologin S., Pandit V., Kale T. Pedicled lateral orbitotomy: A new technique and a case report. Indian Journal of Health Sciences 2014,7(2);125–129.

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ABS00483 Adherence to Consort Extension for Abstracts in Randomised Controlled Trials Published in the Journal of Maxillofacial and Oral Surgery Dr. Akilesh Ramasamy, Dr. Balasubramanian Madhan, Dr. Balasubramanian Krishnan Department of Dentistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry-605006, India Abstract Background/Introduction Under-reporting of abstracts adversely impacts the attention, contribution and utility of the published articles and assessing it is an important quality control measure for any journal. Objectives To evaluate the adherence of the abstracts of published in the journal of maxillofacial and oral surgery (JOMS) to CONSORT extension for abstracts. Methods 737 articles published from 2011 to 2016 in JMOS were screened for randomized controlled trials and 65 eligible articles were included. The compliance to CONSORT extension for abstracts[1] was assessed for each of the 17 items and recorded in four categories as yes, no, partially yes and not applicable. Results Forty eight out of 65 articles did not identify the study as randomized in the title. Sixty three did not mention the study design. The details regarding the methodology of the study were adequate in most studies except for randomization (n=6) and blinding (n=5). The reporting of the results was poor for most parameters except number of participants randomized (n=51). Information regarding trial registration and funding were missing in almost all the abstracts. Overall, median number of reported items was 5 with minimum of 3(n=7) and maximum of 8(n=2). Conclusions There is a severe under-reporting of abstracts in articles published in JMOS. The possible reasons, implications and solutions for the same are discussed. The need for joint effort from all the stake holders (authors, reviewers, editors and publishers) to improve the quality of abstract reporting of abstracts cannot be overstated. References/Bibliography 1. Hopewell S, Clarke M, Moher D, Wager E, Middleton P, Altman DG, Schulz KF and the CONSORT Group (2008) CONSORT for reporting randomized controlled trials in journal and conference abstracts: explanation and elaboration. PLoS Med 5(1): e20.

ABS00534 Cervicofacial Actinomycosis and Its Management: A Report of Two Cases Dr Vini Kaila Vishnu Dental College Abstract Background/Introduction Cervicofacial actinomycosis is an invasive destructive infectious syndrome caused by gram positive, branching filamentous bacteria,

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Actinomyces a common inhabitant of the oral cavity. Most of the cases are traced to an odontogenic source with periapical abscess and post traumatic or surgical complications with poor hygiene and immunosupression as contributing factors. Objectives Diagnosis is often delayed because of nonspecific and prolonged symptoms usually mimicking a malignant or a granulomatous lesion. Methods Solitary or multiple abscess and fistula formation across normal tissue planes accompany chronic draining lesions and may lead to invasion of viscera. Results Hence, early diagnosis and multidisciplinary approach ie appropriate surgical and medical management is mandatory to reduce morbidity. Conclusions In this paper, we report two cases of cervicofacial actinimycosis, one presented with intraoral granulomatous lesion treated with surgical curettage and Intravenous pencillin and another case with extraoral swelling and multiple draining sinuses treated with oral antibiotics. References/Bibliography Jainine et al, Actinomycosis in chroni granulomatous diseases: An emerging and unanticipated pathogen.

ABS00555 Oblique Curvilinear Incision to Zygomatic Buttress Dr. Ananth Kumar G.B. K M Shah Dental College and Hospital Abstract Background/Introduction The role of a TSAD (temporary skeletal anchorage devices) is to provide reliable stability when loaded with orthodontic forces, without damage to the adjacent structures, and allow easy connection to orthodontic appliances with minimal discomfort to patients. The most appropriate application is to enable the predictable intrusion and distalization of maxillary and mandibular molars. In the posterior maxilla, centering the miniplate on the zygomatic buttress ensures the best stability. Location of the incision is particularly important, more so if tooth intrusion is intended. Traditionally vestibular approach has been used for fixation of zygomaticomaxillary buttress region transorally. The disadvantages are limited access and visualization of the buttress, the most distal portion of the incision is difficult to suture, and the buccal fat pad often interferes with both the operation and closure. A newly designed curvilinear oblique incision to access the zygomatic buttress, improves the access, avoids excessive muscle stripping and aids in tension free closure. Objectives 1. To clinically evaluate the incision for accessibility to buttress region 2. To evaluate for herniation of buccal fat pad. 3. To clinically evaluate the fixation of plate at desired position. Methods A Pilot Study Was Carried Out On Evaluate The Same On 6 Zygomatic Buttress Region. Results All 6 Sites Developed No Infection, Gaping Of Wound Or Dehisence. Conclusions The Curvilinear Incision Provides Better Accessibility To Entire Buttress and Aids In Fixation Of The Plate Higher Up On The Zygoma With Less Tension To Tissues.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 References/Bibliography 1. Kelley P, Crawford M, Higuera S, Hollier LH. Two hundred ninety-four consecutive facial fractures in an urban trauma center: lessons learned. Plast Reconstr Surg 2005; 116: 42–49.

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ABS00587 Multiple Impaction in Non-syndromic Patients: A Case Series Manjiri Chakor

ABS00583 Estimation of C-Reactive Protein (CRP) as an Inflammatory Marker in Monitoring Therapy Effectiveness of Postoperative Antibiotics Prophylaxis After Mandibular Fractures Dr Mahesh Goel PGIDS, ROHTAK Haryana Abstract Background/Introduction Maxillofacial Surgeon routinely encounter patients with facial trauma and mandibular fractures alone accounts to 61% of All fractures. The sequel of a mandibular fractures will invariably lead to swelling which may be just an inflammatory response or as a result of infection, prior to treatment or post treatment. This makes it difficult for a surgeon to differentiate between the two. There are many laboratory markers to evaluate the prognosis of healing. Bacterial markers including WBC Count, absolute neutrophil count and CRP estimation are considered. But off late, CRP is gaining importance. Objectives The objective of the present study was to evaluate the efficacy of CRP levels as an inflammatory marker in monitoring therapy effectiveness of postoperative antibiotics prophylaxis following a surgical intervention of mandibular fractures with rigid internal fixation and to correlate the prognosis of the convalescent period. Methods A total of 50 patients of either sex more than 14 years of age with mandibular fractures managed with ORIF and who were eligible as per the inclusion and exclusion criteria we’re allocated to receive the prophylactic antibiotics treatment regimen postoperatively and were subjected to a clinical assessment including efficacy and safety. Results An increase in CRP levels was noticed immediately after mandibular fractures surgery which is considered to be normal mechanism of the body. On the 7th day of the surgery, CRP levels were significantly decreased to attain normal levels indicating abolition of inflammation and normal healing at the surgical site. As the CRP normalize, administration of antibiotics can be terminated, which prevents prolonged usage of antibiotics and it’s side effects. Conclusions The findings of this prospective analysis indicate that CRP is an effective marker for determining of severity of infection, efficacy of treatment regimen and length of the hospital stay for patients with mandibular fractures. Serum CRP reflect immediate effect of the treatment. References/Bibliography Schaller B Soon er Al. The role postoperative prophylactic antibiotics in the treatment of facial features: a randomized double blind placebo controlled pilot clinical study. Br J OMS 2014;52(4):329–33.

VSPM’s Dental College Abstract Background/Introduction Multiple supernumerary teeth are often detected on radiographs. These can be asymptomatic or can result in fascial space infection, resorption of root of the adjacent tooth, malocclusions, delayed or non-eruption of teeth, temporomandibular joint disorder, cyst formation. A great challenge is management of such cases to the clinicians. Hence, correct diagnosis and treatment with the use of appropriate imaging techniques and multidisciplinary intervention are highly important. Objectives The purpose of this study was to describe the clinical characteristics and complications of patients with non - syndromic multiple impaction. Methods A case series of three patients is included for the presentation. Data including age, gender, number, distribution, and location of supernumerary premolars, extraction procedure, and related complications (such as cystic changes, root resorption, or adjacent teeth eruption disturbance) were evaluated. The results are awaited. Radiographic assessment has an important part to play as early diagnosis and intervention. It can help avoid orthodontic problems and dental pathology associated with supernumerary teeth. Results AWAITED. Conclusions AWAITED. References/Bibliography Gawande P, Hebbale M, Patil T, Hindocha A, Halli R. Multiple Impacted Permanent and Supernumerary Teeth in the Anterior Mandible of Nonsyndromic Case: A Systematic Review and Multidisciplinary Approach to Management. J Dent Allied Sci 2015;4:47–51.

ABS00591 Life Threatening Airway Challenges Encountered in Oral and Maxillofacial Practice Dr. Saumya Tripathi Meenakshi Hospital, Thanjavur (TN) Abstract Background/Introduction In a full spectrum oral and maxillofacial surgery (OMFS) practice it is inevitable to escape from a life threatening airway complication. An airway complication in a maxillofacial condition can range from mechanical obstruction of upper airway to tracheal injury to an aspiration led acute respiratory distress. In spite of it being a potentially fatal problem, it has not been documented well except for the upper airway obstruction.

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S84 Objectives To find the frequency of life threatening airway emergency in routine OMFS practice. To describe few rare such conditions. To establish a protocol for early identification and management of such conditions. Methods This is a retrospective study of all the OMFS cases operated in this hospital since October 2015. Only such airway complications which resulted primarily due to oral and maxillofacial trauma, pathology or infection were considered. Conditions which led to airway compromise which were not primarily due to OMFS condition were not included (e.g. insecure airway due to loss of sensorium, neurosurgical causes of tongue fall back etc). It was well-thought-out and a condition was termed as a life threatening airway emergency only if an immediate invasive rescue procedure was required or there was mortality due to such condition. Results 8.5% of the OMFS patients required lifesaving interventions (e.g. upper airway obstruction release, emergency fracture fixation to release gagging effect, evacuation of tongue and floor of mouth hematoma, emergency incision drainage in space infection, aspiration led ARDS condition management, tracheostomy, intubation and ventilator support). Conclusions The study cases exemplify the fact that an OMF surgeon’s working space is at the gateway of airway. Therefore our mere attentive inspection can enable us to promptly identify such potentially fatal conditions which is crucial for management and saving the life of the patient. A multidisciplinary and co-ordinated team approach is essential for the management. References/Bibliography Robert M Kellman et al. Comprehensive Airway Management of Patients with Maxillofacial Trauma. Craniomaxillofacial trauma and reconstruction. Volume 1, Number 1, 2008.

ABS00609 Efficacy of Direct Sinus Lift in Implant Placement Dr. Rajesh Sabnis Rungta College of Dental Sciences and Research, Bhilai, Chhattisgarh Abstract Background/Introduction Efficacy of direct sinus lift for the stability of implant placement. Objectives The present study was conducted with the aim to evaluate clinical efficacy of the direct sinus lift with simultaneous implant placement and bone grafting to evaluate merits and demerits of lateral approach for sinus membrane elevation. Methods This randomized prospective study consisted of 10 patients who met the inclusion and exclusion criteria. The patients were selected irrespective of the age, sex & socioeconomic status, with the residual alveolar bone height between 1 to 4 mm in the edentulous posterior maxillary region. Direct sinus lift was carried out with simultaneous implant placement. Patients were followed up for 36 months of prosthetic rehabilitation. Results Pre-operative alveolar bone height was on an average 2.9 mm (ranging from 1 to 4 mm) with the standard deviation of 0.67 mm.

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 After 36 months of loading, there wasn’t any clinical or radiographical complication. On an average 13 mm bone height was evident (ranging from 11.5 to 14 mm) with the standard deviation of 0.81 mm. Conclusions Direct sinus lift is an excellent technique for the rehabilitation in the cases with severely atrophic posterior maxilla. References/Bibliography Kunal Jodia et al. Sinus elevation with an alloplastic material & simultaneous implant placement: A 1- stage procedure in severely atrophic maxilla. J Maxillofac Oral Surg 2014;13(3):271–280. Kolerman et al. Histomorphometric analysis of maxillary sinus augmentation using an alloplast bone substitute. J Oral Maxillofac Surg 2012;70:1835–1843.

ABS00632 Comparison of Traditional Scalpel, Diode Laser and Electrocautery for Excision of Oral Premalignant Lesions Omkar A. Shetye, Rakshit V. Khandeparker, Praveen Satish Kumar, Saurabh M. Kamat Abstract Background/Introduction Oral premalignant lesions of the oral cavity remain a diagnostic and treatment challenge. They have a potential for malignant transformation. Management of such lesions includes observation, excision, ablation, or topical medical therapies. The gold standard for management of the clinically evident high-grade premalignant disease is excision or laser ablation. Laser treatment has been a well-established modality for management of premalignant lesions and has potential advantages over surgical excision and electrocautery. This study is therefore intended to compare the efficacy of 3 different options of managing premalignant lesions viz scalpel, diode laser and electrocautery. Objectives To compare traditional scalpel, diode laser and electrocautery for excision of oral premalignant lesions. Methods A total of 38 patients reporting to our unit with oral premalignant lesions were randomly divided into 3 groups. Group A (n=13) managed using traditional scalpel, group B (n=12) managed using diode laser and Group C (n=13) managed using electrocautery. Intra-operatively, hemostasis and need for anaesthesia (either topical or injectable) was evaluated. Post-operatively, patients were followed up at regular intervals and evaluated for pain and healing time. The data was tabulated and subjected to statistical analysis. A p value less than 0.05 was considered statistically significant. Results Traditional scalpel was associated with faster healing as compared to groups B and C but required hemostasis and injectable anesthesia. Diode laser had better healing than electrocautery and presented better hemostasis than scalpel and electocautery. Also, minimal to no topical anesthesia was required pre-operatively. The post-operative pain was least with laser followed by electrocautery and scalpel in that order. Conclusions Diode lasers offer superior post-op pain control, good hemostasis with minimal to no need of pre-operative anesthesia as compared to traditional scalpel and electrocautery for managing premalignant lesions of the oral cavity.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 References/Bibliography 1. Funde S, Baburaj MD, Pimpale SK. Comparison between Laser, Electrocautery and Scalpel in the Treatment of Drug-Induced Gingival Overgrowth: A Case Report. IJSS Case Reports & Reviews 2015;1(10):27–30. 2. Tambuvala A, Sangle A, Khan A, Sayed A. Excision of Oral Leukoplakia by CO2 Lasers Versus Traditional Scalpel: A Comparative Study. J Maxillofac Oral Surg. 2014 Sep; 13(3): 320–327.

ABS00651 Effect of Topical Application and Systemic (Oral) Intake of Honey in Chemo-Radiation Induced Mucositis Dr Vibha Singh Professor K.G. Medical University Lucknow Abstract Background/Introduction The cytotoxic effects of chemo-radiation, in addition to their intended effects on cancer cells, unfortunately extents to normal tissue as well, such as gastrointestinal mucosa and bone marrow. This is mainly brought about by the oxidative damage caused by the generation of free radicals. To the head and neck cancer patient, the most crippling ill-effect of chemo-radiationisoral mucositis. In addition to being a potentially dose limiting complication of chemo-radiation, oral mucositis lends a devastating blow to patient’s daily activities and brings about marked reduction in their quality of life (QOL). Objectives The aim of this study was to assess the effect of topical application and systemic (oral) intake of honey in chemo-radiation induced mucositis and to assess its clinical benefits in improving quality of life in patients of head and neck cancer. Methods A total of 50 patients of H&N cancer (25 cases, 25 controls) were enrolled in the study and their QOL was recorded, at regular intervals during radiotherapy. The study group received oral honey along with radiotherapy while the control group received standard oral hygiene instructions only. Results The QOL scores were significantly better in the study group compared to controls after completion of radiotherapy. Conclusions The results obtained from this trial indicate a definite improvement of quality of life in patients of chemo-radiation induced mucositis treated with topical and oral honey over controls. Honey not only seems to help combat the ill effects of cumulative radiation damage pertaining to mucositis like mucosal drying, irritation and dysphagia but also speeds up recovery, expediting the process of return to a normal quality of life. References/Bibliography 1. Song JJ, Twumasi-Ankrah P, Salcido R. Systematic review and meta-analysis on the use of honey to protect from the effects of radiation induced oral mucositis. Adv Skin Wound Care 2012;25(1):23–8. 2. Melanie Charalambous, Vasilios Raftopoulos, Ekaterini Lambrinou, Andreas Charalambous, The effectiveness of honey for the management of radiotherapy-induced oral mucositis in head and neck cancer patients: A systematic review of clinical trials. European Journal of Integrative Medicine 5 (2013) 217–225.

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ABS00686 Role of Percutaneous Radio-Frequency in Management of Trigeminal Neuralgia (1) Dr. Vijay Laxmy Malhotra, Associate Professor, (2) Dr. Dipender Kaur, Associate Professor 1. Dept. of Dentistry, SHKM Govt. Medical College, Nuh, Haryana; 2. Dept. of Anaesthesia, Shkm Govt. Medical College, Nuh, Haryana Abstract Background/Introduction Trigeminal Neuralgia (TN) is one of the most painful neuropathic pains with no universal treatment capable of reverting it completely. Medical therapy remains the first line of treatment but surgery and interventional treatment options are considered in refractory cases and where side effects of medical treatment exceeds risk of interventional procedures. Percutaneous Radio-Frequency (PRF) is one such interventional procedure. Among several means of surgical treatment, PRF has proven to be an invaluable innovation with a unique longevity and has high rates of success, acceptable durability, a respected safety profile, and a high level of patient satisfaction. Objectives The aim of this study was to evaluate the role of PRF in the management of TN. Methods 8 patients (6 females and 2 males; average age 62 years, 5 patients right side and 3 patients left side affected) suffering from classic TN that met the inclusion criteria were selected and PRF was done under fluoroscopic image guidance following standard procedure. Out of 8 patients, in 4 patients mandibular branch (V3), in 2 patients maxillary branch (V2), 1 patient both V2 and V3 and in 1 patient all three branches were involved. The average duration of symptoms was 37 months and average follow up period was 16 months. The outcome of PRF was assessed in follow-up visits in every 2–3 months after the procedure. Patients were assessed using Barrow Neurological Institute (BNI) Pain intensity scores. Results All of the 8 patients experienced initial pain relief with PRF with BNI score I in 4, II in 3 and III in 1 patient. All 8 patients experienced variable degrees of numbness following PRF and facial numbness mostly subsided within 6 months after PRF. One patient suffered from anesthesia dolorosa. There was no mortality and no permanent cranial nerve deficit. Conclusions Although medical therapy remains the first line of treatment, PRF can be considered in selective cases especially in elderly. References/Bibliography 1. Roberto Carlo Rivera Diaza, Jose Libardo Bastidas, Benavidesb, Juliana Garcia Alvarezc, Gasserian ganglion thermal radiofrequency in patients with trigeminal neuralgia, Rev Colomb Anestesiol. 2013;41:127–31. 2. Byung-Chul Son, Hyung-Suk Kim, Il-Sup Kim, Seung-Ho Yang, Sang-Won Lee; Percutaneous Radiofrequency Thermocoagulation Under Fluoroscopic Image-Guidance for Idiopathic Trigeminal Neuralgia, J Korean Neurosurg Soc. 2011 Nov; 50(5): 446–452.

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ABS00699 Planning, Execution and a Benchmark: The First AOMSI Surgical Skill Competition in India and Why It Needs to be Taken Forward Dr Arjun Shenoy Elite Hospital Dept of Maxillofacial Surgery Thrissur

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Methods Review article, Protocol has been quoted from standard text of Committee on trauma by American College of Surgeons. Results It depicts the shortcomings of Indian Health System & Resources for Trauma Management. Conclusions Its easy to summarize and master the protocol and is the need of an hour to salvage trauma patients in efficient manner. References/Bibliography

Abstract Background/Introduction We live in a world surrounded by technology, innovation and simulation. The modern methods to prepare a trainee surgeon for his role have grown leap and bounds. Simulation of procedures on mimicking structures go a long way in bolstering confidence among young trainees. Trainees getting recognized for their skill and intellectual application through the surgical skill competition platform is the future we should be envisioning. Keeping this in mind, We organized the first Zonal AOMSI Surgical Skill Competition comprising of Trainees from three States on August 19th 2017. This presentation aims to showcase the relevance this competition encases and the need to get it implemented at the zonal and/or national platforms. Objectives 1) To narrate the need for surgical skill competitions for Trainees in Maxillofacial surgery and its relevance 2) To share our experience in conducting the first AOMSI Zonal Trainee Competition in 2017 3) To convince the need for implement the competition at the National level. Methods 20 trainees from 10 institutions from 3 states 2 modules- soft tissue and hard tissue module 2 judges- One judge being the Examiner for Royal College of Surgeons 2 international observerse 1 observer from national AOMSI Education Committee soft tissue procedure involved suturing on simulated tissue hard tissue procedure involved ORIF on human mandible specimens. Results Successful completion of the first AOMSI Zonal competition with minimal logistics and cost effectiveness. Conclusions A presentation that wants to show the concept of design and execution of this brilliant platform that needs to be at the national level. References/Bibliography Oxford Specialist Handbooks in Surgery Clinical and Procedural Skills for MRCS Andrew Miller Stuart Enoch and David Hepburn.

ABS00779 Primary Survey of Trauma Patients; ATLS Perspective Dr Amiya Agrawal King George’s Medical University, Lucknow Abstract Background/Introduction Trauma care is still in nascent stage in our country, The presentation tries to focus institution of Primary Survey in Trauma Patients. It focuses on how the resuscitation process proceeds apart from conventional medical education. Objectives To orient & sensitize the health care personnel about concepts & protocol of ATLS.

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Resources for optimal care of injured by committee on trauma (ACS).

Scientific E Poster Section: Cranio Maxillofacial Trauma ABS006 Comparative Study of Single Miniplate Versus Two Miniplates in the Management of Mandibular Angle Fractures Dr. H. Ash Professor & HOD Bidsh Patna Abstract Background/Introduction Monocortical miniplate fixation is an accepted and reliable method for internal fixation of mandibular angle fractures. although placement of a second miniplate may theoretically provide more stability; however, the clinical importance of this issue remains controversial. Objectives The present study assessed the post operative complication and outcomes associated with the fixation of mandibular angle fractures using 1 and 2 miniplates in patient with favourable mandibular angle fractures. Methods A prospective study of 87 patients with favourable mandibular angle fractures was done. In the first group a. 4 - hole miniplate was placed at the superior border through an intra oral approach. in group 2, patient were treated with 2 miniplates, one placed at the superior border and the other on the lateral aspect of the angle at the inferior border through an intra oral and transcutaneous approach using a trocar. post operative complication including malocclusion, malunion, and sensory disturbances associated with surgery. Results In the single miniplate group 25 patients showed lip numbness associated with surgery, 22 patients required additional use of mmf and 3 patients develop infection. In the double miniplate group 20 patients showed lip numbness associated with surgery, 18 patients required additional use of mmf and 1 patient developed infection. None of the patients in either group showed malocclusion or malunion. No significant difference was observed between the groups regarding overall complication rate. Conclusions In Favourable mandibular angle fractures was associated with athis study, use of one miniplate or two miniplates for treatment of fav similar incidence of complications. Thus it seems that the use of two miniplates in this setting may not be warranted, not cost- efficient.

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EPS0024 Perpendicular Plates in Parasymphyseal Fracture Mihika Bala Guru Nanak Institute of Dental Sciences and Research Abstract Background/Introduction The mandible is the most frequent site among facial fractures. The treatment of mandible fracture depends on several factors like the extent of displacement, soft and hard tissue loss, tooth conditions, etc. Fractures with displacements are often treated by open reduction and internal fixation with plates. Plates used for the treatment of a mandible fracture include micro-plates, mini-plates, locking miniplates, reconstruction fracture plates, etc. There have been studies related to placement of miniplates in parasymphyseal region. One of them is perpendicular miniplates. Objectives To evaluate the usage and advantages of perpendicular plates in parasymphyseal fractures. Methods In this technique, one curved miniplate is placed on the middle buccal cortical bone surface and the other on the inferior surface, with four unicortical screws in each of the miniplates. Results Studies have shown stress to be lowest in the perpendicular miniplates as it resists more shearing forces than parallel miniplate fixation. Also, there are other advantages like low rate of malocclusion, low stress shielding, low plate profile, etc. Conclusions We conclude that perpendicular miniplates are better than parallel or single miniplates in treatment of parasymphyseal fractures.

EPS0062 Maxillofacial Gunshot Injuries: Versatility in Patterns and Treatment: Case Series Dr. Anindita Bhagawati, Post Graduate Student Second Year, Dr. A.K. Adhyapok, Professor and H.O.D, Dr. S.C. Debnath, Reader Department of Oral and Maxillofacial Surgery (RDC), Regional Dental College, Guwahati Abstract Background/Introduction Maxillofacial gunshot injuries leads to considerable morbidity. Apart from emergency problems with airway obstruction and neurovascular compromise, reconstruction of bone and soft tissue is challenging. Objectives Facial gun-shot injuries are complex and in our case series it is seen that its management requires application of sound surgical principles and conservative, yet necessary, care to achieve a satisfactory outcome. Methods 3 cases of maxillofacial injuries, done by guns or rifles, were treated in our department of maxillofacial surgery. We compared type and severity of the injuries to the treatment and reconstructive steps. Results The reconstruction of defects done by shotguns needed treatment to bone and soft tissue, to get good aesthetic and functional results. Early and comprehensive surgical management of soft tissue followed by

S87 alignment of fractured bone pieces with plate fixation according to AO/ASIF principles of rigid fixation reduces morbidity. Conclusions Better functional and aesthetic results were obtained by addressing both the soft tissue and bony injuries in minimum number of stages. Our strategy was to repair both soft tissue and hard tissue simultaneously whenever feasible which involved application of arch-bars, direct fixation by wiring or plating and soft tissue repair by meticulous debridement.

EPS0067 Evaluation of Clinical Use of Indigenously Developed Delta Plate in Management of Subcondylar Fracture Dr. Sherin A. Khalam, MDS & Dr. Kala Bagavathy (II yr PG) Rajas Dental College & Hospital Abstract Background/Introduction Condylar fractures make 25–35% of mandibular fractures and warrant a special consideration due to their anatomical differences and healing potential. Success is considered optimal with regard to occlusion, improved mouth opening, absence of mandibular deviation, normal mastication, and absence of ankylosis. Previous clinical and biomechanical studies have recommended two miniplates which requires a certain size of proximal condyle fragment and so applicable in low fracture; also includes excess of armamentarium and increased exposure of condylar region. Objectives This study evaluates the clinical use of indigenously developed titanium delta-shaped miniplate in ORIF of subcondylar fracture. Methods Mandibular condyle is approached by Hinds incision. Delta plate is designed in triangular shape to provide 3-dimensional stability in open ORIF of subcondylar fractures-1mm thick, 20 mm long, & 5mm wide at top and 12 mm wide at base. Results Use of delta plates had 3 main advantages (i) neutralization of changing strains at anterior, lateral & posterior borders, (ii) additional stabilization provided by a compression miniplate and (iii) a small osteosynthesis plate. Conclusions Adaptation of ORIF gives improved results. ORIF with 3-dimensional stability is absolutely necessary for any subcondylar fractures for early functional rehabilitation with minimal complications.

EPS0073 Submental Intubation: An Alternative Access to Airway Dr. Jenin N.T., Ist year PG Trainee Rajas Dental College, Kavalkinaru Abstract Background/Introduction Orotracheal and Nasotracheal intubation are the commonly employed methods for airway management. However in panfacial trauma and bi-jaw orthognathic procedures they will interfere with the surgical access. Traditionally tracheostomy was used as an alternative. Due to

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S88 high risk of iatrogenic complications it is not preferred in all cases. To overcome the morbidity associated with tracheostomy submental intubation is preferred in selected cases. Objectives To see if submental intubation is a viable alternative in Panfacial trauma and Orthognathic bi-jaw surgeries. Methods 5 cases of submental intubation in cases of pan facial trauma. Results Submental intubation permits simultaneous reduction and fixation of all fractures and intraoperative control of the dental occlusion without interference from the tube during the procedure. It is relatively less technique sensitive, associated with less complications and avoids the longer post-operative care needed as in cases of tracheostomy. Conclusions The simplicity of the technique with no specialized equipment or technical expertise required makes it especially advantageous as compared with tracheostomy. It also reduces the incidence of intra operative and post-operative complications and eliminates the risk of side effects of tracheostomy.

EPS0075 Identifying the Risk Factors Causing Iatrogenic Mandibular Fractures Associated with Exodontia: A Systemic Meta-Analysis of 200 Cases from 1953 to 2015 Dr. Ashish Maheshkar SDKS Dental College & Hospital, Nagpur Abstract Background/Introduction Iatrogenic fracture of mandible (IFM) associated with exodontia though rare, they do occur with an incidence ranging from 0.0034 to 0.0075%. Most of the data is in the form of case reports or a small case series. This is an attempt to amass the data available in literature since the last 62 years. Objectives The purpose of this meta-analysis is to identify the etiologies and risk factors leading to IFM associated with exodontia and also the measures to minimize the complication. Methods Articles published between 1953 and 2015 were searched in Medline database. Data was collected and analyzed based on age, gender, extracted tooth, status of dentition, pathological bone lesion adjacent to the tooth, type of impaction, angulation of the impacted third molar, site of fracture, side of fracture, time of fracture, and treatment of fracture. Results A review identified 200 documented cases of IFM associated with the removal of teeth. The reasons for its occurrence found to be multifactorial with a higher incidence in the fifth decade of life with male prevalence. Risk factors more commonly identified were removal of the third molar, fully dentate patient, associated pathology, impacted tooth, angle region, left quadrant, and time interval of 3 weeks postoperatively. Conclusions IFM related to the removal of teeth is a rare complication. Identifying and addressing the risk factors will enable the surgeon to avoid the complication of IFM associated with exodontia.

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EPS0080 Self Tapping Intermaxillary Fixation Screw: An Alternative to Ivy Eyelet Wiring Dr. Tejinder Kaur, Dr. Jasmine Kaur, Dr. Amneet Sandhu Abstract Background/Introduction Intermaxillary fixation is a basic and fundamental principle in the management and treatment of the maxillofacial trauma patient. It serves as a cornerstone of maxillofacial reconstruction, providing a stable base from which facial form and function can be restored. Objectives To compare the efficacy of self drilling, self tapping transalveolar screws with Ivy eyelet wiring for achieving intermaxillary fixation during open reduction and internal fixation of maxillofacial fractures. Methods Both techniques were assessed for: time required for placement and removal of IMF hardware, time required for placement of IMF wires, postoperative occlusion, local anesthesia requirement during removal of hardware, oral hygiene status, glove perforation, and complications associated with both techniques. Results The average surgical time taken and glove perforations were more in Ivy eyelet group. The patient acceptance and oral hygiene was better in intermaxillary fixation screw (IMFS) patients. Conclusions IMFS is a cost-effective and viable alternative to eyelet wiring technique with satisfactory occlusion outcome in maxillofacial fractures. This technique of achieving IMF is relatively quick with minimal incidence of needle stick type injuries, less compromised oral hygiene and better patient acceptance.

EPS0098 Management of Naso Orbito Ethmoidal Fractures The Management of Naso-Orbital-Ethmoid (NOE) Fractures Jun-Jun Wei, Zhao-Long Tang, Lei Liu, Xue-Juan Liao, Yun-Bo Yu, Wei Jing* State Key Laboratory of Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China Abstract Background/Introduction Abstract The bony naso-orbital-ethmoid (NOE) complex is a 3-dimensional delicate anatomic structure. Damages to this region may result in severe facial dysfunction and malformation. The management and optimal surgical treatment strategies of NOE fractures remain controversial. For a patient with NOE trauma, doctors should perform comprehensive clinical examination and radiographic analysis to assess the type and extent of fracture. The results of assessment will assist doctors to make a patient-specific program for the sake of reducing post-operation complications and restoring normal appearance and function as much as possible. The poster that I would present focuses on the advancement of management of NOE fractures including symptoms, classifications, diagnosis, approaches, treatment and new techniques in this field. Objectives For a patient with NOE trauma, doctors should perform comprehensive clinical examination and radiographic analysis to assess the type and extent of fracture.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Methods Reconstruction of the original attachment of MCT Reconstructing the orbital wall Bone tissue engineering. Results The results of assessment will assist doctors to make a patient-specific program for the sake of reducing post-operation complications and restoring normal appearance and function as much as possible. Conclusions Although a number of procedures of NOE fractures have been described, management of NOE fractures remains one of the most difficult issues to fully restore the original facial appearance and function due to the anatomic complexity in this region.

EPS00106 Residual Deformity Correction and Its Outcome Prof. Dr. A. Thangavelu, MDS, DNB, FIBOMS, Dr. S. Kapil Dev Kumar Abstract Background/Introduction Disfiguring post-traumatic deformities of the midface sometimes persist even after the treatment. Such deformities, after healing, are among the most formidable challenges faced by the surgeons, apart from the psychological impact on the patients. Following the basic principles of craniofacial reconstruction and with newer techniques, better results can be achieved. Symmetry is key to proper reconstruction in general and face in particular. Proper facial projection and height must be re-established with harmonious occlusion. Our basic approach to the evaluation of deformities and particularly useful techniques for their correction are presented, with a representative case of malunited panfacial fracture that we treated with titanium mesh along with correction of mandibular deformity by osteotomies. Objectives In Department of Oral & Maxillofacial Surgery we have encountered two cases of post traumatic residual deformity of zygomatic arch and zygomatico maxillary complex fracture. Clinically, deformities of the middle and lower third of face ranges from dentoalveolar discrepancy (malocclusion) to severe facial asymmetry. Facial disfigurement causes social embarrassment and compromised masticatory and speech function. It often has a severe impact on the patients self esteem and affects the quality of life. Methods Accurate assessment by history, clinical examination and special investigations like plain films, dental study models, photographs and CT or MR scanning, with three-dimensional stereolithographic modeling where appropriate, treatment planning, surgery, utilizing a variety of techniques for management of soft and hard tissue deficits or deformities, including osteotomies or bone grafting. Results A person’s physical appearance is an important aspect in social interactions. It is not only the individuals own perception of appearance which not only contributes to the psychosocial effects but also the reaction of others. To improve facial aesthetic is the most powerful motivating factor leading people for surgical correction. Conclusions Jaw deformities may cause pain, dysfunction, excessive tooth wear, difficulty in mastication, speaking, or breathing. Many people live with these problems all their lives, but there is an alternative. Restoring the proper anatomic relationship of the upper and lower jaw helps to reestablish normal function and protect against further deterioration of the teeth and the TMJs. Maxillofacial surgery can help resolve these problems and improve a person’s comfort and selfesteem, allowing him or her to live a happier and healthier.

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EPS00116 Management of Floor of the Orbit Fracture: A Case Report Dr. Chandhini Asokan Sree Balaji Dental College and Hospital Abstract Background/Introduction Location of the orbit predisposes them to injury in faciomaxilllary injuries. There is a high incidence of orbital injury in faciomaxillary trauma. Trauma to the orbit can be either blunt or penerating in nature. Commenest bony injury to the orbit involves floor of the orbit fracture. It is very important for a maxillofacial surgeon to be competent in handling these problems. Objectives The purpose of this case was to assess the aesthetic and functional outcome of orbital floor reconstruction performed with titanium mesh. Methods Clinical examination, patient satisfaction and radiographic investigations were used to assess repaired fractures. Results symmetry was restored, extraocular movements were normal, globe position was normal, lid position was normal. Conclusions Reconstruction of orbital walls defects is a very delicate surgery and difficult to perform. Orbital dissection should carefully be extended to completely expose the defect and allow proper positioning and support to the reconstructive material. Titanium mesh is a suitable material for reconstruction of orbital fractures.

EPS00117 Management of Parasymphysis Fracture: A Case Report Dr. Visalakshi Kaleeswaran Sree Balaji Dental College and Hospital Abstract Background/Introduction Mandible fracture occupies the second most frequent incidence of facial bone fracture with incidence of about 38%. Manibular fractures may lead to deformities either due to displacement of fracture fragments or non-restored bone loss with disturbed dental occlusion with or without TMJ disorder. Consequences of an untreated or an inappropriately treated mandibular fracture may be severe both cosmetically and functionally. Hence it is very important for a maxillofacial surgeon to be competent enough to handle this problem. Objectives The aim of the study was to evaluate the efficacy of miniplate fixation in parasymphysis fracture. Methods Mode of injury, age and sex distribution, site of injury, associated injury and surgical treatment. Results Early intervention using open reduction and internal fixation resulted in minimum morbidity and complications.

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S90 Conclusions The use of mini plate for the treatment if parasymphysis fracture, decreased morbidity and complications and ensuring early return to normalcy.

EPS00118 Management of Angle Fracture Dr. Vijayaravind R.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Results The results of the study will be presented as per the defined protocol. Conclusions Changes in the anatomy of the joint has been observed in the cases with closed management of condylar fractures based on their requirement regarding adaptation to the function.

ABS00140 Efficacy of Low Intensity Pulsed Ultrasound Therapy in Maxillofacial Bone Healing

Sree Balaji Dental College and Hospital Dr Sharwan Kumar Singh Abstract Background/Introduction Mandibular angle fractures represent the largest percentage of mandibular fractures. There are two main reasons for the mandibular angle fracture 1. presence of thinner cross sectional area 2. presence of impacted 3rd molar weakens the region treatment of mandibular angle fracture possess a unique challenge for the surgeons. Objectives The key objective of the study is to address patient evaluation and general management principles and to discuss indications for the satisfactory treatment of mandibular angle fracture. Methods mode of injury, age and sex distribution, site of injury, associated injury and surgical treatment. Results successful establishment of the patient’s pre injury occlusion and function. Conclusions Mandibular angle fractures continue to present challenges to reconstructive surgeons. A thorough history, with investigation into the mechanism of trauma, along with a complete physical examination and proper radiographic assessment are the keys to the development of a satisfactory treatment plan for comprehensive management of these fractures.

EPS00130 Radiographic Evaluation of Condyle Fracture After Closed Treatment

Chandra Dental College; Barabanki Abstract Background/Introduction Bone is a dynamic tissue and its healing is affected by various biomechanical, biochemical, cellular, hormonal and pathologic factors. Delayed healing or non-union, results in functional impairment. In order to overcome this problem low intensity pulsed ultrasound therapy (LIPU) has been used to stimulate bone healing. Objectives Here we present an overview on LIPU with an insight on its mechanism of action, various effects (Physical, Piezoelectric and biological), clinical applications and future prospectives. Methods It was based on 3 electronic database basis (MEDLINE, EMBESE, Cochran database of randomized clinical trials.) For trials of ultrasonography and fracture healing, published from 1939-December 2014. Results It’s a noninvasive treatment modality with minimal complications or side effects. Conclusions Ultrasound therapy has shown accelerated healing in delayed or nonunion, callus consolidation after distraction and on adjunct therapy for osteoradionecrosis. It is an non-invasive treatment modality with minimal complications and provides better health care for the patient.

EPS00146 Modified Retromandibular Approach in Treatment of Subcondyle Fracture

Dr. Depa Anil, Dr. Ritesh Rajan, Dr. Dinesh Jhawar Suganraaj S.V. Abstract Background/Introduction The incidence of condylar fractures is high, but the management of fractures of the mandibular condyle continues to be controversial. The literature suggest that condylar fracture account for 17.5%–52% of all mandibular fractures. There is still no consensus among oral and maxillofacial surgeons world wide regarding open/closed treatment of condylar fractures. Objectives To radiographically evaluate condylar fractures managed with closed treatment so as to assess the changes in the anatomy of the joint which may influence outcome on function of the joint. Methods Radiographical evaluation was done for the patients who reported with condylar fractures to SVS Institute of Dental Sciences, Mahabubnagar from january 2016 to october 2017 and patients who were managed with closed treatment.

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Sree Balaji Dental College and Hospital Abstract Background/Introduction Mandibular fractures are extremely frequent in facial trauma, and 19–52% involve the condyle. Condylar fractures are classified according to the anatomic location (intracapsular and extracapsular) and degree of dislocation of the articular head. In recent years, open treatment of condylar fractures has become more common, probably because of the introduction of plate and screw fixation devices that allow stabilization of these injuries. Objectives Reviewing various approach in literature for reduction and fixation of condylar fracture is important to prevent complications, in my study Tang’s approach to the condyle has been described in detail and advantages has been described.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Methods By treating a condylar fracture using a modified retromandibular approach indirectly from the anterior edge of parotid gland. The degree and type of mouth opening, occulsal relation ship, facial nerve function, and other complications were assessed and evaluated. Results During followup conducted over 12 to 24 months, xray examinations revealed good healing. During follow up no case of anklyosis and salivary fistula was observed. Conclusions In modified Retromandibular approach involving incision from the anterior edge of parotid gland. Facial nerve in corresponding region is completely exposed. Operation is simple and short. This approach is also used for coronoid fracture, ramus fracture, and condyle fracture.

EPS00152 Management of Hemorrhage in Traumatic Patients with Bleeding and Coagulation Disorders Ankita Saraf

S91 Objectives In Advanced Trauma Life Support (ATLS), the ‘‘Golden Hour’’ represents a metaphorical maximum opportunity for optimal care by emphasizing the need for swiftly transport severely injured one to definitive care i.e. from the scene of injury to Trauma Care Unit. Severe injuries to maxillofacial region in polytrauma patient can complicate the early management owing to the regions proximity to brain, cervical spine and airway. Delivering the primary care is utmost important for survival of trauma victim. Methods To salvage such patients algorithm of ABCDE are followed traditionally and often modified and supplemented by other methods, which needs to be started within minutes to hour after accident. Aairway maintenance and cervical spine protection. B- caring part of breathing and ventilation. C- circulation maintenance & hemorrhage control part. D- disability or neurologic status determination step. E-exposure or undress the patient for identification of other injury sites & simultaneously prevention of hypothermia. Results Maximum survival rate can occur if Golden Hour is Capitalized. Conclusions Revolutionary advancement in ‘‘Trauma Care Management’’ domain for past few decades mortality rate has reduced.

Guru Nanak Institute of Dental Sciences and Research Abstract Background/Introduction Many patients with Oral and Maxillofacial Trauma have hematological disorders that interfere with proper clot formation or take medication that alter their coagulation status and place them at an increased risk of bleeding. Objectives Review of management of hemorrhage in traumatic patients with bleeding and coagulation disorders. Methods Results of various studies of management of hemorrhage in traumatic patients with bleeding and coagulation disorders and those under medications were analysed and summarized. Results After taking primary care, the medications and transfusions is altered according to the bleeding and coagulation disorder of the patient or by the anti platelet or anti coagulant drug he or she takes. Conclusions Management of hemorrhage in Oral and Maxillofacial Trauma in a fundamental skill of Oral and Maxillofacial surgeon and should be done with precaution especially with patients with bleeding and coagulation disorders.

EPS00161 General Management of Maxillofacial Trauma Dr. Priyadarshi Sengupta Gurunanak Institute of Dental Sciences and Research, Sodpur, Kolkata Abstract Background/Introduction Trauma is the leading cause of mortality globally. Death were classified as Immediate (scene), Early (In Hospital\4 hours from injury) and Late ([ 4 hours from injury). Statistic showed 61% immediate, 29% early and 10% Late death.

EPS00163 Infected Mandibular Angle Fracture-Risk Factor and Management: A Literature Review Dr. Kirthika R Sree Balaji Dental College and Hospital Abstract Background/Introduction Postoperative infection is one of the most commonly encountered complications after treatment of jaw fractures. Mandibular angle fractures are reported to be associated with the highest rate of infections among other maxillofacial fractures. The cause of most fracture gap infections is either a lack of or inadequate primary management. Immobilization with maxillomandibular fixation and/or splints, removal of diseased teeth in the fracture line, external fixation, use of antibiotics, debridement, and rigid internal fixation has played a role in management. Perhaps the most important advance was the realization that infected fractures also result from moving fragments and nonvital bone, not just bacteria. Controlling movement and eliminating the dead bone allowed body defenses to also eliminate bacteria. The next logical step in the evolution of treatment was primary bone grafting of the resulting defect following application of rigid internal fixation and debridement of the dead bone. Objectives To evaluate the risk factors and its management associated to mandibular angle fractures. Methods By clinical examination, usage of radiographic techniques and other techniques as mentioned in various articles. Results Oral hygiene is a key factor to eliminate and prevent postoperative infection. For patients, the immediate post-traumatic few days are usually associated with the greatest inconvenience encountered throughout the whole treatment course. Conclusions Different factors can increase the risk of infection, including, for example, the patient systemic condition, nature of injury, time of

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S92 medical care, and type of treatment utilized. This poster was aimed to review these risk factors and to highlight the management of the infected mandibular fractures.

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EPS00182 Endoscopic Reduction of Zygomatic Fracture Dr. Shakun Sharm

EPS00176 Osteosynthesis Using the Delta Plates in Mandibular Condyle Fracture Dr Gaurang Thanvi Mahatma Gandhi Dental College, Jaipur Abstract Background/Introduction Conventional studies has suggested closed reduction as the treatment of choice for mandibular fractures for decades. With the newer research and methodology the open reduction of the condylar fracture has become more favorable since osteosynthesis materials were developed in past few decades. Condylar fractures account for 25–35% of mandibular fractures and deserve a special attention as compared to rest of the mandible due to their anatomical differences and healing potential. But the sequela of the condylar injuries cannot be considered suboptimal with regard to occlusion, reduced mouth opening, deviation of the mandible, impaired mastication, ankylosis and internal derangement. The present study evaluates the clinical use of indigenously developed titanium delta-shaped miniplate in open reduction and internal fixation of subcondylar fracture. Objectives To evaluate the biomechanical stability of osteosynthesis using the Delta plate in condylar fractures. Methods A Study was done In 3 patients with subcondylar fracture. Mandibular condyle is approached by-Hinds incision. A Delta shaped 3D miniplates were used in which the base of plate is oriented towards the angle of mandible so that the tensile and compressive stress lines runs parallel to the plate. Results Three-dimensional plates results in more stability than conventional mini plates. The geometric pattern of three-dimensional plate, allows readily adaption to the anatomy of the fracture The delta plate which was used in our study was a non-compression plate made up of titanium. The size and shape of the plate favors the operating surgeon for easy adaptation and fixation of subcondylar fractures. This delta plate can also be use by intraoral approach, Very minimal complications are associated with this plating system. Just after a week of immobilization the rehabilitation and functional loading was possible. Conclusions ORIF with 3D stability gives early functional stability Adapts readily to anatomy of fracture gives better stability and function Early rehabilitation & functional loading possible clinical experience with osteosynthesis of subcondylar fracture of the mandible using delta plate.

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Christian Dental College Abstract Background/Introduction Traditionally, Facial Fractures repair have been performed via an open surgical approach. However, the use of endoscope may allow repair of facial fractures through small incisions with less extensive exposure. Objectives In the less severe zygomatic fracture with segmental fractures of the zygomatic arch the endoscope has been used to visualize the zygoma in the subperiosteal facelift without a coronal incision. Methods A 4 mm, 30 degree telescope inserted through a small temporal incision. Fracture sites at the zygomatic arch and the zygomaticofrontal suture were exposed and fixed with miniplates under endoscopic control. Results - Minimises the scalp scar. - Avoids forehead numbness. - Provides a comfortable postoperative recovery. Conclusions Endoscopic repair gives more accurate fracture visualization as it can be visualized on a television monitor, small external incision and reduced soft tissue dissection.

EPS00184 Evaluation of Intergonial Width in Angle Fractures Dr. CH Shivakanth, Dr. Ritesh Rajan, Dr. Abhinand Potturi Abstract Background/Introduction Angle fractures are most common fractures of mandible with an incidence of 20%–30% of all mandibular fractures. Various methods of plate fixation for angle fractures have been reported in the literature. Objectives To evaluate the intergonial width in treated angle fractures of mandible. Methods A retrospective radiographic analysis was carried out in patients who reported to SVSIDS Mahabubnagar. Results The results of the study will be presented as per the defined protocol. Conclusions Maintaining pre traumatic intergonial distance in angle fractures is paramount and this retrospective radiographic study will analyse the restoration of the same as a primary outcome variable.

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EPS00209 Post-Traumatic Enophthalmos: Our Experience Cynthia Scott (III yr PG), Dr Priyadarsini P. MDS (Reader), Dr. Karthik R. MDS (Reader), Dr. Saravanan C. FDSRCS (Prof), Dr Vivek N. MDS (Prof & HOD)

S93 Methods A retrospective analysis of all mandibular fractures treated in our institution for past 3 years. Results The data will be tabulated and statistical analysis to be presented. Conclusions The outcome of this study would benefit in the definitive treatment plan and overall management of mandibular fracture patients.

SRM Kattankulathur Dental College Abstract Background/Introduction Post-traumatic orbital enophthalmos is not an uncommon sequelae following orbital trauma. Management of post-traumatic enophthalmos can present as a challenge to the maxillofacial surgeon. This post-traumatic deformity is primarily due to alterations in the configuration of the bony internal orbit rather than to changes in the amount of its soft tissue contents. The treatment strategy is mainly the anatomic reconstruction of the internal orbit. Internal orbital reconstruction has evolved to an elegant procedure incorporating various customized biological or alloplastic implants. Objectives We present one such difficult clinical scenario with late presentation of the significant orbital enophthalmos which was successfully managed using a simple customized method. Methods A 22 year old female patient presented to the OPD with a complaint of unesthetic appearance of the right eye following trauma 3 years back. The patient had significant orbital enophthalmos and orbital dystopia. High resolution computed tomography images were obtained. The enophthalmos, the volume discrepancy and the amount of the autologous graft material to correct the enophthalmos was calculated using few simple formulae and data available in the literature. Results A significantly improved functional and esthetic result was obtained using this simple method. Conclusions Customized orbital implants are usually fabricated with the help of high end technology using CAD-CAM and sterolithographic models. This current technology is not reachable to all strata of population. However with the use of thin slices of Computed tomography and few formulae, a near perfect correction of enophthalomos is achievable.

EPS00210 An Evolving Pattern of Mandibular Fractures: A Retrospective Study Dr. Arya Arun (Post Graduate Student), Dr. Priyadarshini, Dr. C. Saravanan, Dr. Vivek Narayanan SRM Kattankulathur Dental College and Hospital, Kattankulathur, Tamil Nadu Abstract Background/Introduction Mandible fractures are among the most frequently seen injuries in the trauma care center setting. Fracture of mandible has been classified on basis of etiology, age of patient, anatomical site, pattern of fracture. Objectives To define current, predictable patterns of fracture based on patient demographics and mechanism of injury of road traffic accident.

ABS00215 A Parotid Fistula–Sialocele: An Uncommon Complication in Sub Condylar Fracture Management Through Trans Parotid Approach and Its Management Presenter- Dr. Anand (MDS 2nd Year). Dr. G. Harsha MDS, MOMSRCPS (Glassgow) HOD and Professor MNR Dental College and Hospital Abstract Background/Introduction sialocele is a collection of saliva in the subcutaneous tissue or in the glandular tissue, when this communicates with skin and drains it is known as parotid fistula. Huge sialocele often seeks drain though an extra oral wound, where as in the absence of extra oral fistula, saliva can be redirected intra orally using stent. If left untreated, a sialocele may develop into a significantly large swelling. We report a series of cases of sialocele formation and conservative methods and surgical management for this condition discussed. Objectives The objectives of this study is to determine the incidence, risk factors and management of sialocele and parotid fistula formation in sub condylar fracture reduction. Methods single institution multiple surgeons retrospective study of patients under going sub condylar fracture reduction and internal fixation through trans parotid approach under general anesthesia over two years (2015–2017). Results The incidence of sialocele in 30 patients operated for condylar fracture reduction and internal fixation through trans parotid approach is 26%. Parotid fistula- sialocele formed by parotid fascia either been damaged and probably the closure of layers was not adequately tight. Conclusions In this series of case we conclude that special compressive dressings and small drains are placed at the surgical site to promote proper fluid drainage as well as to close off any potential areas where saliva can accumulate. Dietary modifications are also prescribed to prevent the production of excessive saliva during the healing phase.

EPS00226 Submental Oro-Tracheal Intubation in Maxillofacial Trauma Dr. Md. Numan, Dr. Madan Mishra, Dr. Gaurav Singh Abstract Background/Introduction Securing an airway during the management of faciomaxillary injuries remains a challenge and is an important part of treatment. Oral intubation precludes the surgical prerequisite of checking dental occlusion. Having the tube in the field of surgery is often disturbing for surgeon. Delivery of anesthesia for maxillofacial surgeries is a

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S94 challenge because the anesthesiologist has to share the upper airway field with the surgeon. Submental intubation is an alternative to tracheostomy and it can be easily performed with little or lesser postoperative complication. Objectives To evaluate the efficacy of submental intubation in the management of maxillofacial trauma. Methods 20 patients were studied with faciomaxillary trauma where submental intubation was indicated. The parameter used to assess the efficacy were: restoration of the occlusion, duration of the surgery, presence of scar, presence of infection, damage to any vital structures or any postoperative salivary fistula. Results Submental intubation allowed reduction and fixation of all fractures without the interference of the tube during surgical procedure in all of the patients. There were no intra-operative complications and none of the patients required post-operative ventilation. There were no significant post-operative complications. Conclusions Submental endotracheal intubation is a useful alternative technique of airway management in patient with panfacial fractures. It demands a certain surgical skill without specialized equipment’s however, it is safe and quick to execute. It allows intraoperative correction of occlusion and enables surgery for associated nasal fracture in the event of concomitant skull base trauma, and avoids the dangers of classical endotracheal intubation.

Section: Cranio Maxillofacial Trauma EPS00231 Coronal Incision: Making it Simple Presenter: Dr. Sharvika S. Aher (PG Trainee) Dr. Pratik N. Suthar (PG Trainee) Guided By: Dr. Pushkar P. Waknis (MDS, FIBOMS, Professor & Consultant) Dr. D. Y. Patil Dental College & Hospital, Pune Abstract Background/Introduction The coronal incision a single versatile surgical approach to the upper and middle regions of the facial fractures. It provides excellent access to the areas with minimal complications. It’s advantages in terms of exposure of surgical field for upper and middle regions of face is far surpassed by any other approach. Objectives To study the versatility of coronal incisions for treating fronto-nasoorbito- ethmoidal fractures and evaluate the advantages, indications and complications associated with it. Methods In this case study, A patient was treated by a coronal approach. A step by step guide makes this method a simple one to perform. Results This study attempts to remove the fear from Coronal Incisions and help young surgeons to deliver quality surgery. Conclusions The coronal incision provides excellent access to the fronto-nasoorbito - ethmodial fractures, aiding in good anatomical reduction and also has added advantages is the most of surgical scar is hidden within the hairline.

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EPS00242 Comparision of Transbuccal Trocar Placement and Extraoral Approach for Mandibular Angle Fractures: Our Experience Presented by Dr. Ayyagari Anusha (MDS Ist Year pg), Guided by Dr. G Harsha MDS, MOMSRCPS (Glasgow) HOD and PROF MNR Dental College and Hospital, Sangareddy-502294 Abstract Background/Introduction mandibular angle fractures continue to be a common type of facial injury.surgical treatment of angle fracture is typically performed by intraoral, extraoral, transbuccal approaches.traditionally when open technique are utilised, extraoral approach is performed through skin incision in submandibular area.however patients develop unsightly scars and there is a risk of injury to marginal mandibular nerve through this approach.in comparision the transbuccal approach performed through an mucosal incision, results in minimal complications. Objectives to determine the ease of accesibility, procedural time, ease of anatomic reduction and its complications of both the approaches. Methods in a single institution, multiple surgeons retrospective review of patients undergoing angle fracture open reduction and internal fixation was studied. Results in extraoral approach the incidence of unsightly scar,facial nerve weakness, infection were found to be more than in that of transbuccal trocar placement. Conclusions based on our observation it was found that transbuccal approach showed fewer complications than extraoral approach.

EPS00267 Biomaterials for Orbital Reconstruction Dr. DIVYA. C Govt. Dental College, Kottayam Abstract Background/Introduction Orbital trauma accounts for 30 to 55% of all facial fractures Orbital floor injuries, alone or combination with other facial fractures, are one of the most commonly encountered midface fractures. Significant complications can occur as a result of these injuries, including enophthalmos, persistent diplopia, vertical dystopia, and restriction of gaze. Currently there is a greater understanding of the complex anatomy of the orbit and changes that occur within the orbit from disruption of its contents caused by trauma. Practitioners generally agree that the optimal treatment is to restore the normal bony architecture and reduce the herniated orbital tissues. Despite advances made in understanding of the injury, wide variation still exists in the method of reconstruction. Objectives Of all the considerations in orbital reconstruction, probably no topic has more differing opinions than the selection of biomaterial with which to reconstruct the orbital walls. This poster reviews the

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biomaterials currently available for internal orbital reconstruction and provides insight into their selection and application. Methods Literature review. Results Material for reconstructing the orbit can be selected based on requirements of the defect matched to the mechanical properties of the material. Conclusions The ideal technique is influenced by many factors, including specific characteristics of the injury and the experience of the surgeon. The purpose of this poster was to outline the important factors of the most commonly used materials and a few of historical interest.

Conclusions All midface fractures need a comprehensive opthalmological evaluation to rule out vision threatening injuries. As per the study the occurence of vision threatening injuries was low. Zygomatic complex fractures was main midface fracture associated with highest incidence of opthalmic injuries.

EPS00268 Evaluation of Ophthalmic Injuries in Midface Trauma

Rajah Muthiah Dental College and Hospital, Annamalai University

Dr. SIBI JOSEPH, Email: [email protected] Govt. Dental College Kottayam Abstract Background/Introduction The orbit is a delicate pyramidal structure comprising seven bones. The injuries to the orbit may be isolated or combined with injuries of craniofacial skeleton. In isolated injuries it may pertain to orbital rims alone or sometimes extend to involve orbital soft tissues. Maxillofacial injuries of the middle third of face commonly destroy the integrity of the orbital skeleton and range from the subtle blow-out fracture to the highly complex orbital comminution. Such trauma to the orbit and surrounding facial structures often lead to the orbital deformity and incapacitating visual dysfunction. Inappropriate diagnosis of these injuries can result in blindness with social and medico legal issues. Objectives To assess the prevalence of opthalmic and orbital injuries in midface fractures and how often a surgical intervention is required in the correction of these injuries. Methods The study was conducted on patients who reported to the Department of Oral and Maxillofacial Surgery OP and Causalty, Government Medical College, Kottayam. Four hundred and one patients who reported with mid face fractures was included in the study. A proforma was formulated to record the patients personal details and for assessment of ophthalmic and orbital injuries. Thorough evaluation was undertaken for each patient reported with mid face fractures. The evaluation included 1. History taking. 2. Clinical examination. 3. Ophthalmological assessment. 4. Radiographic evaluation. 5. Treatment given. Results Out of the 401 patients who have ophthalmic injuries associated with mid face fractures 15.5 % have orbital emphysema, 99.8% have periorbital edema, 96.5% have ecchymosis,98.5% have sub conjunctival haemorrhage, 38.2% have chemosis, 7.7% showed mild reduction in visual acuity, 0.5% showed moderate impairment in accomodation. Most frequently present severe ophthalmic injuries in mid face fracture was diplopia (15.7%), hypoglobus (12.7%),1.2% of patients had optic nerve injury, loss of vision was present in 1 % of patients. 0.5 % of patients each had retrobulbar haemorrhage and corneal laceration. 0.2% have gross proptosis and 1.2% had retinal injury.

EPS00272 Bicoronal Flaps in Cranio Maxillo Facial Trauma Prof. Dr. A. Thangavelu MDS, DNB, FIBOMS (Head, Division of OMFS), Dr. Nithin Sylesh R (PG student)

Abstract Background/Introduction Bicoronal apprach is one of the most versatile approaches to various areas in Cranio Maxillo Facial surgery. Excellent exposure is an added advantage of this approach. Traditionally used by neurosurgeons, its continued popularity among maxillofacial surgeons is due to the aesthetic advantage of the scar hidden in the hair line. Objectives Aim of this study is to explore the approach and uses of bicoronal approach in CMF trauma in the cases that were operated at our institute in 2017. Methods:: 4 of the cases who presented to our department with h/o trauma were treated via bicoronal approach. Surgical difficulties/ benefits were noted and patients were evaluated over a period of 6 months. 3 were complex lefort II/III pan facial fractures (two with residual deformities, one having a frontal bone fracture in addition) and the 4th an isolated frontal bone fracture. Results Reduction of the fracture segments with superior accuracy was achieved using a considerably lesser time than the conventional approaches. Better visibility during the surgery and better patient acceptance after the surgery was noted. Reconstruction with titanium mesh at the frontal bone region and correction of residual deformity were possible with ease due to this approach. Very minimal post operative complications were noted. Conclusions Coronal approaches supplemented by preauricular extension in combination with intra oral approach is found to be superior to the traditional approaches in treating the fractures of upper and middle third of face. Convenience and comfort, indispensable and versatile nature of this flap gives way to excellence for its usage in trauma of upper and middle third of the face.

EPS00274 Unusual Fracture Patterns of the Mandible-Our Experience Dr. Lakshmi Rathan (pg) Dr. Prashanthi, Dr. Karthik, Dr. Saravanan Professor, Dr. Vivek Professor & HOD SRM Kattankulathur Dental College and Hospital Abstract Background/Introduction Mandibular fractures are one of the most common fractures that account for about 60% of all facial bone fractures. There are various

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S96 classifications based on anatomical site, number of fragments, relationship of the fracture to the site of injury, presence or absence of teeth, direction of fracture and favorability. However, in recent times there is change in the fracture pattern owing to varying etiology and different type of injury. Objectives To emphasize the importance of customizing the classical treatment protocol for unusual pattern of mandibular fractures. Methods A retrospective study of the unusual patterns of the fracture mandible were analyzed. The management protocols followed for these situations during the period of three years (April 2014 - august 2017) were summarized. Results will be formulated. Conclusions These unusual fracture patterns do not come under any of the standard classifications and treatment protocols. Hence, there is a need for formulating an appropriate surgical approach, reduction technique and fixation modalities.

EPS00304 Patterns of Mandibular Fracture in University Hospital of Bhubaneswar: A Five Years Retrospective Study Dr. Rakesh Kumar Singh Kalinga Institute of Dental Sciences Abstract Background/Introduction Mandible is the only mobile bone of the facial skeleton which plays an important role in mastication, speech and deglutition. Being a prominent bone of the facial skeleton, it is fractured most commonly among maxillofacial injuries. Mandibular fractures occur twice as often as midfacial fractures, with the etiology ranging from interpersonal violence to sports related incidents but most commonly because of road traffic accidents. Objectives To evaluate the demographic data of the patients with mandibular fractures and to assess the major risk factors and prevention strategies to reduce mandibular fractures. Methods A five years cross sectional retrospective study was conducted by the case records of the patients reported at University hospital of bhubaneswar. Results Most number of cases reported in University hospital of bhubaneswar are of parasymphysis fracture followed by condyle fracture. Majority of mandibular fracture occured in male than female. Conclusions Mandibular fractures are one of the common maxillofacial injuries during trauma by any cause. Identification of the risk factors for the cause of trauma give us a clue to prevent mandibular fractures. Most number.

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EPS00308 Treatment of Malunited Mandibular Fracture: A Report of Two Cases Dr. Ratna Deepika Seshagiri, Dr. D. Y. Patil Dental College and Hospital, Pune Abstract Background/Introduction The posttraumatic complications of jaw fractures related to jaw function and facial deformity include nonunion, malunion, malocclusion, temporomandibular joint dysfunction and facial asymmetry. This report presents cases referred to our department for revision of malunion and malocclusion following inadequate reduction of jaw fractures. Objectives Treatment of malunited mandibular fracture. Methods - Basic investigations were done. - Occlusal splint fabrication was done for guiding occlusion. - Intraoperatively osteotomy was performed in relation to malunited fracture site and occlusion was achieved and maxillomandibular fixation was done. - Postoperative followup and occlusion was maintained. Results Satisfactory postoperative healing and occlusion achieved. Conclusions In these patients, malunion after mandibular reduction led to malocclusion, and revision surgery provided satisfactory results. A precise pre-operative examination and appropriate surgical procedure followed by proper post-operative management are necessary to prevent post-surgical complications of jaw fracture fixation.

EPS00321 Management of Infraorbital Rim Fractures Using Transconjunctival Approach Dr. M. M. Srikanth Kamineni Institute of Dental Sciences Abstract Background/Introduction Zygomaticomaxiillay complex fractures are common among the maxillofacial injuries. These fractures commonly involve one or more walls of orbital cavity. The most commonly used approaches to treat these fractures are Infraorbital, subciliary, subtarsal incisions etc. Though the complications are rare, but they often leave unacceptable scar/ectropion. To avoid these post operative complications an alternative technique of transconjunctival approach can be used for minimal scar formation with superior esthetics. Objectives Two cases of Infraorbital rim fractures with or without involving floor of orbit that are treated through transconjunctival approach and evaluate the amount of surgical exposure and esthetics. Methods Traction sutures are placed on the lower eyelid and incision given 3 mm below the lashes on the conjunctival surface below the tarsus.plane dissection is followed over the orbital septum to the inferior orbital rim by avoiding septal injury during the procedure. Fracture repair done and closed with 5-0 vicryl.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Results Adequate accessibility and surgical exposure gained and no scar formation seen postoperatively. Conclusions Infraorbital rim fractures treated with transconjuctival approach show minimal scar formation and superior esthetics.

EPS00347 Unusual Supero-Lateral Dislocation of Intact Bilateral Mandibular Condyles Associated with Right Parasymphysis Mandibular Fracture: A Case Report with Review of Literature Dr. Ankita B. Bhagat Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Wanadongri, Nagpur Abstract Background/Introduction The dislocation of the mandibular condyle occurs most commonly in an anterior direction due to trauma. On the contrary, posterior, superior, or lateral dislocations of the intact mandibular condyle occur rarely, and very few such cases have reported. Objectives To understand the aetiology, pattern, dynamics and treatment modality of such dislocations. Methods An extensive search for supero-lateral displacement of mandibular condyle done on online literature available in electronic media and found 28 relevant articles (According to available literature we found that 68 condyles were dislocated from glenoid fossa in 49 cases). Results The unilateral dislocations had occurred in 32 cases (64%) while bilateral in 18 (36%) cases out of 50 cases. Conclusions Factors responsible for supero-lateral dislocation of mandibular condyle includes anatomy of joint, type of impact, direction of impact, magnitude of impact, position of mandible, laxity of joint capsule, condition of dentition and other associated fracture. All factors interplay synchronously to bring about supero-lateral dislocation.

EPS00349 Open Reduction and Internal Fixation Methods in the Management of Mandibular Condylar Fracture: A Review Dr. Vaibhav D. Raut & DR. D. Y. Patil Dental College, Pimpri, Pune Abstract Background/Introduction Condylar fractures not only affect the functional jaw movement it also effect on the stability of occlusion. Primary goal of treatment to achieve stable occlusion, maintain facial height and remove TMJ dysfunctions. As there are controversies around treatment of condylar fracture different treatment strategies of these fracture in adult. 1:

S97 Close reduction 2: Open reduction 3: Endoscopic. Even the close reduction is most popular is associated with complication/or depended on patients complained. Hence, recently open reduction has gained important position in the treatment of mandibular is fracture. Objectives Aim of presentation is to overview need for aim reduction and variety internal fixation methods in the management mandibular condylar fracture. Methods Article published in English from 1980 to till 2017 were included in study. Results In literature there are various options are available for plating and fixation of the condylar fracture, such as two plate fixation, trilock delta plates, delta plates, 3D mini plates, four hole plate, resorbable plates, trapezoidal condylar trauma plates, lambda plate, lag screws, minidynamic compression plates, L shaped plates, Y shaped plate, A shaped plate. Efficacy of each plate was discussed in this study. Conclusions Open reduction and internal fixation gives excellent results when performed on properly selected patients. In literature 2 plates fixation give proper stability to the condylar fracture site. The outcome of 3D plates was comparable to that of 2 plate fixation.

EPS00351 Is it Wise to Do Opthalamic Assessment for All Malar Fracture Cases? Dr. Nirdhum Shikha Bapuji Dental College & Hospital, Davangere Abstract Background/Introduction Zygomatic bone contributes to the orbital walls so it carries high chances of severe dysfunction of visual apparatus as the soft tissues absorb more energy when compared to underlying bone following trauma. Objectives Assessment of ophthalmic changes post-malar fracture. Methods A retrospective study has been designed to analyse the requirement of ophthalmic consultation based on the scoring system1.100 patients with malar fracture from January2008 to August2017 were included from our unit. Patients with Lefort II and nasal bone fractures were excluded. Results Patients reported with: Proptosis 1%, blurring of vision 3%, severe vision loss 1%, required early-referral. Eyelid laceration 6%, enopthalmos 5% required routine-referral category. subconjunctival haemorrhage 54%, paresthesia 6%, diplopia 5%, eyelid swelling 1%, of non-refferal category. Patients also presented with motility disorder 2%, blow out fracture 1%, lateral rectus palsy 1%, palpebral palsy 1%. As per the scoring system: Early-referral (1patient), Routinereferral (2patients), Non-referral (6 patients) category. A total of 33 patients were referred from our unit for ophthalmic consultation. Conclusions A maxillofacial surgeon should always assess and evaluate the signs and symptoms of ocular function following malar fractures. For ophthalmic consultation wise decision should be made to avoid any medico-legal issues and for which Al-qurainy I. A. et al scoring system can be used.

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EPS00356 Subbrow Incision for Nasal Fractures Dr. Sonal Anchlia, Dr. Hardi, Dr. Vikash, Dr. Nisha, Dr. Rohit Govt. Dental College and Hospital, Ahmedabad Abstract Background/Introduction Nasal bone fractures treated with open reduction and internal fixation (ORIF) either use unsightly incisions directly in the glabellar region or cumbersome hemicoronal or bicoronal incisions. Till date, subbrow approach has been used in management of frontal sinus fractures. Here we propose a smaller similar version for management of nasal fractures. A bicoronal approach offers adequate exposure but has several disadvantages. Other more direct incisions, such as frontalis rhytid, butterfly, ‘H’, though are smaller give conspicuous scars. The main problem of nasal fractures is aesthetic deformity of face and if the surgical approach leaves a scar, it should not be considered for treatment. Objectives To evaluate a modification of subbrow incision as an approach for ORIF of nasal fractures. Methods For this study, 10 adult patients having nasal bone fractures requiring ORIF were selected. INCLUSION CRITERIA - Patients with displaced nasal bone fractures, with or without concomitant midface and those not possible to fix with closed reduction. EXCLUSION CRITERIA - Patients with undisplaced isolated nasal bone fracture. Patients with cranial fractures requiring bicoronal approach. The incision line was started from the medial most part of the eyebrow to a point slightly medial to the medial limbus axis line following precisely the lower edge of the eyebrow to obtain an inconspicuous scar. Results Stable fixation, restoration of contour deformities and barely visible scars with no postoperative complications were results observed using this approach. Conclusions The modified subbrow approach offers a good cosmetic result and adequate accessibility to perform ORIF of nasal bone fractures.

EPS00362 Versatility of 3D Plate for Zygomatocomaxillary Complex Fracture Dr. Sonal Anchlia, Dr. Ramyata Dayatar, Dr. Shishir kumar, Dr. Nisarg Patel, Dr. Dhruvi Shukla Government Dental College & Hospital, Ahmedabad Abstract Background/Introduction Traditionally, in fractures of the zygomaticomaxillary complex, two separate 2 D plates have been used, one in the infraorbital region and the other in the zygomatic buttress/maxilla region. Objectives The aim of our study was to prove the usefulness of three dimensional (3D) plates in zygomaticomaxillary complex fractures by giving it 3D stability, using only one 3D plate instead of two 2D plates, thereby, not only reducing the implant material but also obviating the need for extraoral orbital incisions. Methods

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 20 patients of zygomaticomaxillary complex fractures were treated using single 3D plates intraorally over zygoma/maxilla to fix both infraorbital rim and zygomaticomaxillary buttress simultaneously instead of two 2D miniplates in the same regions. Patients were assessed postoperatively for occlusion discrepancy, malar asymmetry, neurosurgery deficit, wound dehiscence, local infection, mobility of fracture segment, nonunion or malunion, residual cosmetic deformity and Interincisal opening. Results 34.54% less incisions and 29.06% less miniplates were required when method was used for fixing 3D plates in zygomaticomaxillary complex fractures. The only postoperative complications observe were maxillary sinusitis, wound dehiscence, occlusal discrepancy and infection in one patient each (13.34%). Conclusions Thus, the use of 3D plates in the management of zygomaticomaxillary complex fractures gives good results in terms of both function and esthetics. They stabilize the bone fragments in three dimensions because of their closed quadrangular geometric shape and also result in less number of incisions and less amount of hardware.

ABS00364 Prospective Evaluation of a New Classification of Mandibular Angle Fracture Based on Inferior Alveolar Canal Displacement as Assessed on CBCT Dr. Anbumani P Postgraduate Institute of Dental Science-Rohtak Abstract Background/Introduction Almost all the classifications available in the literature help surgeon in diagnosing the fracture and fracture pattern, but none of the classification helps in deciding the treatment principles and treatment approach for their management. It becomes very difficult for surgeon to decide which approach has to be selected, how many plates to be used and where to fix the plate. Thus, there is a need of widely accepted classification system that will help surgeons to make consistent decision regarding management of angle fractures. Objectives To propose and evaluate a management protocol for the management of mandibular angle fracture based on the degree of displacement of inferior alveolar canal between proximal and distal segment. Methods Forty patients with angle fractures of the mandible were evaluated. We categorized the fractures into 3 classes: Class 1(minimally displaced)—fracture with displacement less than 2 mm; Class 2(moderately displaced)- fracture displacement between 2 mm to 6 mm; Class 3(severely displaced)-fracture displacement more than 6 mm. Our treatment protocol is intraoral superior border approach with application of a single monocortical miniplate(adaptation in two planes) according to Champy’s ideal line of osteosynthesis for class 1 fractures; an extraoral Inferior border approach with application of inferior border plate with at least two holes (bicortical screws) on either side of the fracture line for class 3 fractures and by using randomization either intraoral superior border or an extraoral inferior border approach for class 2 fractures. Results Among 40 patients, 10 had Class 1 fractures (25%), 20 had Class 2 fractures (50%), and 10 had Class 3 fractures (25%). In Class 2 fractures, 10 patients were managed by intraoral superior border

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 approach (Class 2a) and 10 by an extraoral Inferior border approach (Class 2b). No statistically significant differences were found between the three classes in terms of occlusion, neurosensory dysfunction and clinical union. While, within Class 2 patients radiographic union, functional outcomes including pain at the 1-week follow-up and interincisal mouth opening at the 12-week follow-up, status of wound problem in 1 week follow-up, duration of surgery, better direct manipulation for reduction and easier approach for fixation of implant were significantly (P \ 0.05) found to be better in class 2b as compared with class 2a. Facial nerve paresis at 1-week follow-up found in five patients belongs to class 2b group which resolve completely in 12 week follow-up. Conclusions Our new classification based on degree of displacement of inferior alveolar canal between proximal and distal segment as assessed by CBCT can better guide clinical treatment. Class 1 (minimally displaced) fractures treated by intraoral superior border approach, Class 2 (moderately displaced) and class 3 (severely displaced) fractures treated by an extraoral inferior border approach are suggested for better outcome.

EPS00370 Treatment of Nasal Fractures with Novel Modified Splint Dr. Parth Parikh Faculty of Dental Science, Dharmsinh Desai University Abstract Background/Introduction The nose is easily exposed to trauma because it is the most prominent and anterior feature of the face. Its central position and anterior projection on the face predisposes the nose to traumatic injury. An injured nose can bleed from lacerations of the skin. These cuts may need to be repaired and evaluated immediately. Excessive activity may restart bleeding. Blood can also be collected inside the nasal septum tissue spaces. A septal hematoma can cause trouble by injuring or thickening the septal structures. Septal thickening may obstruct the nose. To prevent all these complications and for patient esthetics the external modified splint is used to treat nasal fractures. Objectives This appliance is very useful to treat the early and late complications occur after the septal thickening. Deviation of the septum can be improved by this appliance which helps in improvement of esthetic value. Methods In both the cases flail nasal bones were reduced first then they were stabilised by teflon material inside the nose after that the external nasal splint was stabilised and fixed with sutures to the teflon material inside and to the nose with K wire outside. The nasal splint was placed upto 21 days. Results After 6 months follow up the improvement of esthetic can be seen in both the patients, moreover reduction of flail nasal bones was achieved. Conclusions This nasal splint is very useful in nasal injuries with flail nasal bones. The appliance can be fixed under sedation comfortably. It reduces the patient discomfort as well as improves the esthetic.

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EPS00377 Management of Isolated Condylar Fractures Using 3D Plates Dr. Rachana Singh Saraswati Dental College & Hospital, Lucknow Abstract Background/Introduction Mandibular condylar fractures are most commonly encountered fractures being 17.5 to 52% of all mandibular fractures. Unilateral fractures occurs 3 times more than bi-lateral condylar fractures. The absolute indication of open treatment are condylar fractures with considerable dislocations, when closed treatment doesn’t restabilize occlusion. Open reduction aims at anatomical repositioning and rigid fixation of the fragments, occlussal stability, rapid return to function, maintenance of vertical ramal height, and less long term TMJ dysfunction. Methods of open reduction and internal fixation for the condylar fracture includes kirschner wires, intra osseous wiring, mini plates(2D) & lag screws. Mustafa Farmand in 1992 developed 3D plates and advocated better bio geometry to provide stable fixation over 2D plates. Quadrangle geometry of plates assures 3D stability of fracture sites & offers good resistance against torque forces. Objectives Objective of our study was to evaluate clinical results and to assess efficacy, stability and rigidity of 3D plates for osteosynthesis in mandibular condylar fracture. Methods In our study 10 patients underwent Open Reduction Internal Fixation of isolated condylar fracture using 2mm 3D PLATES using preauricular approach. All patients were evaluated for occlusal stability, TMJ dysfunction, inter-incisal opening, facial nerve weakness at regular intervals, I, e pre op, post op i.e. 1, 3 and 6 months. Results Stability of fracture site was better with reduced infection rate, no complain of pain during jaw movement. Only one patient complained of facial nerve weakness. Conclusions Displacement of condylar fragment, posterior facial heigh reduction, and deranged occlusion can be successfully treated by 3D PLATES fixation.

EPS00391 Management of Fracture Mandible in a Child with Osteogenesis Imperfecta-Our Experience Dr. Liz George, Dr. Sankar Vinod V. Mar Baselios Dental College Abstract Background/Introduction Osteogenesis imperfecta (OI) is an unusual heritable disease that occurs in about 1 in 10,000 to 20,000 live births. The major clinical manifestation is skeletal fragility. Other extraskeletal manifestations include hearing loss, dentinogenesis imperfecta, blue/gray sclerae, hypercalciuria, aortic root dilatation, and neurologic conditions. An eight and half year old patient reported to our department of Oral and Maxillofacial Surgery with a history of fall at home while playing 4 days earlier with swelling of left TMJ area. He was diagnosed with a

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S100 left subcondylar fracture which was managed conservatively. Hardly two months later he again reported with a right side fracture of body of mandible which happened due to fall again while playing and was treated conservatively. Due to increased bone fragility with increased incidence of fracture the patient was sent for a through medical examination and was diagnosed with osteogenisis imperfecta. Increased fracture risk in individuals with OI could stem from a combination of reduced bone mass, decreased bone material and quality. The reduced bone mass can lead to increased stresses within the bone as a result of a smaller area of bone tissue present to support physiological loads contributing to bone fragility in OI. Therefore goals of the treatment in OI are to decrease pain and fractures and to maximize mobility. Physical therapy/rehabilitation is particularly important in children to prevent fractures as well as to increase strength and mobility during fracture recovery as observed in our patient. Objectives Our experience in management of fracture mandible in a child with osteogenesis imperfecta. Methods Treated conservatively. Results Reduced fracture with proper occlusion treated conservatively. Conclusions Satisfactory and successful treatment.

EPS00408 From a Different Angle Raj Lakshmi Manipal College of Dental Sciences, Manipal Abstract Background/Introduction Mandibular fractures have always posed a treatment challenge to oral and maxillofacial surgeons with regards to favourability, managing teeth in the line of fire as well as the number of plates that should be used in treating these fractures. Objectives To assess the different treatment modalities used for treatment of angle fractures in our Institute and their success rate over the years. Methods Approximately 100 patients were assessed based on the number of plates used, presence of tooth in the line of fracture, displacement of fractured fragments, approach taken to expose the fracture. Results Single minimally displaced fractures could be successfully treated with one plate at the oblique ridge while dual angle fractures or those with displacements required more than a single plate for proper fixation. Teeth in the line of fracture if impacted were removed in most of the cases. Conclusions Over time, the management of angle fractures has evolved into a plethora of different perspectives. Proper reduction and rigid fixation goes a long way in providing a good post operative result to the patient. Fate of the third molar should always be decided. Other factors such as which approach should be carried out are primarily case based and decided by amount of displacement and ease of plating.

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EPS00411 Traumatic Optic Neuropathy (Clinical Features and Management) Dr. Siddharth Desai-College of Dental Sciences, Davangere Abstract Background/Introduction Traumatic optic neuropathy (TON) is a serious vision threatening condition that can be caused by ocular or head trauma. The incidence of TON after craniofacial trauma has been reported to be 2 to 5% Objectives To describe the clinical features and management options to the oral and maxillofacial surgeons, so that they could recognize and treat this condition. Methods It is classified as direct and indirect TON based on the cause of injury. Direct TON is caused by a penetrating injury to the area of optic nerve and usually presents as severe visual loss with minimal chances of recovery. Indirect TON is caused by acceleration/deceleration forces due to blunt head or closed globe trauma. The vision loss may vary from mild to total blindness. There are two options for management of TON. One is megadose of steroids and the other is surgical optic canal decompression. Results The evidence base for these treatment options is weak, and the routine use of high-dose steroids or surgery is not without any associated risks. Therefore some clinicians prefer observation alone. Conclusions Maxillofacial surgeons should have a thorough knowledge of this condition and should work along with the ophthalmologist to achieve best results for the patient.

EPS00415 Common Approaches to Facial Trauma-An Overview Dr. Deepak Meena Mahatma Gandhi Dental College and Hospital Abstract Background/Introduction As face is plainly visible to everyone, a conspicuous area of scar can make it cosmetically deformed. -If, it cant be managed intra orally, then extra oral approaches are applied. -the extra oral approaches may be required for fracture of frontal bone, orbit, condyle, ramus etc. Moreover, laceration provide easy access in the treatment. Objectives The aim of this poster is to evaluate different surgical approaches for treatment modalities for facia trauma. Methods There are different approaches to facial trauma- Intra Oral & Extra Oral Approaches to Mid Face- Upper eyelid approaches, Lower eye lid approaches, Tranconjuctival approaaches, Supra orbital eyebrow approaches, Coronal flap, Open sky. Approaches to mandible-Preauricular approach, Submandibular approach, Submental approach, Rithydectomy, Retromandibular approach. Results Laceration provide easy access in the treatment but approach that provide suitable exposure of the fracture site should be used and it should be aesthetically acceptable.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Conclusions The controversies are still going on regarding which incision is the most appropriate in different situations. The ultimate decision is made based on- - the area need to be exposed. -the mastery of the surgery in that. -And obviously it should be aesthetically acceptable.

EPS00445 Subcondylar Fractures-Open Reduction and Internal Fixation Dr. Neelakamal Hallur, Dr. Aaisha Siddiqua, Dr. Syed Zakaullah, Dr. Ashwin, Dr. Chaitanya Kothari, Dr. Shereen Fatima, Dr. Meenakshi Kothari, Dr. Juhi Bendegri

S101 transconjuctival. The transcutaneous approaches being sub-ciliary, sub-tarsal & infra-orbital incisions. Objectives To compare the functional and aesthetic outcome of the three transcutaneous approaches to orbital floor fractures from the patient’s perspective. Methods A retrospective study of patients treated for orbital floor fractures over the last 3 years in our institution were included. A questionnaire based analysis of the functional and aesthetic outcome were obtained. The final outcome of these three approaches were compiled and statistically tabulated. Results Study in progress. The results will be statistically tabulated. Conclusions This study helps the clinician to make an informed decision about the incision to be used for trans-cutaneous approaches to the orbital floor.

Al-Badar Rural Dental College and Hospitals Gulbarga Karnataka Abstract Background/Introduction The Choice of treatment for management of condylar fractures is always debatable. Earlier the preference was towards closed treatment as the surgeons believed that the risks associated with the surgery overweigh its benefits, but with improvisation of surgical technique and availability of good hardware system. Objectives To evaluate - Post-operative occlusion - Post operative mouth opening, - Post operative pain. - Post-operative radiographic healing of fractured site. Methods The study was conducted with a sample size of 10 patients with mandibular Subcondylar fractures. Subcondylar fracture managed by using 3D Trapezoidal condylar plates. Results Postoperatively, occlusion was found to be satisfactory in 90% of the patients. There was a significant increase in the mouth opening post operatively by the end of six months. Pain was not seen in 90% of the patients and remaining 10% of the patients had pain. The radiographic assessment at 6th month revealed union in 80% of the patients and non union in 20% of the patients. Conclusions The use of 3D trapezoidal condylar plates has proved to be effective in management of open reduction and internal fixation of mandibular subcondylar fractures in terms of stability, and functional rehabilitation.

EPS00457 Transcutaneous Approaches to the Orbital Floor-A Patients’ Perspective Dr. Kavitha Arumugam (1st Year Post Graduate), Dr. Priyadarshini MDS(Reader), Dr. C. Saravanan FDSRCS(Professor), Dr. N. Vivek MDS, (Professor & HOD)

EPS00461 Aesthetic Outcome of Depressed Frontal Bone Fracture Dr. Amrutha Varshini K. Sdm College of Dental Sciences and Hospital, Dharwad Abstract Background/Introduction Fractures of the upper face and anterior skull base are challenging neurosurgical, maxillofacial problem. The most appropriate treatment of frontal sinus fracture can be complex and at times controversial. Fractures of the frontal sinus represent between 5% and 15% of facial fractures but occur commonly as a part of craniofacial fractures. Most frontal sinus injuries are sustained in motor vehicle collisions (4485%), with young males most commonly affected (66-91%). Objectives: The objective was to analyze the incidence and aesthetic outcome following surgical correction of frontal bone fractures in our unit. Methods A retrospective study was carried on fractures of face from 2007 to 2016. This poster will highlight on parameters such as male: female ratio, age incidence, etiology, type, associated fractures, management and the associated complications. Results 2160 patients with facial bone fractures out of which 65(3%) patients presented with frontal bone fracture, 45 treated with ORIF. M: F was 3:1, age incidence 20-30years, cause RTA (98%).89% cases were approached through coronal incision and fractures fixed using either mini-plate(30 patients) or titanium mesh(12 patients) which provided excellent outcomes with significantly less complications. Conclusions Frontal bone forms an integral part of the face, hence it is important to restore the form and function by repositioning the fractures into their anatomic position, get a good cosmetic result and most importantly, create a safe sinus.

SRM Kattankulathur Dental College and Hospital Abstract Background/Introduction Orbital fractures commonly occur in maxillofacial trauma causing enophthalmos and diplopia. The most commonly involved walls of the orbit are the orbital floor and the medial wall. Traditionally the approaches to the bony orbit are either transcutaneous or

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EPS00462 Management of Bilateral Blow Out Fracture: Report of an Unusual Case

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Conclusions Animal bites have a wide spectrum of presentation and management. In developing countries a more aggressive approach with respect to antibiotic prophylaxis and post exposure immunization against tetanus and rabies is required.

Arathi S. Mohan Pushpagiri College of Dental Science Abstract Background/Introduction Fractures of orbital floor accounts for 21 % of the fracture of maxillofacial skeleton injuries. Orbital wall fractures present with various signs such as diplopia, enopthalmos and restriction of eyeball. Objectives Reconstruction of unususal case of bilateral blow out fracture with Titanium mesh. Methods The treatment consists of reconstructing the orbital floor defect with material, mainly Titanium mesh that can provide structural support and restore orbital volume. Results Results were satisfactory to restore the orbital volume and reposition herniated structures which has been done by titanium mesh. Conclusions The difficulties in management of these fractures are due to the lack of an uninjured contralateral side for comparison.

EPS00470 ‘Animal Bite, Pet Or Stray; Treat it Right, to Keep the Complications Away’ Dr. Arpita Komal/Dr. R. S. Bedi/Dr. HImanshu Chauhan Saraswati Dental College, Lucknow Abstract Background/Introduction Bite wounds have a special position in traumatology because of their high complication rate compared to soft tissue wounds caused by other reasons. The mammalian bite injuries account for 10% of patients managed with soft tissue injuries in the craniofacial region. Dogs are the most common perpetrators. Other animals like cats, horses, camel, donkey and snakes may be responsible for such accidents. Due to the large number of micro-organisms in the oral cavity, animal bite wounds are contaminated making treatment difficult with the risk of infection, especially in extensive injuries. Objectives To review etiology and management of facial bite injuries caused by animals. Methods All patients who were managed for animal bite presenting during the study period were included. Results Early management of complex animal injuries usually guarantees satisfactory outcome. Antibiotic prophylaxis is indicated for infected bite wounds and fresh wounds considered at risk for infection, like extremely large wounds, hematoma and cat bites, that appear to be more infected than dog bites. Tetanus immunization status and risk of rabies infection should be routinely addressed in bite wound management. Prevention strategies should be considered for preventing animal bites.

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EPS00482 ‘‘Reconstruction of Orbital Floor Fractures with Autogenous Bone Graft Application from Anterior Wall of Maxillary Sinus: A Retrospective Study’’ Dr. Krishna Ramrao Kurawar Swargiya Dadasahen Kalmegh Smruti Dental College & Hospital, Nagpur Abstract Background/Introduction Orbital wall fracture implies a situation where disruptions of the walls or floor have occurred. It is a blowout type fracture where bone fragments with torn periosteum are pushed outside of the original bony orbit. Objectives To support orbital contents, free entrapped tissue and restore the original orbital volume. Methods Ten patients who underwent repair of orbital floor factures with maxillary sinus bone grafts were included in this study. Surgical procedure for harvesting graft and its fixation was almost same in all operated cases. Results The postoperative clinical course was successful in all patients with full recovery of ophthalmological function except one case of postoperative epiphora which subsided on its own after some days without any intervention by ophthalmologist. The preoperative and compared postoperative ophthalmological examination was normal in all operated cases. The patients were satisfied with the aesthetic results. There was no inflammatory, infectious complication at the surgical sites or in the sinus. Conclusions Reduction of orbital floor along with drainage of collection in the maxillary sinus can be easily done through the same approach using anterior wall of maxillary sinus.

EPS00504 Condylar Fractures: Single Plate vs Two Plate Fixation Dr. Aswathy Krishna S. Post Graduate Student Department of Oral and Maxillofacial Surgery Amrita Institute of Medical Sciences Abstract Background/Introduction Open reduction and internal fixation of displaced condylar fractures allows for good anatomic repositioning and immediate function. The fixation methods should have sufficient resistance to oppose masticatory forces and not interfere with the condyle position after reduction. Use of a two plate fixation at the posterior and anterior border of the condylar neck will restore tension and compression

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 trajectories. Thus it provides functionally stable fixation for condylar neck fractures. Objectives To compare the function and outcome of fixation of a subcondylar fracture of the mandible with two noncompression miniplates and a single noncompression miniplate. Methods A retrospective study of 9 patients who had undergone open reduction and internal fixation of subcondylar fracture of mandible was analysed. Stabilisation of fracture segments was achieved with two miniplates in six cases and single miniplate in three. Malocclusion, need for postoperative intermaxillary fixation and radiographic reduction were evaluated in the immediate post operative period and after a period of one month and three months. Results Satisfactory occlusion was achieved for all patients with two plate fixation. Out of three patient with single plate fixation, one patient developed open bite in the immediate post operative period. Two patients with single plate fixation had occlusal discrepancy which was corrected with intermaxillary fixation. Post operative orthopantomogram showed splaying of fracture segments in single plate fixation case. Conclusions Two plates for subcondylar fractures represent the best solution to obtain stable osteosynthesis in comparison to a single miniplate.

EPS00552 Orbital Roof Repair with Titanium Mesh Dr. Prathibha P. M. Pushpagiri College of Dental Sciences Abstract Background/Introduction Orbital roof fracture part of complex midfacial trauma -least incidence in maxillofacial trauma - seldom treated surgically Included under frontobasal trauma. Objectives Overview of orbital roof involvement graded classification & treatment algorithm. Methods 1)Associated injuries & complications 2) classification 3) management 4) repair material. Results Treatment algorithm can be formed -associated be injuries & complications explained. Conclusions Rare occurrence in maxillofacial trauma -mostly conservative management - indication for surgical intervention.

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EPS00553 Study on Transbuccal Fixation of Mandibular Angle Fractures Presenting Author: Dr. Pavan Kumar Co-Author: Dr. Manjula Dr. Sujith Shetty, Dr. Saikrishna D. JSS Dental College and Hospital, Mysore Abstract Background/Introduction Management of angle fractures are technically difficult from intraoral approach because of poor access & difficulty in control of proximal fragment. This study was an attempt to evaluate the results of transbuccal approach (open reduction and internal fixation) to mandibular angle fracture fixation and to restore the anatomic form, functional occlusion and facial esthetics. Objectives To evaluate and assess surgical access and effectiveness of transbuccal approach in fixation of mandibular angle fractures. Methods In this study, 20 patients were randomly selected regardless of age; sex requiring open reduction and internal fixation of mandibular angle fracture with or without other associated fractures of facial skeleton. Patients were approached transorally with transbuccal instrumentation used for fixation of miniplates, where the fracture site was approached through the intraoral vestibular incision. Results Complications such as temporary paresthesia was noted in 4 cases (20%) who had preoperative paresthesia which gradually improved over 2-3 weeks postoperatively. Occlusal discrepancy was seen in 3 patients (15%) corrected with 7-10 days IMF with elastics postoperatively. Pain was mild to moderate in all patients with mean VAS score of (5.95) on first post-operative day, and mean VAS score of (2.05) on 7th post-operative day. Conclusions In all the cases of transbuccal approach, we were able to achieve the anatomical reduction intraoperatively and functional occlusion and facial esthetics post-operatively with IMF(elastic traction) for 7-10 days.

EPS00573 Modalities in the Treatment of Mandibular Angle Fracture Dr. Swapnil S. Sabnis Sinhgad Dental College and Hospital, Pune Abstract Background/Introduction Mandibular angle fracture is one of the most commonly encountered trauma in maxillofacial region. since centuries several treatment options have evolved for the management of these fractures. Objectives following poster summarises different modalities of management of mandibular angle fractures. Methods Open reduction and internal fixation of mandibular angle fracture with 7 hole angle plate via intraoral and transbuccal approach.

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S104 Results fracture management was done successfully via intraoral exposure of angle fracture and fixation through transbuccal approach with trocar and no complication were seen post operatively. Conclusions The need for accurate fracture reduction and fixation via extraoral approach has been greatly reduced since the advent of transbuccal and intraoral approaches in mandibular angle region.

EPS00577 Diagnosis and Management of Late Csf Rhinorrhea in Patient With Frontal Bone Fracture Swapnil S. Garde

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 plates when available, is an alternative that is gradually getting into active use for fracture fixation in pediatric patient. Objectives The purpose of this poster is to review bioresorbable plates and present a case of pediatric mandibular fracture treated using these plate. Methods Not applicable. Results Not applicable. Conclusions The review and our experience with the use of resorbable bone plate in a case of mandibular fracture of a child suggests that although this option is expensive, requires specialized equipment and is technique sensitive, yet it shows satisfactory fracture healing and can be effectively used in pediatric trauma.

Sinhagad Dental College and Hospital Abstract Background/Introduction The management of persistent, post-traumatic cerebrospinal fluid (CSF) rhinorrhea and otorrhea remains a surgical challenge. Repair of CSF leaks has evolved from that of an intracranial approach to one that is primarily extracranial and endoscopic. Objectives Diagnosis and management of CSF rhinorrhea in a patient with frontal fracture. Methods Diagnosis of CSF rhinorrhea with CT cysternography and management with dural repair using facia lata and fat and management of frontal bone fracture with fixation. Results 6 month followup showed no event of CSF leak. Conclusions Csf Rhinorrhea Is Commonly Seen in Frontal Fracture and Noe Fractures. It Can Be Diagnosed With Ct Cysternography and Repair Can Be Done With Neurosurgical Management.

EPS00585 Bioresorable Plates Doing Wonders in Pediatric Maxillofacial Trauma-Review & Report of a Case Dr. Priya Sharma(Author) Dr. Ankita Vastani (Co-Author) Rishiraj College of Dental Sciences & Research Centre Bhopal (M.P.) Abstract Background/Introduction Background-the management of mandibular fractures in paediatric patients has special considerations as compared to the management of similar fractures in adults because the anatomical characteristics of the developing mandible and the presence of tooth buds in the jaws of children and sometimes present with severe fractures in which the closed approach may not be the choice of treatment. The fractures may present with displacement, severe malocclusion, multiple fractures, or comminuted. Under these circumstances, open reduction and internal fixation is the treatment of choice and there is always a search for better plating systems and resorbable bone plate is one such novel choice. *Introduction-Out of the various fixation options such as compression plates, mini plates, lag screws, the use of resorbable

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EPS00596 Comparative Evaluation of Efficacy of Single Plate Versus Conventional Two Miniplates in Anterior Region of the Mandiblular Fractures 1) Dr. Sarjak Oza 2) Dr. Amit Mahajan K. M. Shah Dental College & Hospital, Vadodara Abstract Background/Introduction Locking plate systems offer advantages like, it becomes unnecessary for the plate to intimately contact the underlying bone in all areas. As the screws are tightened, they ‘‘lock’’ to the plate, thus stabilizing the segments without the need to compress the bone to the plate. Moreover it also decreases the hardware usage in the operating table and also aids in the decrease in the operating time. It also decreases the amount of infection and other hardware related problems. Many studies demonstrated that treating anterior mandibular fractures with the use of single locking reconstruction plates, placed at the inferior border of the mandible, could neutralize compression and tensile forces, obviating the use of a second plate at the superior border of the mandible. Moreover with this study it was observed that there were no disturbances in the post-operative occlusion and fracture stability was also seen post-operatively. As torsional forces in the parasymphysis region are very high, Champy had used upper plate as tension band but many surgeons think lower arch bar can be used as a tension band and eliminate the need for upper plate. Objectives To evaluate the efficacy of use of a single plate versus two miniplates in anterior region of mandibular fractures. Methods The study is being conducted under the general anesthesia. Treatment of the Fractures for anterior region of mandible will be done by giving incision intra-orally or extra-orally. The fracture fragments will be reduced in accurate anatomic pre-traumatic occlusion state and fixation will be done using single plate. Results As it is an On-going study results are being awaited. Conclusions This study will let us know about adequate stability and fixation across the fracture line in anterior region of mandible. Hence in future use of single locking plate in anterior region of mandible fracture can be promoted for better surgeon perception and patients compliance.

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EPS00602 Endoscopically Assisted Management of Mandibular Condylar Fractures Dr. Khushboo Changani Abstract Background/Introduction Complications of fractures of this area include malocclusion, such as apertognathia, loss of posterior mandibular vertical height resulting in a facial asymmetry, loss of chin projection in the sagittal plane, and loss of function/mobility of the TMJ. Management of fractures of t0 the mandibular condyle and subcondyle advocate simple closed reduction of fractures, as well as open reduction. Objectives To provide excellent visualization of the surgical field via a small incision Include acceptable minimal scarring. Decreased tissue manipulation and dissection. Decreased postoperative morbidity Quicker return to normal function. Methods There are two surgical approaches used in EAORIF of the condyle: an intraoral approach and a submandibular approach. Advantages of the intraoral approach include the lack of a skin incision, whereas its disadvantage is a smaller optical cavity to work within. The submandibular approach requires a 1.5-cm skin incision at the angle of the mandible, similar to a Risdon incision, placing the facial nerve at minimal risk; however, the optical cavity created has a larger working space with better endoscopic orientation. Once the optical cavity is created, the endoscope is placed and the fracture is visualized. Manual reduction of the fracture is then completed via manipulating the teeth or distracting the mandible in the angle region. Once reduced, a sixhole 2.0-mm non compression miniplate is inserted using a rightangle screwdriver/drill or a trocar. Angled elevators and reductionmanipulation forceps in the Synthesis fixation set facilitate reduction and fixation of these fractures. Results Endoscopic-assisted open reduction/internal fixation of mandibular condylar fractures is a viable alternative to traditional closed or open reduction techniques. However, case selection is important. Ideally, the fracture undergoing EAORIF should be easily manipulated into reduction and have enough stable bone on either side of the fracture to support a bone plate. Conclusions EAORIF is a technique that should be included in the armamentarium of the maxillofacial trauma surgeon when treating mandibular condylar fractures.

EPS00630 Role of Microplate in Midface Fractures Dr. Sivagopi Sree Balaji Dental College and Hospital Abstract Background/Introduction The bones of middle third facial skeleton produce a superficial apperance of strength, but they are fragile and hence get fracture easily so restoration of preexisting anatomical form, functional occlusion and facial esthetics to remain as our primary objectives.

S105 Objectives To evaluate the efiiciency of microplate in fixation of midface fracture. The aim of fracture repair by rigid internal fixation through primary bone healing under masticatory forces. Methods Maximum voluntary bite force was recorded in young individuals of different age group and they treated using microplates in midface, via open reduction and rigid internal fixation. Results There was a progressive improvement in bite force in passsage of time provides good reduction of the fractures due to plates resistant properties the palbaility of plates is negligible in prominent areas of facial skeleton. Conclusions The semirigid fixation was done with titanium microplates and screws, there was good biocompatability and implant rejection or infection was minimal.

EPS00661 Incidence of Maxillo Facial Trauma: 10 Year Retrospective Study Dr. Amal Suresh, Dr. Venkatesh Anehosur SDM College of Dental Sciences and Hospital, Dharwad Abstract Background/Introduction Trauma represents 50% of emergency consultations in developing countries, and is the third cause of death worldwide. A 10 year retrospective study was conducted of the patient reported to SDM Craniofacial Unit from June 2007 to June 2017 to assess the incidence, management and complicatons. Objectives The aim of the present study is to evaluate the incidence, management and complications of maxillofacial trauma from 2007 to 2017. Methods A retrospective study was conducted of patients reported to SDM Craniofacial Unit, Dharwad with maxillofacial fractures, from June 2007 to June 2017. The Medical records were evaluated for principal demographic, clinical, diagnostic and therapeutic data. Percentage analysis was done on the data collected. Results 986 cases ranging from 4-77 years of age group were reported, with male: female ratio of 9:1. The most affected age group was 18-36 years at 64.34% (n=628). Road traffic accidents constituted 46.41%, (n=453) of fractures. Parasymphyseal and zygomatic complex fractures were most common. Among the concomitant injuries, neurological injuries, Infections and malocclusion were frequent postoperative complications seen. Cases of malunion were also reported. Majority of the cases were surgically managed with minimal post-operative complications. Conclusions Trauma, mostly from road traffic accident, constitute the main aetiology of maxillofacial fractures with males being the most affected. Parasymphyseal and zygomatic complex fractures were the commonest fractures seen. Patients managed surgically have shown better results with very minimal or nil post-operative complications.

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EPS00693 Ballistic Injuries-Role of a Maxillofacial Surgeon Dr. Merlin K. Mathai, Guided by Dr. Shalini Krishnan A. B. Shetty Memorial Institute of Dental Sciences, NITTE University Abstract Background/Introduction Ballistic trauma or gunshot wounds is a form of physical trauma sustained from the discharge of arms and munitions. Such injuries cause perforation injuries which is usually avulsive and causes enormous damage to the soft and hard tissues, with severe communition of facial skeleton. Hence, a maxillofacial surgeon whose area of expertise is the head and neck region, plays a very crucial role in the management of such injuries. Objectives A literature review to discuss the most efficient modes of management along with the reconstruction techniques that a maxillofacial surgeon uses in case of such ballistic maxillofacial injuries. Methods Articles published within the last 20 years were reviewed with the help of various search engines using the key words ‘ballistic injuries’, ‘Maxillofacial trauma’, and ‘Maxillofacial surgeon’. The articles were studied based on the treatment protocols that the surgeons used while treating maxillofacial ballistic injuries. Results Immediate surgical intervention rendered by the surgeon prevented severe post op scarring and contractures. Recent advances in the imaging techniques like Stereolithography, 3D CT have proved to be of immense help. However, a well founded and structured treatment protocol based on clinical experience is mandatory in providing efficient, appropriate and successful treatment. Conclusions The role of a maxillofacial surgeon in the multidisciplinary team is quite crucial in the management of maxillofacial ballistic injury since it deals with intricate reconstruction and management of maxillofacial trauma to give an optimum aesthetic and functional result.

ABS00715 Clinical Experience with 3-Dimensional Delta Plate for Transoral Endoscopic-Assisted Osteosynthesis of Condylar Fractures Dr. Ajit Sinha & Dr. Srivalli Natarajan Abstract Background/Introduction Mandibular condyle fractures are one of the most frequent injuries of the facial skeleton. The option for open treatment of mandibular condyle fractures has become more favorable since osteosynthesis materials were developed in the past few decades. However, the rigid fixation techniques of treating condyle fractures remain one of the controversial issues in maxillofacial trauma. Several techniques and plate types like adaption miniplates, minidynamic compression plates, resorbable plates and double plates have been evaluated biomechanically in various experimental and clinical studies. Also various approaches have been used to for ORIF. The present case report is to evaluate the clinical use of titanium delta-shaped miniplate in open reduction and internal fixation of subcondylar fracture via transoral endoscopic assisted approach.

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Objectives To evaluate the clinical use of titanium delta-shaped miniplate in open reduction and internal fixation of subcondylar fracture via transoral endoEndoscopic-assisted ORIF of mandibular condylar fractures. Methods Titanium delta plates used for open reduction & internal fixation of subcondylar fracture via transoral endoscopic assisted approach. Results We have favourable results with titanium delta shaped miniplate in open reduction and internal fixation of subcondylar fracture via transoral endoscopic assisted approach. Conclusions Endoscopic-assisted ORIF of mandibular condylar fractures is a viable alternative to traditional approaches. Case selection is important. Delta plate provides optimum functional and stable osteosynthesis. As more experience is accumulated and greater efı¨ciency is achieved with these techniques, more procedures may be performed.

ABS00720 Comparative Evaluation of 3D Plates and Standard Mini-Plates in Mandibular Fractures: A CBCT Study Dr. Dowlin David, Dr. Shoban Nandy, Prof. Dr. Uma Maheswari Abstract Background/Introduction Though the mini-plates offer good resistance to displacement, it is not able to provide stability in three dimensions against excessive torqueing forces and thus may result in inadequate fixation. Farmand and Dupoirieux in 1992 gave a new plating system which resolved this problem and called it 3D-plating system, which takes advantage of bio geometry system to provide stable fixation. ? the quadrangular geometry offers good stability in three dimension against heavy torqueing forces. These plates are 2X4 mini-plates joined by four interconnecting cross struts. Lai operated on 30 patients with these plates and concluded that this has a promising future in maxillofacial fixation. Objectives The purpose of this prospective study was to compare and evaluate the efficacy of standard mini plates and three dimensional plates in management of mandibular fractures. Methods INCLUSION CRITERIA: - Patients with unilateral or bi-lateral mandibular fractures - Patients not medically compromised - Patients between age group of 14 to 70 years - Fracture line should be clean straight and not comminuted - Patients with no pathological bone disease - Patients with clear dental landmarks EXCLUSION CRITERIA: - Patients completely edentulous - Associated maxillary fracture - Systemic illness PARAMETERS: - Time Taken - Damage to Teeth - Nerve Damage And Paresthesia - Malocclusion. Results 3D plates showed that they could be plated faster, Mean for Group 1 being 2.06 and Group 2 being 4.94, thus reducing the operative time considerably, this was subjected to sample t- test and the difference was significant. - the second parameter was nerve injury, in Group 1 all patients retained sensation and in group 2 one patient (16.7%) developed loss of sensation which on 1 month post-operative review still complained of paresthesia. - the third parameter was damage to the teeth, in group 1 no patients were effected but in group 2 two patients (33.3%) had teeth damage, which was easily visualized using CBCT.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Conclusions The 3D plates seem to result in less complications and gives adequate stability if not more compared to standard mini plate. Since the time take to perform the surgery gets significantly reduced and due to the reduction of implant material of these plates, they offer a suitable and better alternative to Champy’s mini-plates.

ABS00728 Comparative Evaluation of ‘Y’ Modification of Transconjunctival Approach and the Conventional Approach for Management of Zygomatic Complex Fracture-A Randomized Control Trial Dr. Arun Saveetha Dental College and Hospital Abstract Background/Introduction The most important principle in treating fractures, especially those of the face, is the proper reduction. If the bone is not placed into the correct position, stabilization becomes superfluous. Many different treatment modalities have been advocated to repair ZMC fractures, each with variable success rate. With the advent of rigid fixation, there has been a philosophy that stresses wide visualization and accurate reduction combined with 3-point fixation to precisely approximate the fractured segment. However, the disadvantages of three-point fixation include increased surgical time, additional surgical scars and additional hardware. The purpose of this study was to overcome these disadvantages, albeit obtain three point visualization and fixation with minimal incisions so as to reduce the surgical time and scarring. In this study, we have used a ‘Y’ modification of the transconjunctival approach and conventional approach to assessing the advantages of it. Objectives To determine the fracture reduction. To evaluate the aesthetic advantage. Methods Randomized Control Trial. 12 subjects were included in the study. Group I - modification of transconjunctival approach Group II Conventional approach ((lateral brow incision, subciliary incision and upper gingivo buccal sulcus incision) Inclusion Criteria: Isolated Zygomatic Complex fracture Zygomatic Complex fracture with orbital floor fracture Fractures involving Mandible along Zygomatic Complex fracture Exclusion Criteria: Pan facial fracture. Isolated Zygomatic Arch Fracture Statistics: Independent t-test. Results Analysis of various parameters revealed between two groups shows significant differences (with better result in group I (4.66) whereas in group II (8.00) Conclusions The transconjunctival approach has been used classically for treatment of ZMC and orbital floor fractures. We believe that with the transconjunctival approach an excellent surgical exposure is accomplished when combined with Y modification of lateral canthotomy for better-fractured segmentsreduction and three point fixation. This could potentially avoid the use of a second incision in the area when plating the fronto zygomatic suture.

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EPS00735 Management of Maxillofacial Injuries in Pediatric Patient Dr. Akshatha K. I. MDS; Guided by: Dr. B Rajendra Prasad A. B. Shetty Memorial Institute of Dental Sciences, Nitte University Mangalore Abstract Background/Introduction Maxillofacial injuries in children are common comprising more than half of all injuries sustained. In childhood generally impetuous nature and adventurous spirit combine to encourage participation in physical activities with little thought for immediate consequences. Objectives To review the current literature on principles involved in treatment of maxillofacialfacial trauma for pediatric patient. Methods A literature review was conducted on various search engines and relevant articles in indexed journals were analysed. Results Over the past decades, in order to treat craniofacial fractures, several techniques and materials for fixation have been proposed, such as interosseous and suspension wiring, plating and microplating system, miniplate system. In the last 30 years, the most common treatment consisted in the application of metal plates and screws, both for adults and for children. Although controversial, the reported problems about metal fixation included: prolonged recovery, intracranial translocation of plates and screws, increased inflammatory responses, interference with craniofacial growth of the peadiatric skull and interference with diagnostic techniques. Furthermore, ankylosis at the temporomandibular joint after prolonged immobilisation requires protracted rehabilitation. Conclusions The greatest concern when treating the pediatric patient is the effect of the injury or treatment on growth and development. This is both anatomically and psychologically important and may have various effects on management for the different stages of psychological development.

EPS00798 Ballistic Injuries of Craniomaxillofacial Region Dr. Jagadish Patil, Dr. Abhay Datarkar Government Dental College and Hospital, Nagpur Abstract Background/Introduction Ballistic injuries (also called as missile injuries) are caused by gunshot wounds or artillery, shell or grenade. Injuries resulting from firearms in India are fortunately rare, compare to the the United States and certain Latin American nations, where death and injury from firearms are a relatively common occurrence. Although the incidence has increased during past decades, People who remain alive after multiple injury require the coordination of multiple surgical disciplines to optimize the functional and aesthetic consequence. Definitive management of patients with ballistic injury remains controversial in terms of reconstruction of bone and soft tissue defects. However there is consensus about the four main steps in the management of patients with gunshot wounds to the face: securing on

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S108 airway, controlling haemorrhage, identifying other injuries, and repair of the traumatic facial deformities. Objectives To outline the management of various penetrating and perforating wounds caused by high and low velocity ballistic weapons. Methods A Retrospective study was conducted in the tertiary care center for craniomaxillofacial surgeries at Government Dental College, Nagpur in the department of Oral and Maxillofacial Surgery where 6 patients of different ballistic injuries were evaluated and managed in the last 5 years. Results Ballistic injuries can cause a variety of wounds including penetrating and perforating wounds depending on the velocity of the weapons. Cases of these foreign bodies in the craniomaxillofacial region are less reported in the literature. In our department, we have treated 6 cases, out of which 2 patients suffered a blast of handmade pipe explosive, 3 patients due to hit by a low velocity bullet and 1 by a high velocity bullet that caused penetrating injury to the midface region. All patients were treated successfully with full restoration of form, function and aesthetics. Conclusions Gunshot related assaults results in 14o/o of cases and more than 50% of all gunshot cases result in head and neck injuries and out of which 30% to 620/o occur intraorally. Nerve damage, I particularly to the facial and trigeminal nerves, can be expected after severe gunshot wounds to the face. Size & location of foreign body in these cases make it unique and challenging for the maxillofacial surgeons to treat. Thus, to obtain a satisfactory result, a multidisciplinary and correct team approach is required.

EPS00810 Management of Pediatric Mandibular Parasymphyseal Fracture with Acrylic Closed Cap Splint: A Case Report Jain P, Yeluri R, Gupta S, Lumbini P Abstract Background/Introduction Dental trauma in children constitutes a major and serious dental public health problem. Fractures occurring in children present problems in achieving and maintaining stability that are quite different from those in adults. As such, the treatment modality differs in children due to the anatomic complexity of the developing mandible, presence of tooth buds, and eruption of primary and permanent teeth. Objectives The purpose of this poster is to provide an insight on maxillofacial injuries in pediatric patient and to assist the clinician in the management of Mandibular parasymphysis fracture in children with acrylic closed cap splint, a definitive treatment modality. Methods The most common treatment includes cap splints with circummandibular wiring, cap splint cemented onto the arch, and Erich archbar fixation. In this case report, a modified closed cap splint is used for the closed reduction in a minimally displaced parasymphysis

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 fracture. The modified closed cap splint provides adequate stability of fractured fragments and avoid intermaxillary fixation. Results The clinical outcome in the present case indicates that closed cap splint is best method for the reduction of the minimally displaced fracture. Closed cap splint is an effective and more reliable method than open reduction or intermaxillary fixation in terms of ease of application and removal, less time consumption, cost- effectiveness, good stability during healing period and minimal trauma to surrounding tissues. Conclusions Cap splints for treatment of pediatric mandibular parasymphysis reliable fixation techniques with regard to occlusion guided fracture reduction, maximum stability during healing period, ease of application and removal, reduced operation time, minimal trauma for adjacent anatomic structures, wide age group safe usage, ease of maintenance of oral hygiene, and comfort for young patients.

EPS00819 Coronal Approach Work Horse Flap in Oral and Maxillofacial Trauma a Retrospective Analysis Dr. Satish Kharde, Dr. S. R. Shenoi VSPM Dental College Abstract Background/Introduction Various indications for the coronal approach include severe craniomaxillofacial trauma, craniofacial deformities, craniotomy procedures, osteotomies of upper and middle one third of face, harvesting of bone and fascial grafts when needed, for improved access to condylar regions, and also for forehead rejuvenation. Although a variety of transoral and hidden incision are available providing adequate access to the face, but there are still areas of interest for maxillofacial surgeons in which these incisions fail to address, particularly the upper mid-face and craniofacial regions which are better accessed by coronal approach. Objectives The aim of the study was to check the feasibility of coronal approach. Methods Patients of maxillofacial trauma requiring coronal approach from January 2014 to March 2017 in our institute. Out of 22 patients who required coronal approach to expose fracture site, 8 had been operated with hemicoronal approach and 14 with coronal approach. Each case was assessed for the time required to raise the flap, visibility and accessibility to the area, need for additional approaches, postoperative complications including aesthetic and functional results were assessed. Results Awaited. Conclusions Coronal and hemicoronal approach turns out to be a highly indispensable and versatile approach, owing go it’s application in life array of craniomaxillofacial region, truly making it a Work Horse in Oral and Maxillofacial surgery.

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EPS00839 Bone Grafts in Craniomaxillofacial Surgery

Methods Both the condyle were reduced by manual pressure applied on occlusal surface of molar augmented by traction pull by loop of wire around the lower arch bar in molar region after mobilising the parasymphysis fracture using chisel mallet under GA. Patient was discharged with imf after 10 days with active mouth opening physiotherapy. Results Both the condyle were successfully reduced in glenoid fossa with good functional outcome and post operative mouth opening of 30mm was achieved after 30 days. Conclusions The goal of treatment of is to return the condyle to its original physiologic position. While dealing with facial trauma cases surgeon should consider such type of rare presentations for better diagnosis and management.

Dr. Ankesh Kumar Jain Rajarajeswari Dental College Abstract Background/Introduction Bone defects in the craniomaxillofacial skeleton vary from the small (few millimeters) periodontal defects to the large segmental defects resulting from trauma, surgical excision, or cranioplasty. Such defects typically have complex three-dimensional structural needs. Segmental jaw defects require restoration of mechanical integrity, temporomandibular joint function, and intermaxillary dental occlusion. A bone graft is defined as any implanted material that promotes bone healing, whether alone or in combination with other material. Bone grafts can be divided into the following subtypes: autografts, allografts, xenografts, synthetic materials, and any combination. Objectives 1) Biological principles of bone graft healing 2) Different types and sources of bone grafts. Methods Sources of autogenous bone grafts for craniofacial reconstruction can be harvested from iliac crest, calvaria, symphysis, tibia, rib, temporal bone and ramus. Results Bone from the ramus and symphysis was preferred for vertical and horizontal augmentation procedures. Iliac grafts are used for larger defects. Smphysis grafts were beneficial for small defects, such as cleft palate and orthognathic osteotomy defects. Mechanical stiffness of the tibial cortex can be useful in augmentation of atrophic alveolar ridge for implant placement, facial bone augmentation, or bridging an osteotomy defect. Temporal bone can be used to reconstruct maxillary, palatal, orbital rim, orbital floor, or ascending mandibular ramus defects. Conclusions Bone grafts remain the gold standard for reconstructing craniofacial bone defects.

EPS00840 Bilateral Traumatic Superolateral Dislocation of Fractured Condyle-A Rare Case Report with Literature Review Dr. Zohaib Roshan Dept of Omfs, Zadch, Amu, Aligarh Abstract Background/Introduction Anteromedial fracture dislocation of the mandibular condyle is common but a superolateral dislocation of condyle is quite rare. This type of dislocation is often misdiagnosed or completely overlooked and hence inadequately addressed. A case of a 42-year-old male patient who experienced bilateral superolateral dislocation of condyle associated with parasymphysis fracture following a road-traffic accident was managed. Objectives The objectives of this study is to diagnostic features and clinical management of such dislocations with the review of literature.

E-Poster Presentation Section: Craniofacial anomalies EPS0084 The Many Faces of Craniosynostosis—Diagnosis, Surgery and Beyond Dr. Shiju Mathew Jacob Army Dental Centre (Research & Referral), Delhi Cantt Abstract Background/Introduction Craniosynostosis is a condition which is characterised by the premature fusion of one or more cranial sutures in a new born child, often resulting in facial asymmetry and skull shape deformity. The clinical sequelae are variable and includes morphological and functional deficits. Closure of cranial sutures in early childhood is a concern for both the parents and healthcare professionals. Objectives This poster aims to demonstrate the role of imaging in early detection and diagnosis of craniosynostosis in addition to an insight into the management of such cases using different surgical modalities and their outcomes. Methods We intend to present our institutional experience in the management of both syndromic and non-syndromic craniosynostosis. Results The goals of surgical intervention includes the release of the affected suture allowing the unrestricted development of the visceral components (eg, brain, eyes) and 3-dimensional reconstruction of the skeletal components establishing a more normal anatomic position and contour. Conclusions Craniosynostosis may be either isolated or present as part of a craniofacial syndrome with significant implications if undiagnosed. Surgeons caring for infants with these cranial and orbital malformations must maintain a thorough understanding of the 3-dimensional anatomy, the characteristic dysmorphology associated with the different types of synostosis, and the complex interplay that exists between surgical intervention and ongoing skeletal growth.

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EPS00478 Management of Hemifacial Microsomia with a Combination of Mandibular Distraction, Orthognathic and Orthomorphic Surgery: A Case Report Dr. Nithi L. Prem, Dr. Pramod Subash Amrita Institute of Medical Sciences, Kochi Abstract Background/Introduction Hemifacial microsomia is the second common congenital facial deformity. It is characterized by abnormal development of maxillomandibular complex with ear deformities like microtia, accessory preauricular tags or middle ear defects causing hearing impairment. Orthognathic surgery, distraction osteogenesis and augmentation procedures have been the treatment of choice for facial deformity corrections. Objectives Effectiveness of a new surgical protocol for the management of facial deformity in hemifacial microsomia patients. Methods A new surgical protocol was performed in a 20 year old female, who is a known case of hemifacial microsomia. A two-stage treatment protocol has been opted for the management of the facial deformity. First step involves mandibular asymmetry correction using distraction osteogenesis. The remaining deformities are addressed using a combination of maxillary le-fort I osteotomy and orthomorphic surgery (reverse BSSO) of mandible along with malar augmentation. Results Mandibular dysmorphology was almost corrected by distraction osteogenesis. Orthognathic along with orthomorphic surgery was successful in achieving optimal results and there was satisfactory functional and aesthetic outcome. Conclusions Facial dysmorphology of considerable complexity can be well addressed with the new two-stage surgical protocol. After correction of mandibular anteroposterior length deficiency with distraction osteogenesis and maxillary height and occlusal cant correction with orthognathic surgery, orthomorphic surgery is a good option to correct the persisting contour deformity of mandibular angle due to lack of ramus width. Advancement of chin and lateral movement of sagitally split ramus (reverse BSSO) provides adequate mandibular projection and fullness in the angle region.

EPS00477 Impacted 3rd Molar Surgery in Sturge-Weber Syndrome-A Case Report Dr. Akash K S, Dr. Vivek G K, Dr. Akshay Shetty Abstract Background/Introduction Sturge Weber Syndrome is a rare congenital, non familial disorder caused by mutation of the GNAQ gene, it’s characterized by presence of port wine nevus, neurological abnormalities and ocular manifestations such as glaucoma. Diagnosis of Sturge-Weber syndrome is based on having two out of three diagnostic criteria, those being a facial port-wine birthmark, increased ocular pressure, and leptomeningial angiomatosis.

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Objectives Surgical extraction of an impacted mandibular 3rd molar in a patient with Sturge Weber Syndrome. Methods A case of a patient with Sturge Weber syndrome with a symptomatic impacted mandibular third molar was surgically extracted in minor OT under local anesthesia while taking all necessary precautions. There was minimal bleeding intra and post-operatively and no postoperative complications were encountered. Detailed clinical examination, investigations and adequate precautions should be taken during the surgical procedure to minimize any potential complications and manage these effectively. Results Surgical extraction of impacted mandibular third molar was done wherein bleeding due to any injury or rupture of the vascular anomaly was minimized and prevented. Conclusions Management of Patient with Sturge-Weber syndrome is challenging due to the risk of hemorrhage from any of the angiomatosis, so extra care and precaution must be taken when performing surgical procedures in the affected areas.

EPS00558 Fronto-Orbital Advancement: A Boon for Cranisynostosis Dr. Shahzaib Akhter Nasti Abstract Background/Introduction Craniosynostosis is a pathologic condition resulting from the premature fusion of the cranial vault sutures, resulting in craniofacial deformities. Anterior craniosynostosis can involve a combination of metopic unicoronal or bicoronal sutures. This early fusion prevents the skull from growing normally and affects the shape of the head and the face. In addition, in syndromes like Apert’s, a varied number of fingers and toes are fused together (syndactyly). The head is unable to grow normally, which leads to sunken appearance in the middle of the face, bulging and wide set eyes, a beaked nose and an underdeveloped upper jaw leading to crowded teeth and other dental problems. Shallow orbits can cause vision problems. Craniosynostosis also affects the development of the brain which can disrupt intellectual development. Cognitive abilities in people with apert syndrome range from normal to mild or moderate intellectual disability. Additional signs and symptoms may include hearing loss, hyperhidrosis, oily skin with severe acne, patches of missing hair in the eyebrows, fusion of cervical vertebrae and recurrent ear infections. Objectives This poster highlights the importance of Frontoorbital advancement and craniotomy cuts in cases of cranisynostosis and improvement of quality of life in these patients. Methods Cases of craniosynostosis treated/operated in the department of oral and maxillofacial surgery with frontoorbital advancement. Results The operated cases had increased head circumference, a normal looking forehead, Improvement in the head symmetry, disappearance of harlequin sign, normal position of the eyebrow and no complications were seen or reported postoperatively. Conclusions Frontoorbital advancement and remodeling play a major role in correction of cranisynostosis and encourages the patient for a better quality of life, provides a good magnitude of expansion and overcorrection. Different cases may require additional procedures to modify skull shape and measurements.

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EPS00613 A Rare Case Report of Head and Neck Arteriovenous Malformation in Children Dr. Bhakti Bhusan Pati SCB Dental College and Hospital Abstract Background/Introduction AV malformation in children in maxillofacial region is a rare vascular anamoly due to failure of complete involution of fetal capillary bed which results with devlopement of abnormal connection between arteries and vein leading to several potential life threatening complication. Objectives I here by report case of av malformation and discuss its clinical features diagnosis treatment from my institutional experience. Methods We have operated 3 patient below 10 yrs. One on lip, one on right side of mandible involving lingual and facial artery another in the floor of mouth and intraosseous component in the mandible with arterial feeders bilateral lingual artery and draining vein right internal jugular vein, right bracheocephallic vein. Results All the cases having good result, better fuctional activity of the operated site, devoid of post surgical complications and recurrence. Conclusions This case demonstrate rare case of av malformation which was successfully treated by surgical excision. Although rare clinician should aware of their life threatening complication and monitor for recurrence.

EPS00659 Surgical Correction of a Rare Case of Non-syndromic Trignocephaly Dr. Tom Thomas (Resident), Prof. Dr. Ummar. M. MDS (HOD), Prof. Dr. Premkumar, MS, Mch (Neurosurgery) Dept. of OMFS; MES, Dental College and Hospital, Perinthalmanna, Kerala Abstract Background/Introduction Premature closure of the metopic suture results in deformation of the anterior calvarium, resulting in the phenotypic features called trigonocephaly, Trigonocephalic deformities are recognized because of a pathognomic ‘keel-shaped’ deformity of the forehead with a prominent midline ridge, bilateral frontotemporal constriction with compensatory biparietal expansion, supraorbital and lateral orbital retrusion and hypotelorism. Objectives 1) To expand the volume of the cranial vault so as to accommodate the developing brain 2) To allow for normal development of the anterior cranial vault and orbits. Methods An eighteen months old, male patient was brought to our department and was diagnosed as non-syndromic synostotic trignocephaly.

S111 Access through Coronal incision was achieved Bifrontal cranioplpasty was performed and 2cm wide supraorbital rim was removed. Both frontal and orbital rims were remodeled using a resorbable plate and screws Fronto - orbital advancement was done - fixation was done using resorbable plate and screws the gaps in between the segments were packed by bone dust. Results A significant increase in the intercanthal distance, biocular distance, interorbital distance and intertemporal distances were noted. Patient was a Sloan’s class 2 on evaluation (classification of surgical results regarding cosmetic improvement) Conclusions cranioplasty with fronto- orbital advancement is a significant method for correction of trignocephalic deformities.

EPS00671 Emergency Management of Intraosseous Hemangioma of Maxilla—A Rare Case Report Dr. Shekhar S, Dr. Ravi V, Dr. Krishnakumar, Dr. Shyamsundar, Dr. Jaeson Mohanan Painatt, Dr. Girisankar Amrita Institute of Medical Science, Cochin Abstract Background/Introduction Intraosseous hemangiomas are benign vascular malformations and constitute less than 1 percent of all intraosseous tumors and are extremely rare in the maxilla. It exhibits female predilection and peak incidence is between second and fifth decade of life. CT and MRI imagings are gold standard in diagnosing these tumors, which typically has a ‘sunburst’ appearance. This report presents a case of a 6-year-old child with a history of brisk bleeding from the upper alveolus with no preceding history of trauma or pain. Objectives Emergency surgical intervention for intraosseous hemangioma involving maxilla. Methods Computed tomographic imaging and angiogram was suggestive of arteriovenous malformation in the right lower maxilla. She was advised admission but was unable to do so. She was brought back after an episode of severe bleeding at night and was immediately intubated and oral cavity was packed to control bleeding. Embolization of the AV malformation was performed but owing to subsequent severe bleeding, she underwent right infrastructural maxillectomy on an emergency basis. She underwent a second stage reconstruction, with scapular flap reconstruction and tracheostomy under GA, which was tolerated well. The Histopathological examination was suggestive of Intraosseous Hemangioma. Results Effective control of bleeding was achieved through emergency infrastructural maxillectomy. Conclusions Maxillary intraosseous hemangiomas are extremely rare and surgical intervention depends upon degree of disfigurement or repetitive bleeding. In our case, even though embolization of larger feeder vessels turned futile, emergency infrastructural maxillectomy proved successful for effective control of the bleeding.

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EPS00683 Cad-Cam Assisted Management of Depressed Frontal Bone Fracture and Contour Deformity Author: Dr. Sukirti Tiwari, Co-Author: Dr. Abhay Datarkar Government Dental College & Hospital, Nagpur, Email Id: Sukirti. [email protected] Mobile No: 7350016876; Email Id: [email protected] Abstract Background/Introduction Frontal sinus fractures comprise 5-30% of maxillofacial fractures, with isolated anterior table fractures accounting for 33% of frontal sinus fractures. Anterior table frontal sinus fractures can result in aesthetically displeasing contour deformities. Acute anterior table frontal sinus fractures that are depressed may be reduced with an open, closed, or endoscope-assisted approach. Delayed contour deformity camouflage can be achieved using bone grafts, titanium meshes, methyl methacrylate, hydroxyapatite cement, and polyether ether ketone implants. Objectives 1.the aim of frontal sinus fracture repair is to restore form and function and to prevent delayed complications. 2. Timing of surgical repair of frontal sinus fracture i.e. acute versus delayed. Methods A total of 34 patients have been included having frontal sinus fracture of age 22- 58 years (male pt – 27, female pt – 7). Fractures involving only anterior table are surgically corrected within 14 days of trauma. Depressed fractures of frontal bone involving both anterior and posterior table are considered for delayed approach. Treatment of depressed fractures are stereolithographically assisted for accurate contouring of frontal bone. Results all the cases have resulted in esthetically pleasing and precise contouring of frontal bone defect using CAD- CAM stereolithographic models. Conclusions Fractures of the upper face and anterior skull base are a challenging neurosurgical, plastic & maxillofacial surgery problem. Repair may take place in the acute setting, with the goal of fracture reduction with or without fixation, or in the delayed setting with the aim of camouflage, rather than reduction.

EPS00768 Condylar Hyperplasia: An Institutional Management Protocol Dr. Shikha Tayal, Dr. Abhay N. Datarkar Government Dental College and Hospital, Nagpur Abstract Background/Introduction Condylar hyperplasia (CH) is a progressive and pathologic overgrowth of either or both mandibular condyles. These condylar pathologies can adversely affect the size and morphology of the mandible, alter the occlusion, and indirectly affect the maxilla, with the resultant development or worsening of dentofacial deformities, such as mandibular prognathism; unilateral enlargement of the condyle, neck, ramus, and body; facial asymmetry; malocclusion; and

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 pain. Its etiology, classification and pathophysiology remain an enigma so far. Objectives To tailor an algorithm for decision making and management protocol of condylar hyperplasia. Methods Total 5 cases diagnosed with condylar hyperplasia treated surgically are included. Serial cephalometric tracings at 6-12 months interval done to evaluate the condylar activity and Bone scintigraphy to evaluate and confirm the metabolic activity of the bone. Based on the activity of growth, the patients were divided in 2 groups: Group A consists of 3 adult patients of non-growing age and group B contains 2 child patients where growth was still active. Though both groups of patients were treated according to the severity of the facial asymmetry at the time of diagnosis, Group A was surgically managed by low level condylectomy and Group B was treated by high condylar shaving. Based on the degree of facial asymmetry, Inferior border reduction osteotomy of the involved side was done to re-establish the vertical balance. Results After follow up of 6 months, all patients maintain good facial symmetry and balance and a stable skeletal and occlusal relation. The minimum surgical approach is utilized for every patient so that patients do not undergo much surgical and psychological trauma. However, one patient is undergoing fixed orthodontic treatment for occlusal refining. Conclusions The key in diagnosis and treatment planning is whether or not the disease is active at the time of presentation of the patient. Based on the age of the patient and the growth period, minimum surgical intervention is done and a long term stable esthetic and functional outcome is hence achieved in all patients.

EPS00777 Recent Innovations in the Mangement of Craniofacial Fibrous Dyspalsia Dr. Vibha Wodeyar Bapuji Dental College & Hospital, Davangere Abstract Background/Introduction The management of fibrous dysplasia can be challenging. It is a rare entity, but when it involves the craniofacial skeleton it can cause severe deformity, with devastating consequences. Objectives To adopt newer advances in the overall management of craniofacial fibrous dysplasia. Methods The recent advances which have been used in the management of CFD are haptic modelling, rapid prototyping 3D printing, stereotactic navigation system, volumetric soft tissue analysis. Results The methods which have been used had significant advantages: Improved interpretation of image data and preoperative planning, More accurate designing of the surgery, -Clearer patient understanding, -Less patient morbidity and improved esthetics. Conclusions Management of Craniofacial fibrous dysplasia is very complex and requires multidisciplinary approach. These innovative techniques which are evolving helps the patient and the surgeon to deal with the entity in a better way.

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Section: Cleft Lip and Palate EPS00100 Intrauterine Cleft Repair: Step toward Perfection Dr. Ramdas Balakrishna, Dr. Megha Sahu K.L.E Societies and Institute of Dental Sciences, Bangalore Abstract Background/Introduction Fetal cleft repair is an attractive option for the reconstructive surgeon considering the advantages of scar less wound healing. An endoscopic approach would eliminate exposure of the fetus to the outside environment & reduce the risk of a major operation for the mother. Objectives Review literature of Intrauterine Cleft Repair. Methods Literature search and review including online published articles. (Pubmed search) Results This revolutionary technique is still in its own fetal stage and requires further development and research for incorporation in future management of cleft lip and palate in humans. Conclusions Numerous studies performed on animal models are an evidence to potential benefits of foetal surgery for cleft repairs. But its role in nonlife threatening malformation is restricted based on lack of feasibility and risk to benefit ratio of intrauterine intervention. Yet their application in human still awaits ethical & technical clearance.

EPS00255 A Novel Minimally Invasive Technique of Using ToothBorne Hyrax Expansion Screw for Distraction Osteogenesis of Large Alveolar Cleft Defects (HYDISTB) Dr. Sujata Mohanty; Dr. Anjali Verma Head of Department, Maulana Azad Institute of Dental Sciences; Post-graduate Student, Maulana Azad Institute of Dental Sciences Abstract Background/Introduction Restoration of alveolar cleft defects is both essential and challenging for the craniofacial team. Bone in maxillary cleft cases is needed to obtain arch continuity, provide bone support for the dentition, stabilize the maxillary segments, eliminate oronasal fistulae, optimize nasal morphology by the nasal alar cartilage support, and complete placement of the implant. Objectives Because of the high failure rates, large alveolar cleft defects cannot be successfully closed with bone grafting. To overcome these limitations, a completely tooth-borne trifocal distraction appliance was devised and placed after osteotomy in a 19-year-old repaired cleft patient who had a 12-mm alveolar defect on the left side. Methods 1. Identify large cleft defect 2. Identify the transport segments (the number of dental units to be included adjacent to the defect) 3. Form the anchorage unit (posteriors) 4. Reinforce anchorage 5. Place hyrax

S113 screw at the site of osteotomy cuts (junction between transport and anchorage segments: unilateral/bilateral) 6. Separately acrylize transport and anchorage units 7. Attach lingual guiding wire to lingual brackets and tubes 8. Cement appliance at the surgical table after giving osteotomy cuts 9. Wait during the latent period (5to 7 days) 10. Activate the screw with a half a turn twice a day until the transport segments dock 11. Stabilize the transport segments docking together (by means of a wire joining the segments) to allow the regeneration of tissues at the site of distraction.) Results The tooth-borne trifocal distraction appliance was successful in the controlled closure of a large alveolar cleft with minimal invasiveness and low costs making this procedure feasible for a greater number of patients. Conclusions The hyrax expansion screw used as a distractor could bring about controlled bony transport with the desired directional vectors. Its exclusive tooth-borne usage minimizes the invasiveness of the procedure, and the simplicity of the appliance eliminates the need for costly distractors, making such therapy feasible for a greater number of patients. Thus the HYDIS-TB can be used successfully for the controlled closure of large alveolar clefts.

EPS00256 Tissue Engineering in Cleft Palate Dr. Padma E, Junior Resident Govt. Dental College Calicut Abstract Background/Introduction Cleft lip with or without cleft palate is the most prevalent congenital craniofacial birth defect in humans, observed in approximately 1 in 700 live births. Individuals with clefts of the lip, palate, or alveolus often require interdisciplinary treatment into adulthood. The complexity of the tissues and structures involved in cleft palates pose a significant challenge to the treating surgeon. A multitude of surgical techniques have been described to repair clefts of the lip, palate, or alveolus, Bone grafting is carried out to consolidate the dental arch correlated with the stage of canine development the surgical repair of cleft palates is not without consequence. The disturbance of facial growth in multiple dimensions is often the result of cleft palate surgery. Donor site morbidity after bone graft harvest remains a recognized limitation in the reconstruction of the cleft primary palate. The field of tissue engineering aims to restore function to or replace damaged or diseased tissues through the application of engineering and biologic principles. Intended outcome of an implanted tissue engineered construct is a new tissue that is structurally and functionally integrated into the surrounding host tissue. Hence tissue engineering approach for the grafting of the alveolus or soft tissues in the palate may be an useful alternative. Objectives To give a brief idea on the the application of tissue engineering strategies with an emphasis on soft tissue regeneration and alveolar bone regeneration. Methods Article search. Results Current approaches for the treatment of clefts of the lip and palate include surgery and bone grafts; however, there are limitations associated with these therapies. Tissue engineering strategies, particularly alveolar bone engineering and soft tissue engineering, may provide clinicians with new alternatives. The application of these

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S114 emerging technologies to a pediatric population must be well considered. Conclusions A tissue engineering approach may be a useful alternative for the treatment of cleft palates as it mitigates the concerns of donor site morbidity as well as provides additional options including scaffold implantation and growth factor delivery.

EPS00381 Pre-operative and Post-operative Assessment of Auditory Defects in Cleft Lip and Palate Patients Dr. Priyanka (Post Graduate Student), Dr. Sahana. BA, MDS (Associate Professor), Dr. Anil Kumar Desai, MDS (Professor) SDM College of Dental Sciences and Hospital Abstract Background/Introduction Individuals with cleft lip and palate often demonstrate multiple problems with auditory defects a well-known complication but the magnitude which is not generally appreciated in Indian population and accounts for about 97%. Objectives To assess auditory defects in patients with cleft lip and palate following cleft repair. Methods Cleft lip and palate patients between 1 year to 7 years of age who reported to us between July 2016 to August 2017 were assessed for audiometric defects which included impacted wax, discharge, retraction pockets, tympanic membrane perforation, congestion etc pre-operatively and post-operatively at 6 and 12 months. Results Out of 50 patients 30 were found to have significant otoscopic changes like serous otitis media(11 ears), retraction pockets(32 ears), impacted wax(48 ears), bulging of tympanic membrane with cartwheeling of vessels(1 ear), congestion(5 ears), discharge(10 ears) which was seen to improve post palatal repair. Conclusions Continuous follow up, with early diagnosis and treatment, will improve hearing and speech functions and social development of cleft patients in general.

EPS00543 Lip Adhesion Versus Nasoalveolar Molding in Bilateral Cleft Lip Palate Surgery Dr. Teertha Sadashiv Shetty; Co-Authors: Dr. Anil Kumar Desai ; Dr. Niranjan Kumar, Ms Mch (Plastic Surgery), Frcs Medical Director Dept. of Oral and Maxillofacial Surgery, S.D.M College of Dental Sciences & Hospital, Sattur Road Dharwad-580009; Dept. of Oral and Maxillofacial Surgery, S.D.M College of Dental Sciences & Hospital, Sattur Road Dharwad-580009; Department of Sdm Craniofacial Unit, Sdm College of Medical Sciences and Hospital, Sattur Road Dharwad-580009 Abstract Background/Introduction The repair of bilateral cleft lip palate deformities continues to be one of the most challenging areas of the reconstructive surgery. Various

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 technique have been tried to reduce the protruding premaxillary segment. Currently two competing philosophies have evolved: surgical correction involving lip adhesion as first procedure followed by definitive lip repair. Versus surgical correction in conjunction with presurgical moulding of the cleft segments into a more normal anatomic relationship. This study is an attempt to analyze the results of lip adhesion versus Nasoalveolar Molding procedure performed on bilateral cleft lip, alveolus and palate patients with varying degrees of prolabium and premaxilla protrusion. Objectives The objective of this study is to assesses the outcome of the lip adhesion versus nasoalveolar molding in patient with bilateral cleft lip, alveolus and palate. Methods A prospective study was conducted on 20 infants with bilateral cleft lip, alveolus and palate. This infants were divided into 2 groupsNasoalveolar molding group and lip adhesion group. Pretreatment and post treatment clinical, cast and photographic and anthropometric measurements of the individual of lip adhesion were compared with that of the nasoalveolar moulding groups. Results A significant decrease in premaxillary protrusion was noted in Nasoalveolar molding group (9.5mm mean) when compared to 4.5mm mean for the lip adhesion group. Marginal difference noted in reduction of the cleft width bilaterally in both the groups. A 52 % reduction in cleft width was noted in post Nasoalveolar molding group where as lip adhesion group shows reduction of 43.5 %. Effect of post Nasoalveolar molding on the nose was noted with the nasal tip projection of 2.27mm when compared to 0.8mm of lip adhesion group. Conclusions We can conclude that both methods has its advantages and disadvantages which has to tailored and used according to the need of the patient.

ABS00579 Secondary Alveolar Bone Grafting-Challenging the Challenge Dr. Akanshya, Post Graduate-Oral & Maxillofacial Surgery; Dr. Pravesh Mehra, Prof & HOD-Oral & Maxillofacial Surgery Dept of Dental & Oral Surgery, Lady Hardinge Medical College, New Delhi; Dept of Dental & Oral Surgery, Lady Hardinge Medicl College, New Delhi Abstract Background/Introduction Secondary alveolar bone grafting is a routine procedure for patients with cleft lip and palate for the correction of their residual deformity. Since its description, it has become the accepted method for aligning and uniting the maxillary segments and providing space for the eruption of maxillary canines and thus rehabilitating the patient. In the past century, many procedures have been described for the correction of the residual deformity. A careful assessment of the defect and hence weighing all treatment options plays an important role in adequate treatment planning for a patient needing surgical correction of the defect. Objectives primary objective - to achieve maxillary arch continuity and correction of secondary deformity secondary objective - insight into careful treatment planning and review of literature.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Methods A 15 year-old male having a complex residual deformity after multiple surgeries for the correction of cleft lip and palate was treated for the alveolar bone defect with iliac crest bone graft after volumetric assessment of the defect and reviewing the literature for all available treatment options and hence choosing the best available option. Results The surgical procedure resulted in maxillary arch continuity, optimal reconstruction and elimination of the oronasal fistulae. Also better esthetics were achieved after lip revision. Conclusions We present a report regarding a case of alveolar bone grafting, the challenges it threw at us and how we challenged the challenges.

EPS00608 Analysis of Airflow Dynamics in Pre and Post Cleft Septo-Rhinoplasty Procedure Using Computational Fluid Dynamics Dr. R. Manikandhan, Dr. Priyanga R. Abstract Background/Introduction The human nasal airways constitute one of the most complex airflow domains in nature due to the complex internal geometry. Though the nasal and septal anatomy can be studied clinically and imaging the airflow is always not actually analyzed to know the flow pattern. To obtain detailed calculations of flow in the naso-pharyngeal airway of a patient, a computational fluid dynamics model can be constructed using raw data from computed tomogram (CT) images of unilateral cleft patients with deviated nasal septum. Pre and post computed tomograms (CT) are compared following conventional or endoscopic Septo-Rhinoplasty procedure. Objectives To analyze the airflow dynamics of stress, pressure, temperature and velocity in unilateral cleft patients with deviated nasal septum using computational fluid dynamics following Septo-Rhinoplasty procedure. Methods In unilateral cleft lip and palate patients either closed or open rhinoplasties are performed. CT scans are done to study the computational fluid dynamics of airflow in a span of 1 week to 1 month postoperatively. Results Favorable airflow pattern is seen in patients with nasal obstruction and altered nasal morphology following Septo-Rhinoplasty. Conclusions Analysis of airflow pattern using computational fluid dynamics will help us analyze whether the surgery performed was appropriate and successful for that patient functionally and also help us to plan where exactly the maximum flow stress happens in air flow which we cannot see by any other means of imaging techniques.

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EPS00675 Assessing the Efficacy of Sphenopalatine Ganglion Block (SPGB) as an Adjuvant to General Anesthesia in Patients Undergoing Primary Palatoplasty Dr. P. Anantanarayanan, MDS; Dr. V. G. Muruganand MDS; Meenakshi Ammal Dental College Abstract Background/Introduction Cleft lip and palate is the second most common congenital anomaly. Clefts of palate can be classified as complete if it involves both hard & soft palate, and incomplete when it involves only the soft palate. Numerous techniques have been described for surgical correction of cleft palate and always require general anesthesia. The physical wellbeing and pain management postoperatively is a major area of focus and research. The concept of Pre-emptive analgesia works by antagonizing the nociceptive signals before injury. This study was designed to evaluate anesthetic, analgesic effect of bilateral SPGB combined with GA during primary palatoplasty procedure. Objectives Intra-operative assessment of vitals, blood loss and pain • Evaluation of postoperative pain score. Methods:Prospective trial, patients with complete cleft palate, planned for primary palatoplasty were randomly divided into study & control groups. Intra operatively study group received bilateral SPGB with 0.75%Ropivacaine in addition to GA. Intraoperatively vitals, usage of additional drugs, blood loss measured. Surgical field assessed using fromme’s ordinal scale. Postoperatively pain, Hbgms% PCV values assessed. Painfree duration, rescue analgesic used were recorded. Results Statistically significant decrease in mean blood loss, postoperative pain score & the number of rescue analgesics required in study group as compared to control group. Additionally gives hemodynamic stability and better surgical field in study group. Conclusions Administration of 0.75%Ropivacaine as pre-emptive analgesic offers excellent hemodynamic stability, optimal working conditions, perioperative pain relief and smooth recovery.

ABS00678 Reconstruction of Secondary Alveolar Cleft (Very Late Secondary Osteoplasty) with Iliac Graft and Protein Rich Fibrin-A Case Report 1. Dr. Divya James, 2, Prof. Dr. M. R. Muthusekhar 1. Saveetha Dental College and Hospital 2, Head of Department, Department of Oral and Maxillofacial Surgery, Saveetha Dental College and Hospital Abstract Background/Introduction Cleft of the palate and lip have intrigued the clinician for a very long time. Commonest congenital anomaly to affect the orofacial region and since the time of Veau (1931), and at various times efforts have been made to classify and repair these anomalies. Conflicting claims have been made with regard to success and time of surgery in this area. Prominent among these have been the studies of Bohn, Bjork and Skieller, Waite and Kersten and Boyne and Sands. The ilium

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bone is used most commonly as it is easy to access and large amount of bone can be obtained from the area. Objectives 1. To restore function and form by stabilizing the maxillary segments to form a continuous arch form. 2. For provision of an osseous environment which is responsive to orthodontic movement of teeth. 3. For prosthodontic rehabilitation. Methods In this case, very late secondary alveolar cleft grafting were carried out using iliac crest corticocancellous bone graft and protein rich fibrin. Radiographic bone fill was checked post - operatively. Results The case performed in the very late age group showed excellent results, clinically, with complete closure of the cleft defect and achievement of continuity of the dental arches. Good bone fill was visualized radiographically also. Conclusions Specific timing for undertaking alveolar cleft repair may not be all that crucial for a successful alveolar cleft grafting procedure.

Objectives correction of vertical alar discrepancy in cleft patient. Methods A full thickness incision in the alar crease extending caudally to the soft triangle and an alar base incision placed within the alar sulcus, and flaf can be moved in a caudocephalad direction. Results Alar discrepancy was corrected satisfactory in this case with good cosmetic outcome. Conclusions In this procedure vertical alar discrepancy can be corrected with satisfactory aesthetic outcome.

EPS00761 Tongue Flap Used in Closure of Oraonasal Fistula, A Case Report

Sankarsan Choudhury; Dr. B. R. Ambedkar

Dr. Sahil Kamble Y.M.T. Dental College Abstract Background/Introduction Tongue flaps were used for intra oral reconstruction, by lexer in 1904, in the field of oncology for reconstruction. Tongue flaps are used in a number of surgeries but their use in cleft lip and palate is unique because it provides excellent vasculature and the large amount of tissue they provide. Hence tongue flaps are ideal for the repair of large fistulas in palate scarred from previous damage. Despite the improved techniques of repair of cleft palate, fistula occurence is still a possibility either due to an error in surgical technique or due to the poor tissue quality of the patient. A similar case was presented at the department of oral and maxillofacial surgery, YMT dental college on a, 19 year old patient who was suffering from cleft lip and palate. And was treated for the same using a toungue flap.

EPS00792 Correction of Vertical Alar Discrepancy in Cleft Patient: A Case Report Dr. Koustabh Kumar

EPS00811 Primary Palatoplasty: The Efficacy of Prophylactic Antibiotics and Betadine Mouthwash in Preventing Postoperative Infections

Mediland Hospital & Research Centre Sonali Ghai; Institute of Dental Sciences & Hospital Background/Introduction: There are different protocols regarding the use of prophylactic antimicrobial agents in cleft palate surgery. Objectives To determine the efficacy of a prophylactic antibiotic compared with a placebo in reducing postoperative infections in cleft palate surgery. Methods 20 surgical patients were randomly assigned to two groups (group 1: 5 ml of betadine five minutes preoperatively. group 2: 30mg/kg body weight amoxicillin parentally half hour preoperatively). Postoperative complications (surgical site dehiscence) were assessed one month postoperatively. Results No statistically significant difference in surgical wound dehisence was found between the two groups. Conclusions Amoxicillin and betadine prophylaxis are equally effective in reducing postoperative infections in cleft surgery. Hence, antibiotic prophylaxis is not indicated for routine administration in otherwise healthy patients for such procedures.

Section: Orthognathic Surgery EPS0074 ‘‘Genioplasty‘‘……. Is it Miracle……??

Krishnadevaraya College of Dental Sciences Dr. Nupur Jain Abstract Background/Introduction Alar asymmetry could be caused by disharmony of the vertical or the horizontal planes. If the alar asymmetry is attributable only to horizontal plane disharmony, it is relatively easy to correct using general alar base surgery. However, if alar asymmetry is combination of horizontal plane disharmony and vertical retraction, the simple alar base surgery will not be sufficient. In this method a flap is designed to produce total alar movement, including the alar base for correction of vertical alar discrepancy.

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RCDSR Abstract Background/Introduction The chin (mentum) is vital to the human facial morphology as it contributes to the facial aesthetics and harmony both on frontal and lateral views. Osseous genioplasty, the alteration of the chin through skeletal modification, can lead to significant enhancement of the overall facial profile.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Objectives 1. To correct the facial aesthetics. 2. To correct the craniofacial deformities. Methods Sliding Genioplasty and advancement procedure. Results We achieved good results from Genioplasty procedure in Post TMJ ankylosis patient and patient with facial deformities. The facial aesthetics is very good after the procedure. Conclusions The osseous genioplasty should play an important part in the armamentarium of the aesthetic surgeon as well as the craniofacial and maxillofacial surgeon. It is a reliable procedure with predictable bone to soft tissue responses. It allow the chin to be mobilised in all 3 dimensions with predictable soft/hard tissue changes in order to enhance the appearance of the patients,

EPS0078 the Role of 3 D Printed Surgical Splints in Orthognathic Surgery Dr. Manjusha, M., Dr. Ritesh Rajan, Dr. Abhinand. P Svs Institute of Dental Sciences, Mahabubnagar, Telangana Abstract Background/Introduction Accurate treatment planning and meticulous execution of the plan is an important aspect of orthognathic surgery if optimum aesthetic and occlusal results are to be obtained. The advent of 3D imaging and printing technology have undermined the role of conventional acrylic splints made in the laboratory in orthognathic surgery owing to its superior accuracy and ease of preparation. Objectives The poster will highlight the role of tridimensional surgical splints fabricated using virtual surgical planning software and the outcome of the surgeries performed with these splints. Methods A retrospective analysis was carried out in a group of patients who underwent orthognathic surgery at our institute using a virtual surgical planning model and prefabricated 3 dimensional splint. The duration of surgery, the surgical outcome, the cost of manufacturing the splints were assessed and compared with that of conventional acrylic splints fabricated in the laboratory. Results The results of the study will be presented as per the defined protocol. Conclusions The 3D splints have helped immensely in increasing the accuracy of surgical outcome in orthognathic surgery by helping in replicating the treatment plan made more precisely. The greatest disadvantage with the 3D splints is its cost effectiveness compared to conventional splints.

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EPS00143 ‘‘BAD SPLITS’’ in Bilateral Sagittal Split Osteotomy Dr. Shahir Mansuri Karnavati School of Dentistry, Gandhinagar, Gujarat Abstract Background/Introduction Segmenting the mandible in an orthognathic procedure to reposition the toothbearing part is generally known as a bilateral sagittal split osteotomy (BSSO). Historically, different ways of splitting the mandible have been advocated.the Trauner and Obwegeser technique (1955), the Dal Pont modification (1961), and the Hunsuck modification (1968) are the widely documented. Objectives The aim of this poster is to review unfavourable split pattern types reported in the literature, and to present appropriate salvage procedures to manage the different types of undesired fracture. Methods A literature review for the period 1971– 2015 revealed a total of 458 cases of bad splits among 19,527 sagittal ramus osteotomies performed in 10,271 patients (i.e., 2.3% of sagittal splits reported) After the primary screening process, the eligibility criteria were met by a total of 33 reports. Results It appears that in most cases, bad splits can be repaired with additional osteosynthesis measures without having a negative influence on the postoperative course or end results. Conclusions With surgeon’s experience and additional osteosynthesis bad splits can be repaired with good out come and esthetics.

EPS00206 Mandibular Advancement Using Bsso-A Case Report Dr. S. Ravi Raja Kumar M.D.S Professor and Hod [Author] St. Joseph Dental College Abstract Background/Introduction Orthognathic surgery involves the surgical correction of components of facial skeleton to restore proper anatomical and functional relationships in patients with dentofacial skeletal abnormalities. An important component of orthognathic surgery is BILATERAL SAGITTAL SPLIT OSTEOTOMY, most commonly preferred indispensable surgical procedure for correction of mandibular deformities. Objectives To achieve functional occlusion, aesthetics, dental stability and improve psycho social impairments. Methods A 40 year old male patient referred to the department of oral and maxillofacial surgery from department of orthodontics for the correction of malocclusion and backwardly placed lower jaw. After thorough clinical, cephalometric and model analysis the case was diagnosed as Angles class II malocclusion with retrognathic mandible. As a treatment modality a bilateral sagittal split advancement osteotomy was carried out through intraoral vestibular incision and the mucoperiosteal flap was raised. Inferior alveolar neurovascular bundle was identified at lingula. Medial horizontal osteotomy cut was

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S118 made with a bur, just above the lingula and extended along external oblique line towards molar region and making vertical cut through the lower border. Osteotomy of mandible was performed using osteotome preventing injury to neurovascular bundle. Procedure is repeated on opposite side. After 7 mm advancement planned occlusion was established using thin interocclusal acrylic splint, After confirming the position of both proximal and distal segments stainless steel mini plates were used for fixation [2.5 mm x 6 hole]. Closure is done using 3-0 vicryl. Results Post-operative results were satisfactory with good occlusion and esthetics and no associated complications encountered in post-operative phase. Conclusions Mandibular ramus sagittal split osteotomy is the most popular procedure for repositioning mandible. Compared with other techniques such as vertical ramus osteotomy or inverted L osteotomy, sagittal split osteotomy provides better bony interface to supplement healing and allows easier adaptation of rigid fixation.

EPS00237 Maxillomandibular Advancement for Treatment of Obstructive Sleep Apnea Dr. Vidhya V Government Dental College Kottayam Abstract Background/Introduction Maxillomandibular advancement (MMA) is an invasive yet potentially effective surgical option in the treatment of obstructive sleep apnea (OSA) for patients who have difficulty tolerating continuous positive airway pressure and whose OSA has been refractory to other surgical modalities. Maxillomandibular advancement achieves enlargement of the nasopharyngeal, retropalatal, and hypopharyngeal airway by physically expanding the facial skeletal framework via Le Fort I maxillary and sagittal split mandibular osteotomies. Advancements of the maxilla and mandible increase tension on the pharyngeal soft tissue, thereby enlarging the medial-lateral and anteroposterior dimensions of the upper airway. Objectives To identify criteria associated with surgical outcomes of maxillomandibular advancement using aggregated individual patient data from multiple studies. Methods We systematically reviewed the articles from Pubmed, Cochrane Library, Scopus, Web of Science, and MEDLINE from June 1, 2014, to March 16, 2015, using the Medical Subject Heading keywords maxillomandibular advancement, orthognathic surgery, maxillary osteotomy, mandibular advancement, sleep apnea, surgical, surgery, sleep apnea syndrome, and obstructive sleep apnea. Data were pooled using a random-effects model and analyzed from July 1, 2014, to September 23, 2015. Results Forty-five studies with individual data from 518 unique patients/interventions were included. Among patients for whom data were available, 197 of 268 (73.5%) had undergone prior surgery for OSA. Mean (SD) postoperative changes in the AHI and RDI after MMA were -47.8 (25.0) and -44.4 (33.0), respectively; mean (SE) reductions of AHI and RDI outcomes were 80.1%(1.8%) and 64.6%(4.0%),

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 respectively; and 512 of 518 patients (98.8%) showed improvement. Rates of surgical success and cure were 389 (85.5%) and 175 (38.5%), respectively, among 455 patients with apnoea hypopnea index data and 44 (64.7%) and 13 (19.1%), respectively, among 68 patients with respiratory disturbance index data. Preoperative apnoea hypopnea index of fewer than 60 events/hr was the factor most strongly associated with the highest incidence of surgical cure. Nevertheless, patients with a preoperative apnoea hypopnea index of more than 60 events/h experienced large and substantial net improvements despite modest surgical cure rates. Conclusions Maxillomandibular advancement is an effective treatment for obstructive sleep apnoea. Most patients with high residual apnea hypopnea index and respiratory dietress index after other unsuccessful surgical procedures for obstructive sleep apnea are likely to benefit from maxillomandibular advancement.

EPS00262 The Effect of Tranexamic Acid on the Amount of Blood Loss During Lefort I, Anterior Maxillary Osteotomy and Genioplasty-A Prospective Study Dr. Bright E. C. Mar Baselios Dental College Abstract Background/Introduction Orthognathic Surgery is a well established method to correct various forms of dentofacial deformity. As the orofacial region is very vascular, significant blood loss can occur and a subsequent need for blood transfusion is often encountered. Objectives The aim of this study was to assess the effect of a single intravenous preoperative dose of tranexamic acid on blood loss during Lefort I, Anterior Maxillary Osteotomy and Genioplasty under hypotensive anesthesia. Methods A prospective study was conducted consisting of 20 subjects scheduled for Lefort I, Anterior Maxillary Osteotomy and Genioplasty. Amount of intra operative blood loss in 10 patients receiving tranexamic acid(study group) one hour before the procedure was estimated and compared with 10 patients not recieving tranexamic acid(control group) for the same procedure. Estimation of blood loss was calculated by Volumetric method and Gravimetric method. Need for blood transfusion, operating time and pre and post operative Hb and PCV were also measured. Results Blood loss in study group was 284 ? 19 ml which is significantly lower than the blood loss in control group which was 468.5 ? 122.3 ml. Time taken for surgery in study group(116 minutes) was significantly lower than that of control group(161.5 minutes). Conclusions The present study showed that single preoperative intravenous dose of tranexamic acid (10mg/kg) significantly reduced the blood loss in study group compared with control group. The operation time and the need for blood transfusion was also significantly reduced in study group compared with control group.

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EPS00264 Transverse Displacement of Proximal Segments in Bilateral Sagittal Split Osteotomy-A Prospective Study Josepaul C. I. Mar Baselios Dental College Abstract Background/Introduction Changes in various planes after BSSO setback had been studied by various researchers. Here it is an attempt to evaluate the changes occurring in the transverse plane after BSSO setback and fixation with monocortical miniplates and screws. Objectives To evaluate 1. Change in intergonial width. 2. Change in interramal width 3. Change in condylar angulation. 4. Relationship between amount of setback and transverse changes. Methods Prospective study of 15 patients who underwent BSSO setback. PA cephalograms at three time periods were taken. 1. Preoperative 2. Immediate postoperative. 3. 6 month postoperative. Setback is measured using pre and post operative Lateral cephalograms. Results 1. Intergonial width increased after surgery but reduced further. 2. No statistical evidence in the interramal width. 3. No statistical significance in the amount of setback and transverse changes. Conclusions Intergonial width show a definite increase after the surgery but reduced further on due to gonial remodelling. No statistical correlation could be identified between amount of setback and transverse changes.

EPS00302 ‘‘Reasons Behind Bad Splits in Bsso: Contemplating With Evidence ‘‘ Dr. Subhabrata Ghosh Bapuji Dental College & Hospital Abstract Background/Introduction One of the common operative complications during BSSO is a BAD SPLIT, which is an undesirable fracture of mandible at the proximal or distal fragment. A bad split can lead to infection, bony sequestration of fragments, delayed bone healing, post operative instability, relapse etc. Thus the risk factors for a bad split needs to be contemplated. Objectives To observe the incidence of bad splits as against anatomic variations to evaluate the post surgical bone splits in standard operating procedure of BSSO. Methods A retrospective study was designed and the sample was derived from the patients who had to undergo bilateral sagittal split osteotomy (BSSO). CBCT scans were done preoperatively and postoperatively. The patients where a bad or unfavourable split was observed were included in the study. The following factors were studied in them: Operator based: Experience of the operator, Technique used,

S119 Instruments used, Extent of lateral bone cut (1) Patient based: Age of the patient, Presence of an impacted third molar, Mandibular anatomy- form of the mandible, height of the ramus, position of mandibular canal, fusion of cortical plates, ramal occlusal angle (1) Results It was observed that the inexperience of the operator, wrong choice of instruments, a longer lingual cut were major operator based factors which resulted in a bad split. On the other hand an age of more than 25 years, an impacted third molar, a longer and thicker ramus, fused cortical plates and an obtuse angle between ramal-occlusal plane angle proved to be predictive for a bad split. Conclusions This study showed that there are many operator and patient related factors which predilicts for a bad split in BSSO, these factors need to be looked into in detail in order to avoid its incidence.

EPS00319 Orthoprint-A Virtual Reality Dr. Sagar Joshi, Dr. Kalyani Bhate from Dr. D.Y. Patil Dental College and Hospital, Pimpri Abstract Background/Introduction The orthognathic surgery is the standard treatment for the correction of dentofacial deformities, in order to get a stable dental occlusion and facial harmony. The advancement of technology and the evolution of the concepts involved in the diagnosis and treatment plan in this area have been immeasurable, leading to the development of new methods. One such advancement is computer-aided jaw surgery system by a three-dimensional (3D) virtual surgical planning. Objectives to highlight uses of orthoprint in pre-surgical planning in orthognathic surgery. Methods:.stepwise method- 1. image acqusition 2. processing of acquired images 3. 3 D virtual diagnosis 4.3-D virtual treatment planning of orthognathic surgery 5. 3-D virtual treatment planning communication 6. Splint fabrication 7. 3-D virtual treatment planning transfer to operating room. Results It is a very useful tool in pre-surgical planning of orthognathic surgery. Conclusions With all possible details, the orthoprint provides greater predictability, practicality and precision in surgical planning.

EPS00326 Combination of Anterior Maxillary Osteotomy and Anterior Mandibular Subapical Osteotomy-A Case Report Dr. Bitan Bhowmic Sree Balaji Dental College and Hospital Abstract Background/Introduction Maxillary excess can be either anterior or complete. Both show excessive gummy smile with increased over jet and deep overbite. In

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the anterior maxillary excess there is labial inclination of the maxillary anterior teeth and convexity in the facial profile which is limited to the upper lip region. Whereas in the complete maxillary excess in addition to above there is convexity of the inferior orbital rims and nose also. The first report of an anterior segmental maxillary osteotomy (AMO) was published by Cohn Stock in 1921. This clinical case presents report of orthodontic treatment combined with Anterior maxillary osteotomy and Anterior mandibular subapical osteotomy for improving the skeletal, dental, soft tissue and over all aesthetics of a 19 year old female patient. Objectives Treatment objectives were to improve the positioning of the anterior maxilla with a reduction in the gingival exposure, to achieve an ideal overjet, overbite, to correct lip incompetency and achieve an aesthetic profile. The maxillary excess was limited to anterior maxillary region. Methods As the patient was 19years, a combined orthodontic and surgical mode of treatment was planned. It was decided to do extract the first premoalrs and followed by AMO to position anterior maxilla posteriorly by 5 mm and superiorly by 3mm. In the mandibular arch it was planned to correct crowding, molar relation, curve of spee and proclination via extraction of the mandibular first premolars. Retraction of lower anteriors was planeed to create sufficient over jet to facilitate surgical correction.the patient was informed and consent was taken for the procedure. Results There was improvement in facial esthetics with improved lip competency, decreased gingival exposure on smile and rest. The patient was very satisfied with the results of treatment. The excessive vertical dysplasia was dramatically reduced, and most of the cephalometric values were brought into the normal range. Conclusions Through the combined approach by orthodontist and oral surgeon, the patient had a dramatic skeletal, dental, and occlusal improvement. This case illustrates that orthodontic treatment with AMO and Anterior mandibular subapical osteotomy achieved stable, functional, and esthetic result. Patient also reported a better self-esteem. The overall treatment time was reduced.

EPS00422 Bilateral Sagittal Split Osteotomy VS Distraction Osteogenesis for Deficient Mandible

EPS00420 Surgery First Orthognathic Approach

Presenting Author: Dr. Supreet Kaur Grover, Co-authors: Dr. Sujeeth Shetty and Dr. Saikrishna D

AECS Maaruthi College of Dental Sciences Abstract Background/Introduction bilateral sagittal split osteotomy and distraction osteogensesis are the most common techniques currently applied to surgically correct mandibular retrognathia. Objectives To compare the outcomes, advantages and disadvantages of distraction osteogenesis and bilateral sagittal split osteogenesis. Methods patient with bilaterall sagittal split osteotomy- a medial osteotomy, sagittal osteotomy, vestibular osteotomy done with bicortical screws or plate and monocotical screws is used. patient with distraction osteogenesis - osteotomy placed in anterior or superior to mandibular angle and lingual aspect of mandible, distraction device placement and screw fixation is done. Results Bilateral Sagittal Split Osteotomy give accurate lengthening and lesser time consuming. Distraction Osteogenesis accurate lenghthening and decrease potential for relapse. Conclusions both bilateral sagittal split osteotomy and distraction osteogenesis can be considered for lengthening of the retrognathic mandible.

EPS00435 Condylar Remodeling after Orthognathic Surgery and Its Correlation with Condylar Displacement: Review of Literature

JSS Dental College and Hospital Dr. Prasun Kumar Dubey Armed Forces Medical College Abstract Background/Introduction Conventionally, a patient with skeletal malocclusion is managed by preoperative orthodontics, followed by surgery and postoperative orthodontics. It is widely accepted that correction of skeletal discrepancy and surgical repositioning is possible only after removing all the dental compensations. Surgery-first approach is a new treatment paradigm for the correction of dentomaxillofacial deformities. In certain patients with precise treatment planning, surgery first has been acknowledged to reduce total treatment time significantly and to achieve high levels of patient and orthodontist satisfaction.

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Abstract Background/Introduction The position of the mandibular condyles to the temporal bone can be altered via various movements during orthognathic surgery. It can lead to excessive stress to the articular surfaces causing progressive condylar resorption, representing an alteration of shape and volume of the condyle. Thus, in orthognathic surgeries, appropriate condylar position is one of the key factors in achieving postoperative stability. Objectives To examine available literature on Condylar remodelling and condylar displacement associated with orthognathic surgery and discuss its effects on mandibular condyle and condylar movement determining the correlation between them. Methods A systematic review was performed of literature on the Pubmed, Research Gate and Science Direct database from 1980 to 2016 using the following headings: (‘‘orthognathic surgery’’) AND (‘‘condylar resorption’’) AND (‘‘condylar displacement’’).

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Results Review indicated condylar displacements are evident upon sagittal splitting of the rami that can occur medially, posteriorly, superiorly and condylar resorption with respect to the upper and lateral surface of condyle. Direction of the condylar translation was backward, upward, laterally and medially. Conclusions Change in condylar position and condylar remodeling are likely to occur after all types of orthognathic procedures. Condylar anterior surface resorption was more frequent with posterior, superior and medial displacements of condyle.

EPS00451 Evaluation of Esthetic Outcome Following Orthognathic and Orthomorphic Surgery in Mandibular Asymmetry—A Clinical Study Dr. Neelakamal Hallur, Dr. Aaisha Siddiqua, Dr. Syed Zakaullah, Dr. Chaitanya Kothari, Dr. Ashwin Shah, Dr. Shereen Fatima, Dr. Juhi Bendigiri, Dr. Meenakshi Kothari Abstract Background/Introduction Orthognathic surgeries alone, often are unable to resolve contour defects arising from asymmetric growth. For this reason, in the management of facial asymmetry, orthomorphic principles of management are considered to be an adjunct to orthognathic surgery in adults. Objectives The aim of study was to evaluate the changes after orthognathic orthomorphic surgery in patients. Methods In patients with mandibular asymmetries, frontal photographs, P.A Cephalograms, and Lateral cephalograms were taken pre- operatively and post-operatively. On photographs, the amount of chin deviation were measured by recording angle between mid-sagittal line and line drawn to chin point. P.A cephalometric evaluation was done by measuring the distance of chin deviation from mid-sagittal reference line to menton point in millimetres. Lateral cephalometric evaluation was done in terms of advancement of chin in millimetres by measuring distance between Gnathion point to Y- axis. Results The mean correction in the angle of chin deviation on photographs, obtained post treatment was 4.57o with ‘t’ value (-5.6) and ‘P’ value \0.001. The mean correction in the degree of chin deviation obtained is 8.71mm on Postero-Anterior cephalograms. On Lateral cephalograms significant corrections were found with a‘ t’ value -4.36 and ‘P’ value \0.01. Conclusions This study embarks upon the significance of correction with respect to hard tissue and esthetics taking place after orthognathic- orthomorphic surgery and it was concluded that in all patients there was significant correction in mandibular asymmetry post- operatively.

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EPS00468 Consideration for Orthognathic Surgery for Mandibular Deformities During Growth Dr. Sulagna Pal, Dr. Avijit Bharat Bapuji Dental College & Hospital, Davangere Abstract Background/Introduction Waiting for growth to end prior to surgical intervention in mandibular disharmonies is unacceptable in presence of clinically severe mandibular prognathism/retrognathism that is psychosocially damaging to young growing patient necessitating early intervention. However such early interventions may affect postsurgical growth altering initial surgical benefits resulting in less than ideal outcome. A spaced surgical procedure post growth spurt is necessary to maintain the final outcome. Objectives General outline providing management guidelines for orthognathic surgery in mandibular deformities during growth. Methods Material presented is based on available literature dealing with early orthognathic intervention visa –a – vie no intervention in mandibular discrepancies in young age. Results Majority supports early intervention in carefully selected mandibular discrepancy cases and advocates careful postsurgical monitoring and requirement of any final surgical procedure that is needed following growth cessation. Conclusions Paediatric and adolescent patients with mandibular dentofacial deformities may require early intervention during active growth because of functional and psychosocial impairments. Such treatments should be selected individually and with regard to facial growth kinetics status and risks of initial outcome relapse requiring secondary procedures after growth phase.

EPS00507 Pharyngeal Airway Changes Secondary to Mandibular Advancement Surgery By Bsso; A-Ct Based Volumetric Study Dr. Anantanarayanan, Dr. Dennis Abstract Background/Introduction Bilateral sagittal split osteotomy for the correction of mandibular growth defects is commonly performed procedure. The tongue, soft palate, hyoid bone, and related musculature are directly or indirectly attached to the maxilla and mandible; therefore, the dimensions of the oral cavity and pharyngeal airway change depending on the direction and magnitude of the mandibular movements. Airway volume and respiratory function are highly relevant to maxillo-facial-surgeries. Advances in CT imaging and 3D technology allow us to calculate the volume and dimensions of the airway pre and post surgery. Objectives 1. Airway volume changes of nasopharynx, oropharynx and hypopharynx. 2. Cross sectional surface area of the airway at the level of CV1, CV2, CV3 & CV4. 3. Linear measurements such as

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S122 anteroposterior and lateral diameter of the most constricted region of the airway at the level of soft palate and tongue. Methods Prospective study done by obtaining pre and post surgical CT data. Image processing, plane fixation, airway volume changes calculated using MIMICS software. Results The total volume of the airway increased postoperatively which was statistically significant with a P value of 0.045. Conclusions This study concluded that mandibular BSSO advancement caused significant increase in the total volume of the airway.

EPS00508 AMO Combined with Subapical Osteotomy-2 Case Reports Dr. G.G. Sheela Prakash Kamineni Institute of Dental Sciences Abstract Background/Introduction Anterior segmental osteotomy has become an established surgical technique to achieve functional occlusion and improve the facial profile in the treatment of maxillary protrusion. Postoperative nasal changes, however, are somewhat unpredictable. Objectives subapical anterior maxillary segmental osteotomy has been developed to avoid such unintended nasal changes. Methods A horizontal osteotomy was carried out between the apices of the anterior teeth and the piriform aperture, maintaining a distance of approximately 2 to 3 mm to the apices. Lateral to both canines, this horizontal osteotomy was connected with vertical osteotomies carried out along the alveolar socket of the first premolar on the right and left sides. Results Significant changes were observed in hard tissue parameters except the anterior nasal spine. The nasal tip, the alar base, and the lip width remain to have no significant change. The ratio of the upper lip to the maxillary incisor retraction was 0.64:1. Whereas both the nasolabial angle and the philtrum length were significantly increased, the protrusion of the upper incisors and the vermilion length presented decreased. Conclusions Subapical anterior maxillary segmental osteotomy provides a suitable option in the treatment of maxillary protrusion. It provides improvement of the aesthetic profile without nasal changes.

EPS00537 Modified Nasal to Oral Endotracheal Tube Switch-For Modified Alar Base Cinching After Orthognathic Surgery B. Vamshikrishna Guided by Dr. P. Srinivas Chakravarthy, Dr. M. Sridhar Abstract Background/Introduction

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 In Orthognathic surgery while performing anterior maxillary osteotomy there will be alar base flare. To avoid alar base flare we will do alar cinching by placing cinch suture intraorally during surgery. During orthognathic procedure we intubate through naso tracheal intubation to avoid occlusal disharmony while placing cinch suture tube may obstruct and mislead our visual prediction of Alar base. So to avoid this nasotracheal tube is switched to orally. Objectives To introduce and asses efficacy of modified nasal to oral tube switch technique for modified Alar cinching to prevent alar flar after orthognathic and nasal corrective surgery. Methods Changes in Alar base width, upper lip length were measured with digital vernier calipers and nasolabial angle(cotg-sn-ls) on lateral cephalogram at 1st 3rd 6th months after surgery.the time taken and ease of tube switch were noted.the data oibtained were tablated and interpreted using test of significance. Results Study results showed no statistical significant diference in perinasal soft changes among both groups but tube switch appears to be beneficial to prevent alar flare. Conclusions Modifies alar base cinching was performed effectively in patients with modified tube switch technique it increased positive results in comparision with non shift, the technique of tube switch used is effect in prevention of alar flare.

EPS00619 A Digital Analysis of Upper Middle and Lower Pharyngeal Airway Addhankisagar Guided By Dr. Anand Vijay Sibar Institute of Dental Science Abstract Background/Introduction To see the pharyngeal spaces difference after orthognathic surgery. Objectives Digital difference. Methods By CT analysis. Results Showed positive changes. Conclusions A better way for planing surgery.

EPS00622 Complications in Orthognathic Surgeries Dr. Naman Khare; Guided by-Dr. Vikram Shetty A B Shetty Dental College, Mangalore Abstract Background/Introduction An old surgical adage states, ‘‘if you have not had any complications, you have not performed enough surgeries as yet.’’ the diverse range of procedures that collectively come under the umbrella of the term ‘orthognathic surgery’ are widely recognized to be safe, although it

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 has been consistently stated that clinicians must expect the unexpected. Numerous examples of unusual or rare complications of such procedures have been published. The purpose of this literature review is to gather reported complications of orthognathic surgery, and provide a discussion relating to those classified as unusual or rare. Objectives To review current literature on the expected and unexpected complications encountered in orthognathic surgeries. Methods A literature review was conducted on various search engines and relevant articles in indexed journals were analyzed. Results It is clear that orthognathic surgery is a safe area of oral and maxillofacial surgery, although it carries a number of rare risks depending on the exact techniques used. This review has identified complications including all possibilities, from neurological, infective, bony, and haemorrhagic to psychological, anesthetic, and other complications. Conclusions The diverse range of procedures that collectively come under the umbrella term of orthognathic surgery are widely recognized to be safe, although it has been consistently stated that clinicians must remain vigilant to the unexpected complications, which have been discussed here.

EPS00643 History and Modifications of the Sagittal Ramus Split Osteotomy Raj Jaiswal Abstract Background/Introduction The historical development of orthognathic surgery has followed a rather stepwise, intermittent course. The first mandibular osteotomy is considered to be Hullihen’s procedure in 1849 for the correction of a protruded alveolar mandibular segment. The first osteotomy of the whole mandibular body for the correction of prognathism was performed by Blair in 1897. He was also the first author to present a classification of jaw deformities. The operations performed, described, and published by Blair and Angle marked the beginning of the development of oral surgery. In 1953, the sagittal split osteotomy evolved into a procedure that could be accomplished intraorally, without transfacial approaches and without leaving visible scars. The bilateral sagittal split osteotomy can be considered a milestone in surgery in general. Objectives Objective is an attempt to isolate the modifications, which marked significant advances of bilateral sagittal split osteotomy. Methods The basic design of the sagittal ramus split surgical procedure evolved very quickly. The original operation technique by Obwegeser was shortly after improved by Dal Pont’s modification. The second major improvement of the basic technique was added by Hunsuck in 1967. Since then, the technical and biological procedure has been well defined. Resolution of the problems many surgeons encountered has, however, taken longer. Some of these problems, such as the unfavorable split or the damage of the inferior alveolar nerve, have not been satisfactorily resolved. Results Further modifications, with or without the application of new instruments, have been introduced by Epker and Wolford, whose modification was recently elaborated by Bo¨ckmann. The addition of a fourth osteotomy at the inferior mandibular border in an in vitro

S123 experiment led to a significant reduction of the torque forces required for the mandibular split. Conclusions The literature was reviewed, and the last modifications of the successful traditional splitting procedure are presented narrowly. It indicates the better the split is preformatted by osteotomies, the less torque force is needed while splitting, giving more controle, a better predictability of the lingual fracture and maybe less neurosensory disturbances of the inferior alveolar nerve.

EPS00658 Naso-Pharyngeal Airway Changes following Maxillary Setback and/or Superior Repositioning by Lefort I Osteotomy—A Volumetric Ct Study Dr. P. Anantanarayanan, Dr. Praveen Kumar Meenakshi Ammal Dental College & Hospital, Chennai Abstract Background/Introduction Orthognathic surgery produces changes in the human airway. When the maxilla is superiorly repositioned, there is reduction in airflow & volume of the nasal cavity. The effect of maxillary setback and/or superior repositioning by Lefort I osteotomy on nasopharyngeal airway is determined. Objectives To compare the changes in pharyngeal airway and surface area at T0 (Pre-surgical) and T1(Post-surgical) after Lefort I impaction with/ without setback. Methods Patients presenting skeletal Class II or Class III malocclusions who underwent maxillary and mandibular surgery were enrolled. LeFort I osteotomy procedure for a setback and/or superior repositioning in isolation or concomitantly with a mandibular or chin procedure were performed in the patients, and rigid fixation done. CT images were taken before surgery(T0), and 6 months after surgery(T1). Results The post-operative mean volume/surface area of Nasopharynx, and Hypopharynx decreased but the post-operative mean volume/surface area of Oropharynx increased when compared to their respective preoperative mean volume/surface area in both the groups (Lefort I impaction with/without setback). Conclusions Maxillary impaction surgery (Lefort I impaction with/without setback) has a significant impact on Nasopharyngeal airway dimensions (Surface area/Volume), which correlates with the nasal airway function.

ABS00725 Tranexamic Acid Versus Haemocoagulase on Intraoperative Blood Loss During Orthognsthic Surgery Melvin George. A. Saveetha Dental College and Hospitals Abstract Background/Introduction

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S124 Craniofacial region is highly vascularized due to which procedures which require osteotomy are associated with significant amount of blood loss. Orthognathic surgery is one such procedure where significant amount of blood loss can be expected. This can be reduced by various techniques such as hypotensive anesthesia postioning of surgical field above the heart and the use of drugs such as antifibrinolytic agents and factor V, X activator. Objectives The objective of this study was to compare the intraoperative blood loss during orthognathic surgery following preoperative intravenous injection of tranexamic acid or haemocoagulase. Methods 15 patients who underwent orthognathic surgery were selected for the study. Inclusion criteria included healthy patients who required orthognathic surgery who did not have any syndromes, patients who did not have any known allergy to tranexamic acid or haemocoagulase. Exclusion criteria were syndromic patients and patients who had known adverse reactions to tranexamic acid or haemocoagulase. Group 1 consisted of patients who were given IV infusion of 10mg/kg tranexamic acid half hour before the procedure. Group 2 consisted of patients who were given direct IV infusion of 3 IU haemocoagulase half hour before the procedure. Intraoperative blood loss was measured by measuring the amount of blood collected in the suction jar minus the amount of saline used for irrigation and weighing the gauze used for soaking blood pre and post operatively. Results The mean blood loss in group 1(tranexamic acid group) was 417 ml and in group 2 (haemocoagulase group) was 525 ml which was statistically significant p\0.05. Patients in both groups did not require blood transfusion post operatively. Conclusions The results of this study show that preoperative IV infusion of tranexamic acid is better in controlling blood loss compared to preoperative direct IV infusion of haemocoagulase in orthognathic surgery.

EPS00741 Ugly Proportions to Beautiful Propositions Dr. Padma Priyanka Datla, Dr. Sridhar M Abstract Background/Introduction Asymmetry is an alteration of balance between structures. The face usually presents with a mild degree of asymmetry in majority of the population, which is usually left unperceived. When the degree of disharmony is more severe, the condition is rendered noticeable. This affects not only the function but also the aesthetics, which in turn has a huge impact on the patient. Overall facial harmony and aesthetics are strongly influenced by the chin. A rare technique is carried out to acquire symmetric and harmonious face in accordance with facial aesthetics. Objectives To evaluate the effectiveness of surgical correction of facial asymmetry by a rare technique and assess the final anticipated outcome. Methods Procedure to reshape and re contour the facial asymmetry was done using rotational genioplasty. During the procedure a correction of 12 to 14 mm of the deviation was done along with rotation of the chin. Results A harmonious facial contour and a reasonably good anticipated aesthetic result was achieved following the use of this technique where the final aesthetic result was quite satisfactory to the patient too.

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Conclusions In comparison with the other types of genioplasty this technique has given quite satisfactory results, which are very much close to the anticipated preoperative results.

EPS00749 Splint Free Surgically Guided Orthognathic Surgery Dr. G. Jeevan Kumar Bapuji Dental College and Hospital, Davangere Abstract Background/Introduction The repositioning of maxillary and mandibular segments is essential for aesthetic and functional outcomes in orthognathic surgery. With the giant leap in three-dimensional (3D) computer-aided surgical simulation (CASS) technology development, surgeons are now able to simulate and test various surgical plans in a computer until the best possible outcome is achieved. Objectives The purpose of this study was to evaluate a personalized orthognathic surgical guide (POSG) system for bimaxillary surgery without the use of surgical splint. Methods Surgeries are planned with the computer-aided surgical simulation method. The POSG System is designed for both maxillary and mandibular surgery. Each consisted of cutting guides and three dimensionally (3D) printed custom titanium plates to guide the osteotomy and repositioning the bony segments without the use of the surgical splints. Finally, the outcome evaluation was completed by comparing planned outcomes with postoperative outcomes. 1 Results All surgical procedures including double-jaw surgeries are completed successfully using POSG system without the use of surgical splint. All the patients achieved good final occlusion without postoperative elastic traction. There was no sign of abnormal bleeding, breakage of the custom plates, or any difficulty in using the POSG system. Conclusions The results of the study indicated that POSG system is capable of accurately and effectively transferring the surgical plan without the use of orthodontic surgical splints.

EPS00782 ‘‘Computational Fluid Dynamics Study of the Pharyngeal Airway Space Before and After Mandibular Setback Surgery’’ Dr. Vinitha Annavarjula Bapuji Dental College and Hospital Abstract Background/Introduction In orthognathic surgery, the bilateral sagittal split osteotomy (BSSO) is commonly performed for mandibular setback or advancement. Such surgery can improve occlusion, masticatory function, and aesthetics by changing the mandibular position. But these surgeries have their influence in invading the pharyngeal airway space which will further deteriorate in patients with Obstructive sleep apnoea.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Objectives The purpose of this study was to investigate the relationship between the pressure drop in the pharyngeal airway space and the minimum cross-sectional area of the pharyngeal airway before and after mandibular setback surgery using computational fluid dynamics, in order to prevent iatrogenic obstructive sleep apnoea. Methods Patients with mandibular prognathism underwent bilateral sagittal split osteotomy for mandibular setback. Three-dimensional models of the upper airway were reconstructed from preoperative and postoperative computed tomography images, and simulations were performed using computational fluid dynamics. Results The pharyngeal airway space and the minimum cross-sectional area were calculated and the relationship between them was calculated. In all cases, minimum cross-sectional area was found at the level of the velopharynx. After surgery, the pharyngeal airway space increased significantly and the minimum cross-sectional area decreased significantly. Conclusions The results of this study suggest that surgeons should consider bimaxillary orthognathic surgery rather than mandibular setback surgery alone, to prevent the development of iatrogenic obstructive sleep apnoea when correcting a skeletal class III malocclusion.

EPS00785 ‘‘Physiological Positioning’’: A New Strategy for Mandibular Osteotomy by Using Short Lingual Osteotomy Without Fixation Dr. Varun Kocher Bapuji Dental College and Hospital, Davangere Abstract Background/Introduction Short lingual osteotomy adapted without rigid fixation followed by a unique regimen including only one day of MMF called as ‘‘physiological positioning’’ can be used to treat mandibular prognathism. Objectives The efficacy of physiological positioning provides good postoperative dental and skeletal stability without causing any symptoms associated with the TMJ or progressive condylar resorption. Methods A total number of 18 patients were included. The positions of SNB, FMA, and Me were measured postoperatively to assess skeletal stability, changes in the angle and perpendicular length of the upper and lower central incisors to assess dental stability. Results Results showed that both skeletal and dental stability were excellent. The width to which the jaw could be opened recovered early, and only one showed disorder of the temporomandibular joint. Conclusions The technique of physiological positioning by jaw exercise after osteotomy, suggests various advantages, such as lack of serious complications, reduced operating time and duration of MMF, early recovery of jaw movement, and avoidance of symptoms in the TMJ

S125 and thus may be a reasonable way of treating skeletal mandibular prognathism.

Section: Distraction Osteogenesis EPS00145 Transport Distraction Osteogenesis Irene Ann Shibu Rajarajeswar Dental College and Hospital, Bangalore Abstract Background/Introduction Transport distraction osteogenesis is a newer and effective method in the reconstruction of bony defects with an advantage of osteogenesis and histogenesis. It is used for the treatment of long bone defects resulting from trauma, oncological resection and other severe congenital or acquired deformities. A free segment of bone is gradually moved across the osseous defect. After the transport bone reaches the other end, compression forces are applied till the transport and target segments are fused. This novel biological transport disc represents an effective non-secondary injury method to enhance new bone formation in non-vascular transport distraction osteogenesis. Objectives 1. To discuss the advantages and disadvantages of transport distraction. 2. To review the current concepts and application of transport distraction in maxillomandibular defects. Methods This is a retrospective analysis of patients who underwent transport distraction for the correction of different defects. After the latency period of 10 days, the distraction was initiated at a rate of 0.25–1 mm/day. The distraction period continued until the segment with the transport disc reached the distal base. The total consolidation periods ranged from 6 to 14 weeks. Results Transport distraction has good results both esthetically and functionally. Bone resorption remains a critical issue for this reconstruction technique, though blood supply is continuously maintained. Conclusions Transport distraction osteogenesis potentially benefits patients with segmental bony defects following tumor ablation.

EPS00266 Determination of Efficacy of Platelet Rich Plasma in Accelerating the Mineralization of New Bone Following Distraction First Author-Dr. Shobhit Rastogi (Former Postgraduate Student) Second Author-Dr. R.S. Neelakandan, Professor &HOD; PRESENTER - Dr. Manish Anand (First Year OMFS PG) Meenakshi Ammal Dental College; Dept of OMFS, Meenakshi Ammal Dental College; Meenakshi Ammal Dental College) Abstract Background/Introduction The stages of Distraction Osteogenesis are under the direct control of various growth factors and cytokines produced locally at the distracted site. Modifying growth factor and insulin like growth factor

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S126 have been identified to influence the process of Distraction Osteogenesis. Objectives To evaluate the efficacy of platelet rich plasma in mineralization process using periodical radiological investigations. To minimize the consolidated phase so that Distractor could be removed at earliest for patient compliance. Methods Six patients who went reconstruction of continuity defect in maxilla/mandible with transport distraction were selected. The Distraction regenerate was classified and compared based on the radiographic classification of distraction regenerate put forth by Cope & Samchukov. Ten ml of venous blood was withdrawn from basilic vein of right hand and was prepared y centrifuging via 2 step protocol.the lower one third Platelet Rich Plasma was injected into the distracted callus. The assessment of PRP on mineralization was illustrated y serial occlusal radiograph and orthopantomogram. Results Out of six patients included in this study, the maximum mineralization after injecting PRP was observed in five patients at two weeks and four weeks in other one. The quality of bone formed was 2c. Conclusions PRP has a favorable effect on human osteoblast like cells, initiates connective tissue healing and activates macrophages. This study opens up new perspective to demonstrate the effect of PRP in accelerating the mineralization content of new bone.

EPS00287 Distract First and Release Later-Treatment Outcomes Dr. Pavan Kumar Reddy. E, Dr. Ritesh Rajan Svs Institute of Dental Sciences, Mahabubnagar, Telangana Abstract Background/Introduction TMJ ankylosis is a disorder of the joint which occurs secondary to trauma, local or systemic infection, or systemic disease. Surgical techniques in Distraction Osteogenesis have improved substantially in recent years and has become a first option in correction of many Mandibular malformations. Both intraoral and extraoral devices are being marketed which have their own advantages and disadvantages. Objectives The poster will highlight the- 1. The effective mandibular lengthening achievable by distraction osteogenesis. 2. Benefits of DO prior to TMJ ankylotic release. Methods A series of cases treated at our unit with Distraction Osteogenesis preceding TMJ ankylosis release will be presented here. Results The results of the cases will be presented accordingly. Conclusions The combination of correction of facial deformity using Distraction Osteogenesis as the primary procedure and release of ankylosis as the secondary procedure provides good functional and aesthetic results in patients with facial deformity due to TMJ ankylosis.

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ABS00320 Distraction Osteogenesis in Temporomandibular Joint Ankylosis Dr. Irene Suzette Philip Divyajyothi College of Dental Sciences and Research, Gaziabad Abstract Background/Introduction Distraction osteogenesis is a biomechanical process of bone tissue formation where the distraction forces which act between bone segments affect biological potential of bone by forming callus of determined length and height. Objectives To evaluate the efficacy of distraction osteogenesis in temporomandibular joint ankylosis. Methods This poster is done by referring 15 articles and textbooks. Distraction Osteogenesis of the Facial Skeleton - William. H. Bell. International Journal of Oral and Maxillofacial Surgery. Orthodontic Waves. Results In patients with temporomandibular joint ankylosis, simultaneous gap arthroplasty with distraction osteogenesis is found to be more effective and also helps in correction of severe dentofacial deformity. Apart from bone lengthening it also has secondary effect on lengthening of soft tissue to correct temporomandibular joint ankylosis associated with facial asymmetry or micrognathia, as it reduces the need for second surgery and difficulty in intubation, increases length of mandible, corrects deformity, thereby resulting in an acceptable facial esthetic and function. It is safe and reliable method of treatment. Conclusions I hereby conclude that distraction osteogenesis has been one of the most innovative concepts in craniomaxillofacial surgery. It is increasingly used for correction of craniomaxillofacial deformities. It enables correction of deformities earlier than osteotomy.

EPS00337 Transport Distraction Osteogenesis: A Boon in Mandibular Reconstrcution Dr. Harsh K. Desai, Dr. N.N. Andrade Nair Hospital Dental College, Mumbai Abstract Background/Introduction Oral & Maxillofacial Surgeons are often confronted for the reconstruction of resected jaw(s). The approach in jaw reconstruction has significantly evolved since the advent of Transport Distraction Osteogenesis. It has an advantage of eliminating donor site morbidity, being popularized for its potential in growing back native ‘host’ bone. Objectives The objective is to discuss the novel and varied applications along with the advantages of Transport DOG in reconstruction of Mandibular defects. Methods 15 patients who underwent any type of resection of the mandible were taken up for reconstruction of the defect using TDOG (monofocal, bi/ tri-focal DOG). Only 2 patients reported with intraoral exposure of

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 the transport disc which was managed appropriately. Rest of the patients showed uneventful healing. Results Radiographic studies were done for all patients & USG studies for most of them to assess the consolidation achieved at the distraction site. Conclusions TDOG can be considered a viable option & holds a promising future in the field of reconstruction of jaw defects. It also dispenses the need for additional bone grafting except for the minimal bone grafting required at the docking site.

EPS00455 Maxillary Advancement by Rigid External Distraction and Mandibular Setback by Evro in Adult Cleft Lip and Palate Arunkumar Shadamarshan R. Armed Forces Medical College Abstract Background/Introduction Facial profile correction in patients with cleft lip and palate present multiple challenging problems for the maxillofacial surgeon. Scarring from previous surgeries, often multiple, absence of maxillary and alveolar bone, multiple missing teeth pose special problems in maxillary advancement. Conventional orthognathic surgeries for maxillary advancement often results in considerable relapse, less than acceptable post-operative result, facial balance and esthetics. Objectives Evaluation of Rigid External Distraction in maxillary advancement and Mandibular setback by EVRO in Adult Cleft lip and Palate patients. Methods RED for maxillary advancement EVRO for Mandibular setback. Results Distraction osteogenesis for maxillary advancement especially using the Rigid external distractor device, based on the concept of cranial anchorage is an acceptable alternative to conventional orthognathic surgery in these patients. The results are further esthetically pleasing when combined with surgical setback of the mandible if indications exist for the same. Conclusions This poster depicts a case of Maxillary advancement by Distraction osteogenesis using Rigid external distractor device combined with setback of the mandible by External Vertical Ramus Osteotomy. The Cephalometric changes immediate post-surgery and after 18 months of follow up is also presented.

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EPS00581 Facial Asymmetry: Aetiology, Diagnosis and Treatment Dr. Sheron Mathews Vydehi Institute of Dental Sciences Abstract Background/Introduction Facial asymmetry is common in humans. Significant facial asymmetry causes both functional as well as aesthetic problems. When patients complain of facial asymmetry, the underlying cause should be investigated. The aetiology includes congenital disorders, acquired diseases, and traumatic and developmental deformities. The causes of many cases of developmental facial asymmetry are indistinct. Assessment of facial asymmetry consists of a patient history, physical examination, and medical imaging. Medical imaging is helpful for objective diagnosis and measurement of the asymmetry, as well as for treatment planning. Components of soft tissue, dental and skeletal differences contributing to facial asymmetry are evaluated. Frequently dental malocclusion, canting of the occlusal level and midline shift are found. Management of facial asymmetry first aims at correcting the underlying disorder. Orthognathic surgery is performed for the treatment of facial asymmetry combined with dental occlusal problems. A symmetrical facial midline, harmonious facial profile and dental occlusion are obtained from treatment. Additional surgical procedures may be required to increase or reduce the volume of skeletal and soft tissue components on both sides to achieve better symmetry. Objectives The aim of this poster is to discuss the various aetiological factors diagnostic modalities and to throw some light of the surgical steps followed in our institution. Methods Two cases of facial asymmetry one secondary to hemifacialmicrosomia(34/F) and other secondary to temporomandibular jointankylosis(21/M)underwent distraction osteogenisis of the mandibule unilaterally. Results The cutaneous scars produced by the extraoral distraction of mandibular pins are always conspicuous and are often hypertrophic. In the two cases presented here, an intraoral distractor was used to avoid this problem, and oblique device placement was applied to increase the vertical and horizontal dimensions of the ramus and the body. Conclusions Distraction osteogenesis can shorten the admission and operation time, the risk of surgery, and the possibility of relapse. Above all, the direction and amount of bony lengthening can be controlled, and soft tissue as well as hard tissue can be lengthened.the cutaneous scars produced by the extraoral distraction of mandibular pins are always conspicuous and are often hypertrophic. In the two cases presented here, an intraoral distractor was used to avoid this problem, and oblique device placement was applied to increase the vertical and horizontal dimensions of the ramus and the body. Although more experience and long-term follow-up are needed, it isconcluded that distraction osteogenesiscan be useful for the resolution of facial asymmetry.

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EPS00604 Distraction Osteogenesis and Its Role in Post Ankylotic Deformity Dr. Keerthana K. SDM College of Dental Sciences & Hospital, Dharwad, Karnataka, India. [email protected], Ph No. 9886535292 Abstract Background/Introduction Distraction Osteogenesis has evolved in OMFS & gained popularity due to the limitations of orthognathic surgery especially in asymmetry cases. The technique gained wide acceptance after Gavril ilizarov identified the physiologic & mechanical factors governing the successful regeneration of bone. Distraction osteogenesis is a new variation of orthognathic surgical correction of dentofacial anomalies. Objectives The aim of this poster is to showcase the extended versitality of distraction osteogenesis in post ankylotic deformity where conventional orthognathic surgery is not feasible. Methods Retrospective study at our unit from 2011 to 2016 of 5 patients between the age group 18-30years. Results All patients had excellent outcomes with minimum complications. Post distraction orthodontics was required in all patients to settle the occlusion. Conclusions The corrections of secondary deformity in ankylosis pose a greater challenge due to undergrowth, gross midline shift & discrepancy between soft & hard tissue growth pattern. Though Orthognathic surgery has a role in minor deformity, DO with its technique, precise planning offers excellent outcome.

EPS00656 Maxillary Anterior Segmental Distraction to Correct Maxillary Deficiencies in Patients with Cleft Lip and Palate Dr. M. Kalyani, Guided By Dr. Kishore M. Vishnu Dental College, Bhimavaram Abstract Background/Introduction Maxillary hypoplasia is a major issue in cleft lip and palate patients, and predictable surgical maxillary advancement is required. The treatment outcomes of cleft lip and palate including maxillary growth, speech, dental occlusion, and the facial profile, have improved remarkably as a result of team approaches that start in the newborn period and the evolution of surgical procedures. Objectives This case report is to report the effect of Distraction done by a hyrax screw incorporated in an acrylic plate in the treatment of two maxillary deficient cases with cleft lip and palate. Methods After making vertical and anterior cuts between the premolars on both sides, a hyrax screw was mounted on an acrylic plate for the slow anteroposterior expansion of maxillary arch.

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Results The expansion was achieved by turning the hyrax screw 1 mm per day after the latency period. Treatment was discontinued after achieving satisfactory over jet and occlusion. Conclusions present cases obtained remarkable improvements in the patient’s facial aesthetics and occlusion without disturbing her speech mechanisms.

ABS00717 Management of OSA: Role of Distraction Osteogenesis Author - Dr. Neeraj Bansal, PG Student (Oral and Maxillofacial Surgery); Co-Author - Dr. Pravesh Mehra Prof & HOD (Oral and Maxillofacial Surgery) Lady Hardinge Medical College, New Delhi, India. E-mail Id – [email protected] Address – Room no. – 312 B, RMO-B, New PG Hostel Lady Hardinge Medical College, Opposite Kalawati Saran Children Hospital, New Delhi -110001 Phone no.9971338761, 8076405462; Lady Hardinge Medical College, New Delhi, India Abstract Background/Introduction Obstructive sleep apnea (OSA) is the Cessation of breathing during sleep because of a mechanical obstruction, such as a partially collapsed trachea, retropositioning of the tongue in the airway, which blocks airway passage, or a large amount of tissue in the upper airway. It is a common respiratory sleep disorder characterized by snoring and episodes of breathing cessation or absence of respiratory airflow (=10 seconds) during sleep despite respiratory effort.[1] OSA may occur in adults with mandibular or maxillary retrognathia or in infants and children with airway obstruction as a result of congenital micrognathia or midface hypoplasia which may be due to Treacher Collins syndrome, Robin sequence etc. There are various modalities available for the management of OSA ranging from conservative to surgical. Distraction Osteogenesis (DO) is a technique of bone lengthening that uses the body’s healing potential to form new bone. Because of the magnitude, morbidity, and potential instability of standard surgical techniques for large expansions of the facial skeleton, the use of DO as a minimally invasive alternative has become commonplace.[2] the presentation discusses the role of DO in the management of airway obstruction and OSA. Objectives To analyse the role Distraction Osteogenesis as a modality for the management of OSA. Methods Pre and post treatment lateral cephalogram and results of sleep study of a 22 year old male with severe mandibular deficiency were evaluated for changes in airway space, profile and apnoea–hypopnoea index. Results There was significant increase in airway space, with better profile and reduction in apnoea–hypopnoea index. Conclusions DO to expand the facial skeleton is an alternative to standard orthognathic surgery for selected patients with OSA. Greater advancements without a bone graft and the associated donor site morbidity, scarring, and potential for infection can be achieved.

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EPS00774 Variable Treatment Options for the Management of Recurrent TMJ Ankylosis in Growing Children in Overall View Dr. Manikandhan Meenakshi Ammal Dental College Abstract Background/Introduction Management of temporomandibular joint (TMJ) ankylosis in children is challenging for the Oral and maxillofacial surgeon as it involves the mouth opening, airway obstruction, dentofacial deformity, nutrition and quality of life. Although the surgical techniques to treat TMJ ankylosis have improved, the anticipation of re-ankylosis is persistent. Treatment failure could be associated with surgical errors or inadequate intensive postoperative physiotherapy. Surgical treatment should be individually tailored and adequate postoperative physiotherapy protocol is mandatory for success. Objectives This presentation describes the case of a 12 year old boy with inability to open mouth from past 4 years, who had been operated for bilateral ankylosis with gap arthroplasty 2.5 years ago. To discuss on the various treatment modalities for Temporomandibular Joint (TMJ) reankylosis in growing children and to determine the relevant treatment for preventing relapse, reconstituting new condyle and creating neo condyle which will grow to attain growth equal to maxillary growth. Methods A case study of 12 year old boy with reankylosis of TMJ. Results Various treatment modalities for recurrent TMJ ankylosis would be discussed. Conclusions It is an overview to discuss correct treatment planning tailored to each patient at different stages of growth to maximize the function and growth of the mandible.

Section: Facial Aesthetic Surgery EPS0032 Minimally Invasive Technique for Correcting Deviated Nose Dr. Viren Shirish Patil, Dr. Shandilya Ramanojam Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth Dental College and Hospital, India, Pune Abstract Background/Introduction When it comes to facial attractiveness, facial symmetry has a prime importance. Nasal osteotomy, also known as rhinoplasty is an aesthetic procedure a surgeon can perform to enhance patient’s appearance and give them a new acceptable and aesthetic look. This procedure can be done in patients that present with facial asymmetry or patients who are willing to have a new look and due to various reasons such as traumatic injuries, genetic abnormalities etc. Crooked nose has always been a surgical challenge for surgeons. It is of cardinal importance to achieve both functional and aesthetic

S129 improvements. Deformities of the deviated nose can differ from patient to patient, and there is no single method that can be used for every deviated nose. Correction requires a complete understanding of the diagnosis and the treatment plan of the patient having nasal deviation. So it is very necessary for a Maxillofacial surgeon or a plastic surgeon to have a proper knowledge of surgical management and correction of the unaesthetic look of the patient in a less invasive way. Objectives To throw light on a minimally invasive technique in correcting deviated nose. Methods Three stab incisions were taken. Two on the lateral wall of the nose and one on the dorsal hump of the nose was done. The nasal bone was explored and the osteotomy was performed as a result the deviation of the nasal septum was corrected and the incision site was approximated by 4 ‘0’ Ethylon suture material. Nasal splint for three weeks was given to the patient. Results The results revealed expected facial symmetry post-operatively by advocating minimally invasive surgical technique. Conclusions We can conclude that the therapeutic management based on a specific anatomical and quality of life analysis will indeed help the facial aesthetic surgeon and patient for the betterment of the patient’s treatment for correcting deviated nose.

EPS0040 Surgeon’s Friend: 3D-Photogrammetry Dr. Johnson A. G., Junior Resident Govt. Dental College Calicut Abstract Background/Introduction Medical imaging is the most important source of anatomical and functional information, which is indispensable for today’s clinical research, diagnosis and treatment, and is an integral part of modern health care. Most of the clinically evolving abnormal situations are actually evolving in space, ie. They are 3D processes. There are numerous parameters inherent to these 3D processes that have in general been understudied and have the potential to better delineate the actual pathologic process and probably contribute significant prognostic information. Therefore, accurate 3D-information extraction is fundamental in most of the situations. Photogrammetry has an important role to play. Photogrammetry’s comparative advantage is the ability to produce process and exploit in 3D, big amounts of highresolution data in a geometrically consistent, robust and accurate way. Objectives To give a brief idea about the technology and a quick glimpse into what this technology can do. Methods Literature review and article search. Results 3D-Photogrammetry is a technology that can make measurements and data collection more accurate leading to a better treatment planning and easier and more realistic 3D predictions which helps in better patient education. Conclusions 3D-Photogrammetry is a tool that is gaining popularity fast among the various disciplines of medicine. It is being used for various purposes ranging from simple data collection to vast research purposes. The 3D-Photogrammetry helps us surgeons in various ways such as data

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S130 collection, treatment planning, patient education, virtual surgeries and various research purposes.

EPS00134 Scar Revision & Techniques in Oral & Maxillofacial Surgery Dr. Anirudha Singh

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Results Smaller and lesser the depth of the defect a free fat graft were more desirable or precise deposition into the defect though multiple sittings were necessary. In comparison larger dermis fat graft has an ideal advantage to fill in larger composite defects with more retention than free fat graft, probably due to better vascularity of the dermis received from the recipient site. Use of PRF and PRP and stem cells along with free fat graft had an added advantage. Conclusions Both forms of replacement have its own advantages and disadvantage and the decision making was purely based on the severity of the defect.

Mahatma Gandhi Dental College Jaipur Abstract Background/Introduction Scar formation is an inevitable consequence of the healing process, which can either result from surgical procedures or trauma. Scar revision helps to make it less obvious and cosmetically/functionally more acceptable through transforming several variables by: softening irregular scars; improving the color; filling depressions; reorienting, narrowing or flattening the scar; or correcting anatomic units distortions. Objectives To discuss various techniques for revision of scar, to achieve aesthetically agreeable outcome. Methods Z-plasty, W-plasty, M-plasty, Geomatric broken line closure & non surgical techniques. Results Improved aesthetics form,function psychological & emotional status of patient. Conclusions An ounce of prevention’’ Surgical planning and technique – Wound care • Counseling • Timing • Careful analysis • Appropriate technique.

EPS00135 Free Fat Graft V/s Dermis Fat Graft for Augmentation of Maxillofacial Defects Dr. Manikandhan, Dr. Shalini Rudra Raju, Dr. Sailesh Kumar Meenakshi Ammal Dental College and Hospital Abstract Background/Introduction Clinical/Therapeutic use of free fat V/s dermis fat graft is debatable for maxillofacial use. Each technique has its own advantages and disadvantages in terms of procurement, processing, fixation to defect and retention of the graft. The authors attempt in this study is to compare the autologous free fat graft with the dermis fat graft in augmentation of maxillofacial defects. Objectives To compare free fat graft and dermis fat graft in augmentation of maxillofacial defects. Methods Craniofacial defect of varying degree have been selected ranging from simple lip thickness defect in cleft lip to extensive composite defect in hemifacial atrophy. Either free fat graft from abdominal or thigh area were harvested or dermis fat graft from paraumbilical area of the lower abdomen was chosen as the site for donor area.

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EPS00186 ‘‘An Evaluation of Efficacy of Microneedling Therapy in the Management of Facial Scars-A Clinical Study.’’ Dr. Susmitha. Chebrolu, Co-Author-Dr. Sridhar Sibar Institute of Dental Sciences, Guntur Abstract Background/Introduction Microneedling is known by various synonyms like collagen induction therapy or dermaroller therapy. Over the decade, new innovations and techniques have been emerged and is expanding with exciting advances in arena of facial rejuvenation to overcome this traditional limitations, among which one such treatment modality is MICRONEEDLING THERAPY. this procedure do not damage the skin or remove the epidermal layer, shorter healing time, used in any skin type and on all area of the body where lasers and deep peels cannot be performed, convenient office procedure an cost effective than other alternative therapy, well tolerated and accepted by patients, skin does not become sun sensitive, can be used after laser resurfacing or in those with very thin skin, easy to master technique with tool that has been specially designed, can be performed with topical anesthesia. Objectives The aim of the study is to evaluate the efficacy of microneedling in the management of facial scars and the objective are to compare the preoperative and post operative improvement in grading of scars to satisfy patient with his/her appearance. Methods A total number of 14 patients who needed treatment and presented to the outpatient department of oral and maxillofacial surgery were included in the present study.the patients who were co-operative, motivated and esthetically conscious with facial scars due to trauma, soft tissue injury scars following incision and drainage, post surgical scars, scars following surgery of cleft lip correction, post acne scars were random;y selected. Pre-operatively patient and observer improvement scales with signed consent form which is mandatory for all patients. Improvement in grading of scars post-operatively were assessed. Results In the present study there is a significant improvement in the grading of facial scars were we assessed for height of scar, color of scar, patient and observer satisfaction scale pre-operatively. This shows the efficacy of micro-needling therapy. There was also positive patient satisfaction. No significant postoperative complications are noted. Postoperative inflammation subsided within two days. Pain during the procedure is easily tolerable by the patient and no post-operative pain is noted.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Conclusions Microneedling therapy can be considered as an effective modality of treatment for scars in patients with an added advantage of minimal downtime and effective improvement. It is simple and cost effective technique in the treatment of facial scars. The significant result achieved in this study provides scope for wider and increasingly targeted use of microneedling for the management of facial scars. Our study included less number of cases and short duration of follow up period; So further work is still required firmly establish the efficacy of microneedling for facial scars.

EPS00191 Versatility of Abbe-Estlander Flap in Lip Reconstruction Kommuri Bajibabu Government Dental College & Hospital, Vijayawada Abstract Background/Introduction The lips are an important part of an individual’s personal contributing to aesthetics as well as having an important functional role. Various conditions like tumor excision, trauma, and congenital deformities are among the major aetiologies that result in lip deformities compromising the aesthetics as well as function, thus requiring lip reconstruction. Reconstruction of the lip becomes an especially challenging task due to various anatomic factors. There are various techniques for the lip reconstruction like Gillies fan flap, Karapandzic flap, Bilateral advancement flap, Bernard-Burow flap, Nasolabial flap, Perialar crescentic advancement flap, Dieffenback method, Depressor anguli oris flap and free flap. Another technique that has been proven very useful for the reconstruction of lip defects is the use of Abbe-Estlander flap. The conventional Abbe-Estlander flap is composed of skin, muscle, and mucosa with the pedicle containing labial vessels. In this poster the versatility of Abbe-estlander flap, indications, contraindications, different types of techniques in lip construction are discussed. Objectives To evaluate the versatility of Abbe-Estlander flap in lip reconstruction with regard to function and aesthetic outcome. Methods Abbe-Estlander flap that involved the commissure was used for reconstruction. Results Results in terms of aesthetic and functional outcome. Conclusions Abbe-Estlander flap is safe and a reliable flap which is technically simple to perform, and provides functionally and aesthetically pleasing result and affords versatility in flap design.

EPS00201 Tissue Expanders in Reconstructive Oral and Maxillofacial Surgery Dr. Ramdas Balakrishna/Dr. Chethana R/K L E Society’s Institute of Dental Sciences, Bangalore Abstract Background/Introduction Physiologic tissue expansion in its natural ways has fascinated man since time immemorial. However, tissue expansion for medical

S131 purposes was first investigated and reported only in the early twentieth century. Presently, the principle of tissue expansion is being used in the reconstruction of many soft tissue defects, large and small alike. The reconstruction of large defects which were previously regarded as challenge for oral and maxillofacial as well as plastic surgeons, are now possible using tissue expansion. Making use of the viscoelastic nature of the skin, considerable amount of tissue expansion based tissue engineering is possible in the maxillofacial region. Objectives Literature review on tissue expanders in oral and maxillofacial surgery. Methods Literature search and review including online published articles. (Pubmed search) Results Tissue expanders can be used in a plethora of situations such as in skin contractures, skin defects, post neoplastic reconstructions, alopecia reduction procedures etc. Conclusions The development of tissue expansion has enabled head and neck surgeons to manage defects that cannot be closed primarily. In cases where other methods of reconstruction such as local flaps, free flaps and normal tissue grafts are assessed to be non viable, tissue expansion is an apt solution for esthetic reconstruction in the head and neck region.

EPS00249 Correction of Various Facial Deformities Using De Epithelized Dermal Fat Graft Dr. Neethu T S 2nd MDS Student, Dr. Jacob John Professor Dept of Omfs, Azeezia College of Dental Science and Research, Kollam Abstract Background/Introduction soft tissue reconstruction is frequently required in maxillofacial surgery for the correction of developmental, posttraumatic, post surgical defects.diffrent materials including alloplastic materials can be used to correct these defects but may experiance complications like infection, protrusion,facial tissue in growth etc. fat harvest for augmentation in maxillofacial defects is relativly inexpensive, safe and readily available procedure. Objectives to determine the efficiency of deepithelized dermal fat graft to correct a soft tissue defect. Methods Two patients were selected, one with a developmental soft tissue defect in the forehead and other with a post surgical defect and scr contracturein relation to the lowe jaw. fat harvested from right abdominal area with minimal hair growth. Epidermis with hair follicle removed and desired amount of de epithelized dermal fat graft harvested. In the first case tunneling done through loose areolar tissue plane and fat graft placed to correct the defect. In second case supraplatysmal level dissection and tunneling done to place the graft and to correct the post surgical deformity. Results One year follow up done for both the cases, which reveals a good soft tissue contour without ant scarring or donor site morbidity. Conclusions Although there are diffrent alloplastic materials available for reconstucting soft tissue defects in maxillofacial region, all of them results

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S132 in various complications. As fat graft is an autologous graft it lacks host immune response, non carcinogenic and is acquired with a minimally invasive procedure. after performing the above two case it seems that autologous de epithelized dermal fat graft provides an effective measure of soft tissue volume deficit restoration.

EPS00316 Scars: Why Hide it When You Can Revise IT Presenter: Dr. Pratik Suthar (PG Trainee) Dr. Sharvika Aher(PG Trainee) Dr. Aditi Saha(PG Trainee) Guided by: Dr. Sonal Shah (Reader) Dr. D. Y. Patil Dental College and Hospital, Pune Abstract Background/Introduction Scars arise from a variety of etiologies in the perioral region and among these, defects of the lip figure prominently. The high visibility of the lip complex makes even minor defects readily apparent. Despite a plethora of new techniques and various refinements, residual deformities continue to be a recurring feature in most patients. Scar revision involves much more than simply excising a scar and doing a better closure of the wound, and is often more challenging than the initial surgery. The pathophysiology of wound healing, anatomy, correct surgical techniques, proper tissue handling, and good surgical principles must be adhered to, along with proper perioperative care for successful scar revision. Objectives To minimize facial scarring and improve facial esthetics. Methods 4 patients who reported to our department with chief complaint of scar over the lip were taken up for W-plasty procedures to revise the scar and improve esthetics. All our patients were taken up under general anesthesia. Results Satisfactory. Conclusions The success of scar revision, or camouflage, is dependent on many parameters. Some of these include scar location, patient age, and nature of the initial injury, condition of the adjacent tissue, skin loss, ethnic background, skin type, patient expectations, and scar orientation. Best results are achieved only after considering these factors during surgical planning.

10. EPS00322 Masseter Muscle Hypertrophy-A Case Report Dr. Gaurav Vishal Institute of Dental Sciences, Bareilly, Uttar Pradesh Abstract Background/Introduction Masseter muscle hypertrophy is a relatively uncommon condition that can occur unilaterally or bilaterally. It was first described by Legg in 1880. Most commonly occurs in 2nd & 3rd decades of life. It is mostly idiopathic, although numerous factors such as malocclusion, bruxism, or TMJ disorders have been cited but not proven

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 conclusively. Several treatment modalities are reported ranging from simple pharmacotherapy to more invasive surgical reduction. Objectives To know the fate of surgical treatment. Methods The patient reported with unilateral bulging on left side of the mandibular angle region and didn’t complain of any pain or discomfort. Physical examination & MRI reveals unilateral masseter hypertrophy without local inflammation. OPG reveals hyperplasia of ramus of mandible on the left side. Results 6 months follow up was done of the case & result was good on the basis of aesthetic of the patient. Conclusions The masseter mucle is essential for adequate mastication & plays an important role in facial esthetics. The masseter hypertrophy was removed along with re-contouring the lower border of the angle of mandible. There is no associated complication was observed in six month follow up.

EPS00344 Modified Sagittal Split Osteotomy for Correction of Facial Asymmetry with Posterior Open Bite Dr. Birsubhra Roy Faculty of Dental Sciences, S.G.T University Abstract Background/Introduction Correction of deformities of jaw in patients with facial asymmetry is challenging. The degree of asymmetry increases with distance from cranium. Common features include lateral mandibular deviation that increases from upper to lower face with posterior open bite. Recent advances in surgical techniques involving midline mandibular osteotomy combined with sagittal split osteotomy of the mandibular ramus for systematic control of inferior third of the face have been observed. Objectives To correct concurrent facial asymmetry with unilateral posterior open bite by using modified sagittal split osteotomy and primarily reduction of enlarged tongue. Methods 21year old male patient presented with facial asymmetry, right posterior open bite and macroglossia. Presurgical orthodontic treatment carried for one year. Right deviation of chin, depressed nasal tip, short columela & shallow mentolabial sulcus. Under GA, unilateral sagittal split osteotomy performed at right side, osteomised distal segment was positioned, plating done using 4 hole plate with gap. Extraction of 31 with midline osteotomy done. Osteotomised segment positioned for maximum correction and 2mm plates placed using 4 hole plate with gap. Reduction glossectomy performed, not involving the tip. Results Improved esthetics & function seen 3 months postoperatively. Improved facial symmetry and significant bite correction with better intercuspation. Conclusions In our experience U/L sagittal split osteotomy combined with midline osteotomy can provide good results in the correction of facial asymmetry with dental components of malocclusion.

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EPS00382 Autologous Cheek Fat Grafting for Facial Rejuvenation Dr. Thara Chandra S, Dr. Ummar M MES Dental College Abstract Background/Introduction Fat grafting has been used successfully for soft tissue augmentation since 1983. Structural fat grafting, or lipostructure, term coined by Coleman, is one of those methods and possibly the most popularized one, because of it’s didactic presentation and widespread reporting. Objectives The objective of the present study was to clinically evaluate the efficiency of structured fat grafting when redefining facial contours. Methods 21 year old lady came with a complaint of hollow cheek which made her look weak and unattractive. Fat was harvested from thigh and abdomen using 10 ml syringe. After the harvest, incision (2-3mm) was placed and fat was placed accordingly to enhance cheek fullness. Results She had a more aesthetic and healthier appearance with cheek fullness when came 6 months post-operatively. Conclusions Structured fat grafting proved to be an efficient adjuvant technique for redefining facial contours. However, the fat volume to be grafted should be adequate for the specific needs of each area. Complications were minimal and a single session of grafting was enough to achieve the desired result.

EPS00401 Surgical Management of Bilateral Masseteric Muscle Hypertrophy Dr. Ashish Kashyap Himachal Pradesh Govt Dental College Shimla Abstract Background/Introduction Masseter muscle hypertrophy is characterized by unilateral or bilateral enlargement of the masseter muscles affecting both females and males after puberty. In most cases of masseter hypertrophy it is bilateral and symmetric, but asymmetry is not unusual. The masseter muscle is essential for adequate mastication and is located laterally to the mandibular ramus, and thus plays an important role in facial esthetics. A hypertrophied masseter will alter facial lines, generating discomfort, and negative cosmetic impacts in many patients. Muscle function may also be impaired, thus introducing conditions such as trismus, protrusion, and bruxism. Masseter hypertrophy leads to the prominent mandibular angle which is considered to be aesthetically unacceptable. Here we report the management of bilateral massetric hypertrophy by a surgical intraoral approach involving the debulking of the masseter muscle with bicorticalostectomy of the angle of the mandible. The patient was satisfied with both functional outcomes and aesthetic outcomes on both facial profile and frontal view. No complication was seen intraoperatively and postoperatively after a 12-month follow-up period.

S133 Objectives The aim of this report is to present an intra oral approach consisting of masseter muscle reduction and ostectomy of the angle region of mandible. Methods A case report of 14 yr old female patient with bilateral masseter muscle hypertrophy. Results Intra oral approach included debulking of masseter muscle and ostectomy of angle region of mandible. Conclusions Well designed adequately powered clinical trials are required for a definitive comment on the success of this treatment modality.

EPS00407 Endoscopic Techniques in Oral and Maxillofacial Surgery Dr. Tejinder Kaur, Dr. Sarika Kapila Shri Guru Ram Das Institute of Dental Sciences and Research, Amritsar Abstract Background/Introduction The endoscope has been described as an extra set of eyes and is the basis of innovation across multiple surgical disciplines and the fabrication of a new class of instruments and surgical techniques. Endoscopic techniques have been widely used in the craniomaxillofacial region. The endoscopic techniques are presently used for the treatment of orthognathic deformities, obstructive salivary gland disease, maxillary sinus disorders, trigeminal nerve injuries, TMJ disorders, Rhinoplasty and face lift surgery. Objectives Not applicable. Methods Endoscopic technique allows the surgeons to perform operations with better access through small incisions. They help to achieve equivalent or superior outcomes with decreased morbidity and faster recovery when compared with the standard techniques. Functional endoscopic nasal surgery allows a clearer view of the operative field, a more accurate correction of nasal obstruction and better control of bleeding. In older patients, this technique helps to minimize some of the undesirable sequelae of the traditional open procedures such as alopecia, scalp paraesthesia and facial edema of the subperiosteal lift. Other benefits include small and remotely placed incisions with acceptable scars, direct visualization of a magnified and illuminated operative field for surgeon and unobstructive view for the assistant. There is a shorter length of hospital stay and faster patient recovery. Results Not applicable. Conclusions The current disadvantage is the expense of the equipment and the time, effort required to learn to operate remotely with visualization on a 2-dimensional screen. This poster highlights the multitude array of indication and efficacy of endoscopic techniques in oral and maxillofacial surgery.

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EPS00469 Knotless Barbed Sutures-An Unique Wound Closure Tool Over Conventional Monofilament Sutures 1. Dr. Krishna Madhuri 2. Dr. Sampada PVL 1. Oral and Maxillofacial Surgery-PG 1st Year 2. (Oral and Maxillofacial Surgery-PG 1ST Year) Bapuji Dental College and Hospital-Davanagere Abstract Background/Introduction The introduction of barbed sutures provided an opportunity to explore the use of technology to approximate soft tissues. In recent years a number of knotless barbed self-anchoring suturing devices have become available alternative to closing and securing surgical wounds. Objectives To compare commercially available Knotless Barbed sutures against a Conventional Monofilament sutures. Methods It is found that Non-barbed monofilament sutures tend to migrate towards the middle of the incision where the tension is greatest, thereby causing incisional inflammation and predisposing to wide scars or suture pull through. A bidirectionally barbed suture is placed along its length which change direction somewhere near the suture midpoint to create a mirror image array of barbs in the opposite direction. Therefore when arranged in tissues, one end anchors the other. They can thereby be used to close wounds or move tissue differentially along the suture towards the point at which the barbs change direction. Results The Knotless barbed sutures resulted in decreased operating time, improved tissue apposition, more even distribution of tension along the length of the wound resulting in less dehiscence, reduction of ischemia, less suture extrusion, minimum tissue relapse and better wound healing when compared to monofilament sutures. Conclusions Knotless, absorbable barbed sutures devices are a safe, efficacious and viable alternative for cosmetic skin closure and yield wound strength and tissue reaction scores that are comparable to those from closures performed with absorbable monofilament sutures and secured with knots.

EPS00487 Boomerang-Plasty: A Mini Invasive Technique for Esthetic Restoration

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Methods this procedure includes analysis of degree of prominence of jowls and is complemented with neck liposuction and platysmoplasty. Results The recovery period is 2-3 weeks. pre and retroauricular scars over time were imperceptible. Conclusions Boomerang plasty restores the mandibular contour from the angle to the chin by eliminating jowls. It is a simple procedure with highly satisfactory and stable effects.

EPS00599 Versatility of Midface Degloving Approach in Oral and Maxillofacial Surgery Dr. R. S. Neelakandan MDS Dr. P. Anantanarayanan MDS Dr. Thomas Zachariah MDS Meenakshi Ammal Dental College & Hospital, Chennai Abstract Background/Introduction Traditional approaches to the midface include the Weber-Fergusson incision and the lateral rhinotomy approach which leave a visible scar on the face. The midfacial degloving approach is used to expose tumors of the maxilla, nasopharynx, orbits and central compartment of the anterior and middle cranial fossae. Objectives To assess the versatility and accessibility to the midfacial skeleton using midface degloving approach. Methods We present 4 cases operated with the midface degloving approach: 1) benign maxillary tumor 2) maxillary cyst 3) quadrangular LeFort1 osteotomy 4) panfacial trauma. The patients were orally intubated (to allow for endonasal incisions). This approach entails a maxillary vestibular incision and three intranasal incisions (bilateral intercartilaginous, complete transfixion and bilateral piriform aperture incisions). Results This approach had favourable outcomes in terms of accessibility and esthetics. Conclusions This approach gives excellent exposure to entire midface from the root of zygoma from one side to the other including the infraorbital rims, body of zygoma, anterior maxilla, buttress and the pyriform rim. The advantage of this approach is that all incisions are placed within the intraoral and intranasal regions without any scars on the face.

Authors: Dr. Shinja Dixit, Dr. Siddharth Rawat School of Dental Sciences, Sharda University Abstract Background/Introduction There is an increased demand to improve facial appearance & preserve youthful appearance for as long as possible. Minimally invasive facial procedures have boomed amongst the patients with less evidence of scar, low risk & rapid recovery being some of the attractions. Some patients are even interested in treatment of specific units of the face. This poster presents an alternative technique to treat jowls through limited incisions. Objectives to describe an alternative technique to specifically correct the jowls through a minimally invasive procedure called boomerang-plasty.

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ABS00628 Dynamics of Superficial Muscular Aponeurotic System in OMFS D Y Patil University-School of Dentistry D Y Patil University-School of Dentistry Abstract Background/Introduction to understand the importance of smas in omfs. Objectives To understand the implications, Anatomy, Uses of smas in OMFS.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Methods Articles were referred to and review of literature was done. Results SMAS is an important part of the head and neck anatomy which is encountered on regular basis. Conclusions SMAS is encountered in various surgeries in OMFS as an important anatomical landmark.

EPS00641 Aesthetic Chin Augmentation-Adjuvant to Othognathic Surgery: Dr. Prajakta Wankhede, Dr. Geetanjali Mandlik, Dr. Ekta Keswani, Dr. Gokul Venkateshwar

S135 disciplines in cosmetic surgery. For being a competent Rhinoplasty Surgeon, the complete understanding of the anatomy and physiology of the nasal structure is essential. The manipulation of the four parameters: The Tripod, Pedestal, Dorsum & Soft tissue envelope allows the surgeon to recreate the desired alterations. An absolute understanding of the grafting materials with the proficiency of the surgeon, is used to meet the unique needs of the patient. The most commonly used Autograft in Rhinoplasty is Septal Cartilage. Used in case of spreader, alar or tip grafting. The most commonly used Allograft is A-cellular Dermal Matrix, used as a graft camouflage. The Alloplastic grafts used in Cosmetic Rhinoplasty range from silicone to poly-tetra-flouro-ethylene to poly-diaxone in cases of a deficient nasal dorsum. As conclusion, the Autologous septal cartilage is the gold standard for graft material in cosmetic rhinoplasty. However incase of a deficient donor site, additional donor site has to be created adding an increased surgical risk and time. Hence at this time, Allografts are indicated. Injectable alloplastic grafts are used for minor correction and can greatly improve outcomes, obviating the need for surgery.

Dr. D. Y. Patil School of Dentistry and Hospital Abstract Background/Introduction Introduction:Standards for an aesthetic face are dynamic. Chin forms the strong aesthetic sub- unit of the face.the idea of chin augmentation or enhancement is to preserve the inverted triangle of youth and have a good chin projection. Objectives Indications:A receding or weak chin is a significant aesthetic impediment to a pleasing face. Poor projecting chin can hamper the outcome of a good Orthognathic surgery. Poorly projected chin is one of the indications for increasing its projection and its convexity in the profile view for aesthetically pleasing facial appearance. Methods This poster discusses various procedures to augment chin using different types of chin implants, dermal fillers,fat grafting, etc., the choice of implant materials are Gortex, Silastic, Medpor, Mersilene. With respect to implant placement, in surgical technique, an intraoral or a submental incision may be used to develop subperiosteal or a supraperiosteal pocket, depending on the preference. A drain may or may not be used. Results Chin augmentation is an effective way of improving chin projection. Conclusions With properly sized implant, chin augmentation offers an easy and effective means of correcting the deficiency by derma fillers or fat grafting can improve the chin soft tissue projection.

EPS00669 Grafting Materials in Cosmetic Rhinoplasty-Review of Literature Dr. Revati Bhaskar YMT Dental College and Hospital, Kharghar, Navi Mumbai Abstract Background/Introduction The nose lies directly between two most important features of the face, eyes and mouth. A beautiful nose is pleasing to the eyes. Rhinoplasty has long been regarded as one of the most challenging

EPS00700 Laser Assisted Lip-Repositioning for Gummy Smile Dr. N. Srinath, Dr. Mahadeepa Kar Krishnadevaraya College of Dental Sciences, Bangalore Abstract Background/Introduction Gummy smile is a condition in which an overexposure of the maxillary gingiva ([3mm) is present during smiling.the proper diagnosis and determination of its etiology are essential for the selection of right treatment modality. Gummy smile can be soft tissue or hard tissue. The aetiology may be due to anterior dent alveolar extrusion, vertical maxillary excess, short upper lip, a hyperactive upper lip or a combination of these causes. Although some gingival display(gummy smile) gives the impression of a youthful smile, a gingival display larger than 3mm is considered unattractive. It can affect about 10.5% of the population, with a female to male predominance (2:1) Objectives To assess the efficacy of laser assisted lip-repositioning and patient satisfaction. Methods Local Anaesthesia was given. Incision was marked. Frenectomy was done. Mucosal strip was removed. Lip length measurement was done postoperatively. Results Measurement of lip length and gingival display was done at 2nd,4th week, 3rd, 6th month time intervals. Conclusions Since we got clinically satisfactory result, it is an efficient technique for gummy smile correction. It can be used as an excellent alternative to more costly procedures with high morbidity rates. It is also minimally invasive with minimal postoperative pain and swelling. In future we can look forward to witness this procedure for correction of gummy smile extensively alone or in combination with other surgical procedures.

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EPS00706 Surgical Scar Revision Nishedh Rahangdale

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Conclusions Cosmetic surgeries including facelift operation are becoming increasingly popular, and facial rejuvenation remains one of the most commonly requested aesthetic procedures. Many lifting procedures can be used in order to reduce sagging of skin and subcutaneous tissues and create more youthful face.

Rishiraj College of Dental Science & Research Centre, Bhopal (M.P.) Abstract Background/Introduction Most surgical patients end up with a scar and most of these would want atleast some improvement in the appearance of scar. This e-poster reviews the principles of prevention and treatment of suboptimal scars. Objectives To review various relevant techniques of scars in maxillofacial region. Methods NA. Results NA. Conclusions Surgical techniques of scar revision includes Z-plasty, W-plasty, V-Y-plasty, Geometrical Broken-line closure, Fusiform elliptical excision etc. Using sound techniques for wound closure surgeon can to a certain extent prevent suboptimal scars. Post operative care and other adjuvent therapies of scars have also been described. Further emerging trends in scar revision and reduction are Gene therapy and Autologous fat grafting. It is hoped that this review helps the surgeon to formulate a comprehensive plan of management of scars of patients.

EPS00722 Facelift: Facial Rejuvenation Dr. Hirak Patel (Trainee)

EPS00791 Facial Implants (Chin Implant) for the Augmentation of Chin-A Case Report Dr. Krishna Shama Rao, Dr. Chethana, Dr. Uroof CKS Teja Dental Sciences and Research Institute, Chadalawada Nagar, Tirupati, Andhra Pradesh Abstract Background/Introduction The chin plays a very important role in overall facial appearances and aesthetic procedures to augment the chin in patients with microgenia can improve overall facial balance. Objectives Usefulness and versatility of the porous high density polyethylene implants for correction of various facial deformities as an augmentation of chin. Methods Prefabricated porous high density polyethylene implants were used in two patients with microgenia for augmentation of chin. Results Good esthetic results were achieved in all the patients treated with porous high density P olyethyelene implants with no complications. Conclusions Porous high density polyethylene alloplastic implant is an excellent biomaterial for augmentation of chin.

Karnavati School of Dentistry, Uvarsad, Gandhinagar Abstract Background/Introduction A facelift, technically known as rhytidectomy. Facelifting is a facial rejuvenation procedure in which by dissection of subcutaneous layers and different suturing techniques we stretch the skin and make patient look younger. It can be roughly divided into facelift surgery and nonoperative, less invasive procedures, like fatgrafts, fillers, botox injections, thread-lifts or laserbrasion. Facelift surgery is procedure most directly associated with rejuvenation, due to its fundamental ability to restore anatomical changes caused by aging. Various methods of facelifting have been developed over years. Objectives To evaluate aesthetic results after surgical facelifting. Methods Facelift Surgery involves removal of excess facial skin, with/without tightening of underlying tissues and redraping of skin on patient’s face and neck. Surgical facelifts are performed under general anesthesia or deep twilight sleep. Original concept of facelift involves simple excision of excessive skin in lateral portion of face. The procedure then evolved to include subcutaneous undermining and redraping of skin flap against gravity. Results High patient acceptance and good aesthetic results were achieved, with almost complete restoration of facial symmetry 1 year postoperatively.

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EPS00796 Nasal Bridge Augmentation: Costochondral Graft Versus Silicone Implants Dr. N. Srinath, Dr. Arundhati Singh Krishnadevaraya College of Dental Sciences Abstract Background/Introduction Saddle nasal deformity characterized by a hypoplastic nasal bridge with or without a poorly supported nasal tip is one of the craniofacial developmental anomalies and a possible consequence of trauma. Other potential causes are syphilis, Wegners granulomatosis and post rhinoplasty. The popularity of augmentation rhinoplasty is increasing among the Asian population. Various autologous and alloplastic materials are available for the procedure but still there is a controversy regarding which material is best. Bone graft can be harvested from calvarium, iliac crest or rib while cartilage grafts are obtained from nasal septum, ear concha or costochondral. Here, we are presenting the merits and demerits of both costochondral graft versus silicone implants in nasal bridge augmentation. Objectives To evaluate and compare the surgical procedure, outcome and the patient satisfaction in both the cases.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Methods Study was done on 20 patients. Rhinoplasty performed. Costochondral grafts and silicone implants placed. Results Silicone implants were shown to be less effective due to a higher rate of infection, extrusion and rejection in spite of it’s less bulkiness and can be shaped easily when compared to costochondral grafts. Conclusions So, overall costochondral grafts are better for nasal bridge augmentation procedures when compared to silicone implants.

EPS00817 Botox and Derma Fillers-The Twin-Face of Cosmetic Dentistry Dr. Richa Guru Nanak Dev Dental College and Hospital, Sunam Abstract Background/Introduction Botulinium toxin and derma fillers are well known for their use in aesthetic dentistry. Objectives Botulinum toxin and derma fillers have made their way into dentistry for both dental aesthetic and therapeutic uses. They provide most significant, minimally invasive procedure at low cost with limited to no recovery time. This information will be focused on the mechanism of action and various uses of botox and derma fillers in the maxillofacial areas along with its future implications in dentistry. Methods Advances in better understanding of both the static and dynamic relationship of soft tissues on the oro-facial complex have opened new avenues in treatment, and so through the use of botox and derma fillers oro-facial complex can be safely sculpted and functionally modulated. Results There is significant improvement in aesthetics through the use of botulinum toxin and derma fillers. Their use as a part of cosmetic treatment can relieve pain, restore pain, restore function and help to create a perfect smile. Conclusions In summary, use of botulinum toxin and derma fillers appears to be a effective method for cosmetic treatment in maxillofacial region.

EPS00820 Its Simple-Your Dimple Dr. Namrata Chourasia Abstract Background/Introduction Facial dimples are considered as an important part of a beautiful smiling face. They occur in both sexes with no particular preponderance, may express unilaterally or bilaterally and are genetically inherited as a dominant trait. Natural dimples appear upon smiling and perhaps because of that, dimples are generally associated with cheerfulness. As the awareness about and willingness to undergo cosmetic surgery has increased, the demand of surgical creation of dimples on face has also increased. When dimples occur on the face

S137 they are highly prized because face is highly visible and its an important outlet for expressing thoughts and emotions beyond words. Objectives To accentuate a smile, thus increasing the perception of attractiveness, sociability, and facial beauty by creating cheek dimples surgically. Methods We used a simple technique for creation of dimples, marking the dimple site extra orally and giving an intraoral incision and suturing the buccinator muscle. Results This procedure is safe, reliable and easily reproducible. As no tissue is excised, chances of bleeding is less. Conclusions With this procedure, the patient satisfaction rate is very high.

EPS00841 Esthetic Correction of Frontal Hypoplasia Using Tissue Expander Dr. Shajee. Mk, Dr. Ummar. M (Prof&H.O.D) Dept of Omfs MES Dental College and Hospital Abstract Background/Introduction Tissue expansion in its natural ways had fascinated man from pre historic times itself. but tissue expansion for medical purpose was first tried and reported only in the early half of 20th century. Presently the principle of tissue expansion is being used in reconstruction of many hard and soft tissue defects of larger dimensions which were previously regarded as great challenge for maxillofacial and plastic surgery. Making use of the viscoelastic nature of skin, considerable amount of tissue engineering is possible in the maxillofacial region. Objectives To evaluate the versatility of tissue expanders for reconstruction of hypoplastic frontal bone. Methods A 24 year old male presented to our department with frontal hypoplasia. Plan was to reconstruct the defect cosmetically with acrylic implant. As tissue approximation was not adequate to increase the amount of tissue required for anastomosis we used a tissue expander.a crescent shaped silicone expander were implanted under the galea. Over several weeks, saline was added to the expander through a injection port. The surface area of over lying skin was gradually increased through a process of ‘‘biologic creep’’ providing increased tissue to reconstruct the defect. After adequate inflation has occured the expander was removed and defect was reconstructed. Results We were able to achieve increased surface area over the tissue by mechanical creep and biological stretch which was used for resurfacing of the defect. It improved the quality and quantity of soft tissue and facilitated primary wound closure and reduced the incidence of wound dehiscence and exposure of bone graft. Conclusions Knowledge of tissue regeneration in tissue expansion is important for its clinical application. Ultimately one is able to achieve increased surface area of the tissue by mechanical creep and biological stretch.it improves the quality and quantity of soft tissue and facilitate primary wound closure and reduced the incidence of wound dehiscence and exposure of bone graft. tissue expansion has certainly earned the status of being an indispensable adjunct for reconstructive procedure in maxillofacial surgery.

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Section: Maxillofacial Implant ABS004 Application of 3D Printing in Oral and Maxillofacial Surgery: A Case Report Dr. Ayesha Moin, Dr. Akshay Shetty Sri Rajiv Gandhi College of Dental Sciences and Hospital, Bengaluru Abstract Background/Introduction Three dimensional (3D) printing has been widely adopted in medical fields. Application of the 3D printing technique has even been extended to bio-cell printing for 3D tissue/organ development, the creation of scaffolds for tissue engineering, and actual clinical application for various medical parts. Of various medical fields, craniofacial plastic surgery is one of areas that pioneered the use of the 3D printing concept. Rapid Prototype technology was introduced in the 1990s to medicine via computer-aided design, computer-aided manufacturing (CAD-CAM).the medical models or bio-models based on the 3D printing technique represent 1:1 scale portions of the human anatomical region of interest obtained via 3D medical imaging. The procedure for the fabrication of medical models consists of multiple steps: (1) acquisition of high-quality volumetric 3D image data of the anatomical structure to be modeled, (2) 3D image processing to extract the region of interest from the surrounding tissues, (3) mathematical surface modeling of the anatomic surfaces, (4) formatting of data for rapid prototyping, (5) model building, and (6) Quality assurance of the model and its dimensional accuracy. Objectives This paper presents a case report of secondary deformity correction following a Pan facial trauma using 3D printing technique for the reconstruction of temporal bone segment. Methods This is a a case report of secondary deformity correction following a Pan facial trauma using 3D printing technique for the reconstruction of temporal bone segment. Results Nil. Conclusions Despite advances in 3D printing there are significant barriers and controversies; some of which are unrealistic expectation regarding tissue/organ printed, safety and security issues, and regulatory approvals. Regardless of the challenges, 3D printing is expected to play an important role in the trend towards personalized medicine and revolutionize healthcare.

EPS00133 Screw Retained Hybrid Implant for Maxillary Posterior Edentulous Ridge Dr. Sonal Anchlia, Dr. Shishir Kumar, Dr. Ramyata Dayatar, Dr. Hrushikesh Gosai Govt Dental College and Hospital, Ahmedabad Abstract Background/Introduction The need of sufficient bone around the endosseous implant is critical for the success of implant. In the sinus area of the maxilla, the vertical

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 height of the bone is often less. Hence, to avoid sinus lift and bone grafting procedures, the present study was aimed. Objectives The present study was aimed at evaluating the efficacy of the Hybrid implant in overcoming the height and width problem of the alveolar bone in the maxillary posterior edentulous region. Methods 12 implants were placed in the maxillary posterior region. Inclusion Criteria:- This was a prospective research design with 10 adult patients included in this study wherein - Patients with inadequate bone height in maxillary posterior edentulous region - Patients with close approximation to maxillary sinus Exclusion Criteria: - Medically compromised patients - Maxillary anterior and mandibular edentulous regions the implant was a prefabricated thin laminar plate having a vestibular part with three screw holes and a palatal part with two screw holes. This implant is placed subperiosteally and is fixed to the cortical bone. Results Implants were placed in an average bone height of 7.7 mm. All the patients experienced pain during the 1st week postoperative period but that gradually decreased in intensity. No mobility of implants or any bone loss during the postoperative period was observed. Two cases showed screw exposure, one on the buccal and one on the palatal side. Conclusions Hybrid implants showed good stability and minimum complications, while preventing sinus lift procedures and bone graft requirements in the maxillary posterior region.

EPS00170 Anatomic Root-Analogue Dental Implants Dr. Ramandeep Singh Bhullar, Dr. Amit Dhawan Sri Guru Ram Das Institute of Dental Sciences and Research, Amritsar Abstract Background/Introduction In a quest to provide best-quality treatment, results, and long-term prognosis, physicians must be well versed in emerging sciences and discoveries for more favorably suitable options to patients. Bio engineering and regeneration have rapidly developed, and with them, the options afforded to surgeons are ever-expanding. Rapid development in biomedical engineering demands the application of modern computerized measurement techniques. Computer aided co-ordinate measuring technique can be particularly applied to evaluate the shape of non-technical structures with high accuracy. Dental implants are one of those advancements in dentistry. Objectives (Not Applicable) Methods (Not Applicable) Results Root analogue dental implants are the immediate anatomic zirconia/ ceramic dental implant. Their are designed to fit perfectly into the space left behind when tooth is extracted. The principle of ‘differentiated osseointegration’ dictates the innovative implant design. Root analogue dental implants involves a simple procedure, are logical, non-surgical technique, no sinus lift procedures required and no bone augmentation procedures needed. There are negligible alterations in natural anatomy of the root. Since no metal is used, the results are the most aesthetic.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Conclusions Thus my poster enhances our perception towards the root analogue dental implants.

EPS00177 Efficacy of 2mm 3D Locking Mini-Plates in the Management of Anterior Mandibular Fractures Dr. Neelakamal Hallur, Dr. Aaisha Siddiqua, Dr. Syed Zakaullah, Dr. Ashwin Shah, Dr. Chaitanya K., Dr. Shereen Fatima Al Badar Dental College and Hospital Gulbarga Abstract Background/Introduction To treat Anterior Mandibular fractures dynamic compression plate, eccentric dynamic compression plate, lag srews & monocortical non compression plates were used which is fixed at lower border. Thus fixing of plate at lower border fails to control the superior border fanning so tension band is required for better stability. To overcome these shortcomings 3D locking plates were introduced. Objectives To study the efficacy of 2mm 3D locking titanium mini plates in management of anterior mandibular fractures. Methods 20 patients with displaced, undisplaced fracture of anterior mandible underwent open reduction and internal fixation using 2mm 3D titanium locking mini-plates and 2mm — 10mm locking screws. Study parameters included were, assessment of intra-operative stability of fracture segments after fixation and clinically for occlusion and healing. Radiographic healing at 1st, 6th and 12th week was assessed using Digora software. Results Postoperative clinical evaluation showed the occlusion to be satisfactory in all 20 patients. Radiographic healing of fracture was assessed in terms of bone density achieved on OPG and PA mandible using Digora software between 1st, 6th and 12th week and was found to be statistically significant. No case of wound dehiscence, plate/ screw fracture, screw loosening was observed. Conclusions The use of 2mm 3D titanium locking plate has proved to be effective in the management of anterior mandibular fractures.

EPS00178 An Evaluation of Clinical Outcome of Placing the Tubero-Pterygoid Implants in Posterior Atrophic Maxilla-A Clinical Study Author- Dr. Suvvari Ramakrishna, Co-author- Dr. P.S. Chakravarthi SIBAR Institute of Dental Sciences Abstract Background/Introduction pterygoid implants has been defined as implant placement through the maxillary tuberosity and into the pterygoid bone. The use of pterygoid implants was first described by Tulasne in 1992, in which implants were anchored in the pterygoid area, which provide a stable anchor as it is very dens bone. This techniqe used smaller implants which are

S139 paraliel to the posterior wall of the maxillary sinus. They allow anchorage in posterior atrophied maxilla without sinus lift procedures. Objectives This study was performed to evaluate clinically and radiographically the success of dental implants placed in the posterior atrophic maxilla. Methods 10 participants (4males, 6 female, Average age - 35 years) with partial edentulism associated with narrow atrophic alveolar ridges with adequate height and willing to participate in the study were included. Initial drill was made followed by consecutive drills and simultaneous implant placement was performed. A total of 10 implants were placed. No graft material were used. Stability, achieved ridge width and radiographic crestal bone loss were assessed 3 months postoperatively. Results All the implants were clinically and radiographically stable at the end of 3rd month follow up. All ten implants were surrounded by adequate amount of bone required for successful functional rehabilitation. Conclusions Placing the implants in posterior atrophic maxilla will help in maintaining the alveolar ridge width and height. It also decreases the rehabilitation time and improves quality of bone support.

EPS00185 Socket Shield Technique: Neoteric Approach for Ridge Preservation & Immediate Implant Placement: A Case Report Dr. Priyanka R. Sawadkar, III Yr. M.D.S.Trainee (P.G.), Dr. Yogesh Kini, Prof. & Guide, Dr. Mukul Padhye, Prof. & Dean Faculty, Dr. Gokul Venkateshwar, Prof. & H.O.D. D. Y. Patil University, School of Dentistry, Navi Mumbai Abstract Background/Introduction Implant therapy is in the age of being increasingly aesthetically driven, not merely restorative. With the increasing popularity of immediate implants, particularly with anterior tooth extraction, the relevance of socket changes following extraction has come to the fore. Healing of extraction sockets undergoes a remodelling process which leads to horizontal and vertical bone loss. There have been several strategies employed to minimize these aesthetic problems using grafting technique to retain the original dimensions of the bone after extraction which require the use of bone grafting materials, additional surgical site morbidity and there still remains an uncertainty of the long term outcomes. Socket shield technique has demonstrated the potential in preventing buccal bone from resorption in animal and clinical studies. Objectives To corroborate a cost effective & minimally invasive method to preserve alveolar ridge & simultaneous implant placement. Methods 1 subject advised for extraction & immediate implant placement with maxillary right lateral incisor was anaesthetized using local infiltration. A sliver of tooth (12) on the facial side attached to the periodontal ligament was left in situ using a straight fissure bur & an appropriate size implant was placed consecutively & followed up for 1 week, 1 month & 3 months post operatively for consecutive procedures.

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S140 Results Single implant placement with good post operative outcome was achieved with minimal ridge resorption. Conclusions This presentation reviews a clinical case to show the socket shield technique & its advantages.

EPS00245 Horizontal Bone Augmentation for Implant Placement in Deficient Alveolar Ridges Dr. Parth Shah D. Y. Patil School of Dentistry Nerul, Navi Mumbai Abstract Background/Introduction With the advancement of reconstructive techniques, implants have become an increasingly available option for replacing missing dentition in patients. One of the challenges with implant placementis an unfavorable local condition of the alveolar ridge due to atrophy, which may cause insufficient bone volume in the horizontal and/or vertical dimensions. Many options for treatment of alveolar ridge defects are available, including varying surgical techniques as well as bone graft options. Objectives This review evaluated the success of different surgical techniques for the reconstruction of edentulous deficient horizontal alveolar ridges and the survival/success rates of bone grafts placed in the augmented areas. Methods 30 cases done at our institute with mean follow up of 6 months were included. The procedures considered were onlay bone grafts, khoury technique, ridge split, sandwich technique, bone shield and Titanium mesh. Success and related morbidities of the augmentation procedures were analyzed. Results A total of 30 cases were reviewed. However, it was difficult to demonstrate that one surgical procedure offered better outcomes than other. Conclusions Every augmentation procedure requires substantial planning and different augmentation technique. Every surgical procedure presents advantages and disadvantages. Priority should be given to those procedures which are simpler and less invasive, involve less risk of complications and reach their goals within the shortest time frame.

ABS00281 Evaluation of Buccofacial Bone Height in Immediate Implant Placement with Socket-Shield Technique Using Cone Beam Computed Tomography Dr. Ahamed Irfan K.A. The Oxford Dental College and Hospital, Bengaluru Abstract Background/Introduction Preservation of bone and soft tissue in the anterior region is the most important and challenging task to deliver best functional and esthetic

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 outcome for the patient. Socket Shield Technique preserves the buccal bone thereby preventing the resorption of the bone.and giving the best treatment outcome for the patient. Objectives The objectives of this study is to evaluate the buccal\facial bone height mainly in anterior maxilla in immediate implant placement with Socket Shield Technique using Cone Beam Computed Tomography. Methods Patient with an uninfected root or fractured crown which requires immediate implant placement was chosen for the study, pre operative CBCT was taken and required implant was chosen, the thin shield of root in the buccal surface of the socket is left remained in the socket with the remaining part removed with minimal trauma to the socket and surrounding tissues followed by immediate implant placement. 4 month post operative CBCT was taken to correlate the buccal bone height pre and post operatively. Results our study showed that the buccofacial bone resorption is very minimal compared to conventional immediate implant loading. Conclusions Socket shield technique is an ideal technique for anterior immediate implant placement if there is any uninfected root or tooth present which requires implant placement.

EPS00285 Evaluation of Hybrid Implant in Posterior Edentulous Maxilla with Inadequate Bone Dr. Varghese Mani, Dr. Aabu Varghese Mar Baselios Dental College, Kothamangalam Abstract Background/Introduction In the field of prosthodontics the ultimate objective is to provide artificial teeth which remains firm under normal oral activities and will appear natural to the sight. The hybrid implant was invented by a senior oral and maxillofacial surgeon Prof Dr. Varghese Mani. The invention is a piece of art, which is a combination of both sub periosteal and endosseous implant. Objectives To study the rehabilitation and evaluation of posterior maxillary edentulous space i.e. Maxillary- premolar, 1st molar and 2nd molar area with hybrid implant and evaluate the hybrid implant post operatively for 6 months (1stmonth, 3rd month, 6th month). Methods All patients above 20 years who reported to outpatient department of Mar Baselios Dental College, Kothamangalam for replacement of the missing tooth according to the inclusion and exclusion criteria. All the patients were explained about the method of the study, about the new implant system, possible complications and other alternative methods of replacement of missing teeth and a detailed consent is taken from patients who are willing to participate in the study. Results When evaluated the hybrid implant showed good stability with the Periotest values showing significant p- value of 0.007. None of the patients developed any post-operative complications during the study period. Overall according to the evaluation during the study period the hybrid implant system proved to be a stable, patient and clinician friendly, economic implant system. It also prove to be a safer alternative to sinus lift and bone grafting for placement of endosseous

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 implants in areas of posterior maxilla with inadequate bone and also avoid complex surgical procedures and long treatment period. The limitation of this study is that the implant system was analyzed only for a shorter period of time with lesser number of patients in a single center. Conclusions Hybrid implant system is an effective system for the rehabilitation of posterior maxillary edentulous spaces with inadequate bone for endosseous implant placement and also cost effective and patient friendly. It proves to be a safer alternative for sinus lift and bone grafting. Further long term studies and multicenter studies and modifications in design are needed for a more confirmatory efficacy about the hybrid implant system.

EPS00296 Ligaplants-Tissue-Engineered Ligament Implant Sweta Parna Deb (Institute of Dental Sudies & Technologies) Abstract Background/Introduction The combination of PDL cells with implant biomaterial is known as Ligaplants. The ability to use autologous dental progenitor cells (DPCs) to form organized periodontal tissues on titanium implants would be a significant improvement over current implant therapies. Periodontal ligament (PDL)-derived DPCs can be used to bioengineer PDL tissues on titanium implants. PDL dental progenitor cells can exhibit differentiative potential characteristic of stem cells. PDL DPCs can organize periodontal tissues in the jaw, at the site of previously lost teeth, indicating that this method holds potential as an alternative approach to osseointegrated dental implants. It ensures that the formation of PDL Collagen fibers oriented perpendicular to the implant might improve cementum formation on its surface. Objectives Placement of ligaplants can alleviate problems that conventional implants are commonly faced with; such as gingival recession and bone defects of the missing tooth site. Methods Ligaplants can be applied in cases of periodontal bony defects, where the conventional implants can’t be installed. The cultured PDL cells that surround the implants will act as support and anchorage in the place of normal PDL. Results Ligaplants as tooth replacement has decisive advantages as compared with osseosintegration devices due to their property of periodontal tissue regeneration. Conclusions Ligaplants is relatively easy, because the implant is not tightly fitted to its site. Patient may not have to undergo bone grafting, inconvenience and discomfort with the ligaplants placement. The ligaplant system mimics the natural insertion of natural tooth roots in alveolar bone.

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EPS00317 Alveolar Ridge Split & Immediate Implant PlacementCase Reports Dr. Bhavik Miyani Narsinhbhai Patel Dental College & Hospital; Visnagar Abstract Background/Introduction Lateral ridge split technique is a way to solve the problem of the width in narrow ridges with adequate height. Simultaneous insertion of dental implants will considerably reduce the edentulism time. Objectives For correction of defective ridges some solutions presented including: Onlay lateral ridge bone grafting, horizontal osteodistraction and Guided bone regeneration techniques. Lateral ridge split technique is a way to solve the problem of the width in narrow ridges with adequate height. Methods Two patients were treated with ridge split technique & immediate implant placement. Submerged implants were used and 3 months later healing caps were placed. Patients were clinically re-evaluated at least 6 months after implant loading. Results Mean value for presplit width was 3.20 ± 0.34 mm while post-split mean width was 7.57 ± 0.49 mm. Mean gain in crest ridge after ridge splitting was 4.37 ± 0.15 mm. Conclusions Ridge splitting technique in both jaws showed the predictable outcomes, if appropriate cases selected and special attention paid to details; then the waiting time between surgery and beginning of prosthodontic treatment can be reduced to 3 month.

EPS00350 socket Shield Technique Dr. Fahad Khan Chandra Dental College, Barabanki Abstract Background/Introduction The socket shield technique provide a promising treatment adjunct to better manage risks and preserves the post extraction tissues in aesthetically challanging cases. Objectives post extraction healing is normally associated with with loss of alveolar ridge width and height; this alteration of ridge ridge contour compromioses the three dimensionalpositioning of implant. & accordingly hampers the the required primary stability. Methods in 2010 Hurzeler introduced this in which it was advised to retain partial buccal root fragmentsand immediate implant placement should be done. Results here we present a case report of this technique in restoration of 21, till the period of 1 year, in fallowup it was found thatt osseointigration was successful without anycomplication.

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S142 Conclusions The socket shield technique provide a promising treatment adjunct to better manage risks and preserves the post extraction tissues in aesthetically challanging cases.

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EPS00385 Immediate Dental Implant Placement with or Without Autogenous Bone Graft-A Comparative Study Dr. Sonalika Kabi

EPS00361 Comparison of Two Regimens of Amoxicillin in Early Clinical Outcome Following Two Stage Dental Implant Surgery: A Clinical Study Dr. Remya G., Dr. S. Mohan Government Dental College, Kottayam Abstract Background/Introduction Dental implant is a foreign material embedded within the living tissue of maxilla or mandible to support or replace missing or diseased teeth. Dental implant generally has a high success rate, but there is a group of cases in which implants fail. Infection is thought to play an important role in the failure, as implant placement surgery is of the clean contaminated type. The contamination of the implant surface by bacterial biofilm during surgical procedure can lead to an inflammatory process of the hard and soft tissues thus decreasing the implant success rate. Many different techniques have been used to avoid infection during surgical procedure such as the use of chlorhexidine mouth wash rinse before the intervention, double aspiration to avoid salivary contamination of the surgical wound, reducing the amount of saliva secreted using atropine and by the use of various prophylactic antibiotic regimens. Many studies suggested that use of prophylactic antibiotic prior to implant surgery will significantly reduce implant failure. Objectives To compare the early clinical outcome between two regimens of amoxicillin in two stage dental implant surgery. Methods A total of 20 subjects needing dental implant placement were randomly allocated to one of the two antibiotic prophylaxis regimen groups. In the first group, dental implants were placed after the administration of a single preoperative dose of antibiotic (2 g of amoxicillin); no postoperative antibiotics were given. In the second group, dental implants were inserted without any antibiotic prophylaxis; only postoperative dose of 500mg amoxicillin given every eighth hourly for 3 days. The surgical sites were assessed for pain, swelling, erythema, wound dehiscence, and pus formation at 3rd,7th, 14th day. Results The results showed that there were no statistically significant differences between the two antibiotic regimens for the variables compared. Conclusions A single preoperative antibiotic dose may be as effective as a post operative course of antibiotics for 3 days, in obtaining a similar success rate for dental implants.

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Scb Dental College & Hospital, Cuttack Abstract Background/Introduction Replacement of missing tooth has evolved from removable dentures to fixed dentures and recently to dental implants. The need of sufficient bone around the endosseous implant is critical for the success of the implant.the present study was aimed to evaluate the efficacy of autogenous bone graft for replacement of the missing teeth. Objectives To prospectively evaluate the various outcome like intraoperative, perioperative and post operative in terms of implant survival. Methods A prospective research design with a follow up after 1st week,2nd week,3rd week,1st month,3rd month,6th month and 1st year postoperatively. 2. Sampling method Population: All patients who reported for replacement of missing teeth. Inclusion criteria 1. All patients above the age group of 16years 2. Patients who need replacement of single or multiple teeth in the anterior or posterior region of the maxilla and mandible. Exclusion criteria 1. Medically compromised patients. 2. Patients having craniofacial syndromes. 3. Sample size 5 patients were selected taking into consideration the inclusion and exclusion Criteria. Results Results PAIN All the patients were non symptomatic during the 1st month to 1st year postoperative periods. Mobility We experienced mobility during the 1st and 2nd postoperative periods where the implants were inserted in the mandibular molar region. Bone loss Radiographic assessment showed no bone loss during the postoperative periods. Conclusions immediate implant placement with autogenous bone graft showed good stability and minimum patient discomfort during one year postoperative period evaluation. The implant system leads to new prospect in the field of prosthetic rehabilitation.

EPS00417 Ridge Splitting with Immediate Implant Placement: Review of the Rationale Presenting Author: Namitha M H Co-authors: Dr. Saikrishna. D, Dr. Sujeeth Shetty JSS Dental College, Mysore Abstract Background/Introduction The treatment of patients with atrophic ridge who need prosthetic rehabilitation is a common problem in oral maxillofacial surgery. Several techniques are available to enhance bone volume for implant placement. Expansion of existing residual ridge is a novel method to prepare the atrophic maxilla and mandible for immediate implant insertion and augmentation. This technique, being only suitable for enhancing ridge width, requires the availability of adequate bone height. The goal is to expand the ridge to allow placement of an

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 appropriate size implant for proper prosthetic contour and biomechanical support. Objectives To understand biomechanics of ridge splitting technique and its efficacy as a method to overcome prolonged and repeated follow ups for implant placement. Methods Publications on the subject were searched up to August 2017 on electronic databases (Pub-Med, MEDLINE, ScienceDirect, Zotero) for articles published in pre-reviewed journals using key words [(Dental implant) (Dental implantology AND Narrow ridges) (Thin ridge augmentation) (Alveolar ridge splitting) (Split crest technique)]. Results Alveolar ridge splitting may be considered as an approach that demonstrates high implant survival rate, adequate horizontal bone gain and minimal intra and post operative complications. Conclusions Alveolar split expansion is an excellent tool for regaining alveolar ridge width but the procedure should avoid bone fragment dislodgement or flap detachment of the out-fractured plate, which leads to bone devitalisation and subsequent remodelling resorption.

EPS00471 Bioactive Surface Dental Implants Dr. Rachakonda Swamy Kamineni Institute of Dental Sciences Abstract Background/Introduction Branemark introduced the Osseo-integration system in 1977, a healing period of at least 3-4 months without loading has been advocated to achieve Osseo integration of dental implants. Branemark’s protocols have been reevaluated and modified significantly by the development of non submerged healing for two-stage implants, immediate or early implant placement after tooth extraction, and immediate or early loading. Moreover, with the improvement of implant surface technology, which has shortened the loading waiting period from 12–24 weeks to 6–8 weeks without reducing the success rate, faster and steadier. Osseointegration can be attained. A threestep surface treatment that combines mechanical and chemical treatment methods to achieve a unique, three dimensional, macro, micro and nanostructured bioactive titanium surface - the Bio surface. The Bio surface stimulates cell attachment, differentiation and bone matrix synthesis leading to an increased bone-implant contact in a shorter time. Objectives To assess stability of early loaded dental implants using bite force and study the level of osseointegration. Methods Pilot drill was used to give an initial ditch over the crestal bone and using a depth gauge/paralleling pin, implant position is confirmed. After sequential osteotomies using 1.5mm, 2.8mm, 3.2mm and 4.8mm drills with a predetermined depth were carried out. An appropriate Implant fixture was screwed into the osteotomy cut with adequate torque, and cover screw was placed and screwed tightly. Flaps were closed using 3-0 black braided silk with interrupted suturing. Results The Implants had more stability with bone quality and the osseointegration is found to be good.

S143 Conclusions The statistical evaluation of data shows that for LASAK BIONIQ implants, a healing period reduced to four weeks for maxilla and six weeks for mandible.

EPS00480 Zygomatic Implants a Graft Less Solution in Atrophic Maxilla Dr. Venkatesh Balaji Hange K.D. Dental College and Hospital, Mathura Abstract Background/Introduction Implants have been more sensitive in maxilla as compared to the mandible when the maxilla is severely resorbed and atrophic, therefore usually bone grafting or sinus augmentation is required. In Europe an alternate technique for the placement of maxillary implant without using graft or sinus augmentation developed called zygomatic technique which used in zygomatic implants. Objectives Alternative solution to bone grafting in severely atrophic maxilla i.e. graft less technique. Methods Intrasinus technique/classical technique, modification of intrasinus technique, extra maxillary implants, zygomatic implant without anterior standard implant, sinus slot technique, immediate loading. Results The introduction of zygomatic implant by branemark in 1997 showed 97% success rate and this new technique offers as alternative to bone grafting or sinus lift procedure, which involves rather invasive surgery. Conclusions Currently the gold standard procedure to treat a severely resorbed maxilla is by grafting but failure rates of 10-30% have been reported. The zygomatic implant shown better results as compared to bone bone graft and present a new gold standard procedure in compromised maxillary bone.

EPS00505 Comparative Analysis of Proprietary Preimplant: Guided Surgery Planning Softwares Namely Nobel Clinician Tm and Cs 3d Imaging Software Tm Dr. Manodh, Dr. Praveen Kumar Meenakshi Ammal Dental College and Hospital Abstract Background/Introduction To optimize implant placement and reduce surgical complications, the clinician must have full knowledge of bone anatomy so any osseous topography & bone volume excesses or deficiencies can be corrected before implant placement. The 3D computer-assisted interactive preimplant planning software has accuracy and reliability required for implant placement and aids in shorter surgical & healing time, minimally invasive and less complications.

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S144 Objectives To analyse and compare the following parameters: - Bone height, width & length - Implant angulation, length & diameter - Location of safe zone. Methods The CBCT study was carried using Kodak 9500 Cone Beam 3D system, the exposure was 90KV and 10MA, 200lmx200lmx200lm voxel size,10.8 sec acquisition time & 184x206mm field of view. Nobel clinicianTM & CS 3D imaging softwareTM was used to analyse the parameters. Results The precision of the measurement of available bone height, width & length and location of safe zone was similar in both the software packages and it was not found to be statistically significant. Whereas, the implant length and diameter was statistically significant as it was more precise in Nobel ClinicianTM software when compared to CS 3D Imaging SoftwareTM. Conclusions This study had detailed two proprietary softwares and also the essential differences between the two for facilitating implant planning and surgery. Thus, 3D imaging and its analysis with appropriate software packages can make our implant planning, execution of surgery and prosthesis foolproof.

EPS00514 A Light on Clinical Outcome of Implant Placement in Freshly Extracted Socket with Different Techniques in Anterior Maxillary Region and Limitations Posed By Each S. Sridhar Guided by Dr. P. Srinivas chakravarthi. Dr. M. Sridhar, Dr. Raja Sathish Abstract Background/Introduction Aim of this study is to evaluate success of dental implant placement in freshly extracted socket in maxillary anterior region by three different techniques. Objectives 1. To preserve alveolar ridge height before implant placement and check loss or gain after implant placement 2. To prevent the second surgical intervention and reduction in rehabilitation and treatment time. Methods Three different techniques have been used to evaluate the success of implants clinically, radiographically as related to hard tissue and osteointegration. Technique 1:ridge expansion technique in immediate extraction socket Technique 2:conventional method of implant placement in immediate extraction socket Technique 3: Socket shield technique in immediately extracted socket. Results Those three different techniques have been used in this comparative study where all the implant clinically and radiographically stable at the end of 3 months follow up. All the implants were surrounded by adequate amount of bone and required for successful functional rehabilitation. Conclusions Above those three technique of implant placements has got their own advantage and disadvantages. Ridge expansion technique: By using this technique we can place implant even in narrow or atrophied alveolar ridge of maxilla. conventional technique: This technique is best as we have got good access to site of implant placement to

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 overcome problem of angulation and alignment of implant placement. socket shield technique: This technique has got advantage by preventing labial cortical plate in condition like thin labial cortical plate but disadvantage is this is technique sensitive.

EPS00584 Platelet Rich Fibrin in Immediate Implant Placement Dr. Taradevi Narayan P.V Abstract Background/Introduction Loss of tooth in the anesthetic zone is a traumatic experience. Immediate implant placement increases psychological confidence, decreases total treatment time and fewer surgical procedures. During immediate implant placement, various materials are used to fill the gap for better osseointegration. Platelet rich fibrin (PRF) is a simple, natural and inexpensive alternative. Objectives Effect of platelet rich fibrin following immediate implant placement. Methods The tooth is carefully removed and a thorough curettage of the alveolus is performed. Modification of the alveolar socket is carried out and appropriate implant is placed. The gap between the implant and socket wall is filled with PRF which is prepared from the patient’s blood sample. The sample is taken without anticoagulant in a glass/glass coated tube and immediately centrifuged at 3000 rpm for 10 minutes. Three layers are formed: cellular plasma, PRF clot and red corpuscle base at bottom. The PRF clot is isolated and put in a sterile cup. It is transformed into a membrane through compression between two sterile gauze. After placement of PRF suturing is done. Results PRF helps in healing process and facilitates osseointegration. Immediate post operative inflammation and discomfort is less. Conclusions PRF is an acceptable, minimally invasive technique with low risk and satisfactory clinical results. PRF in patients after tooth extraction and immediate implant placement show high - success rate of bone graft, anti - infective ability. It also facilitates a natural healing and maturation of the peri implant bone and soft tissue around the implant.

ABS00649 Basal Implantology DR. MD. Manzer and Divya Jyothi College of Dental Sciences and Research Institute Abstract Background/Introduction Basal implanvology also known as bio cortical implanvology. It is modern implanvology system which utilized the basal cortical portion of jaw for retention of implants. Basal bone is defined as osseous tissue of the mandible and maxilla under lying the alveolar process. It is relatively fixed and unchanged. Traditional implant use alveolar bone which is lost after teeth removal and decrease throughout life as function is reduced but basal bone remain intact throughout life. Basal implants have many advantages over conventional implants.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Objectives The objective of poster is the appropriate use of basal bone, which not absorbed in the course of life time and anatomically remains the same. Thus implant which take support from the basal bone as an excellent and long lasting solution for tooth loss. Methods This poster is done by reviewing 19 articles from NATIONAL JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY. Results Immediate loading (prosthesis is fixed within 72 hours), one piece implanvology (so minimum interface problem between connections), minimum invasive, better distribution of masticatory forces. Conclusions Basal implant are used to support single and multiple unit restoration of upper and lower jaw. They can be placed in extracted socket and also in healed socket.

EPS00679 Efficacy of Direct Sinus Lift in Implant Placement Dr. Mukesh Kumar Kashyap Rungta College of Dental Science and Research, Bhilai, C.G. Abstract Background/Introduction The present study was conducted with the aim to evaluate clinical efficacy of the direct sinus lift with simultaneous implant placement and bone grafting to evaluate merits and demerits of lateral approach for sinus membrane elevation. Objectives -To evaluate clinical efficacy of the direct sinus lift with simultaneous implant placement and bone grafting. -To evaluate merits and demerits of lateral approach for sinus membrane elevation. Methods This randomized prospective study consisted of 10 patients who met the inclusion and exclusion criteria. The patients were selected irrespective of the age, sex & socioeconomic status, with the residual alveolar bone height between 1 to 4 mm in the edentulous posterior maxillary region. Direct sinus lift was carried out with simultaneous implant placement. Patients were followed up for 36 months of prosthetic rehabilitation. Results Pre-operative alveolar bone height was on an average 2.9 mm (ranging from 1 to 4 mm) with the standard deviation of 0.67 mm. After 36 months of loading, there wasn’t any clinical or radiographical complication. On an average 13 mm bone height was evident (ranging from 11.5 to 14 mm) with the standard deviation of 0.81 mm. Conclusions Direct sinus lift is an excellent technique for the rehabilitation in the cases with severely atrophic posterior maxilla.

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EPS00692 Zygomatic Implants: A Valuable Alternative for Acquired Maxillary Defects—A Review Dr. Dnyaneshwar Chitte I Mds Guided by Dr. Gopinath Thilak A. B. Shetty Memorial Institute of Dental Sciences, Nitte University, Mangalore Abstract Background/Introduction The reconstruction of acquired maxillary bony defect after pathology removal, debridement or avulsive trauma is among the most challenging areas in oral and maxillofacial reconstruction. The goal is to improve patients quality of life by restoring form and function. Zygomatic implants were developed by Prof. Branemark and are being used to obtain stable retention in post maxillectomy patients with an insufficient bone for conventional dental implant placement. Objectives To review current literature on role of Zygomatic Implants in restoring Acquired Maxillary defects. Methods A literature review was conducted on various search engines and relevant articles in indexed journals were analysed. Results Zygomatic implants could represent a viable surgical option to obtain a satisfactory oral function rehabilitation even in case of extensive maxillary defect. Conclusions Zygomatic implant is a valuable alternative in reconstruction of acquired Maxillary defects.

EPS00711 Indirect Maxillary Sinus Lift through Hydraulic Technique for Endosteal Dental Implants with PRF mixed Alloplastic bone Graft vs Alloplastic Bone Graft Alone: A Comparative Clinical Trial Dr. Darshalkumar D. Panchal Narsinhbhai Patel Dental College & Hospital, Visnagar Abstract Background/Introduction Deficit bone height along the maxillary sinus portrays a significant difficulty for placement of implants in posterior edentulous maxillary jaw. As Maxillary Sinus Pneumatisation is an inevitable natural aging process by which the volume of sinus increases by compromising vertical maxillary bone height, newer techniques have been developed to increase the vertical bone height to place an adequate length endosteal implant in such posterior maxillary edentulous areas by vertical sinus floor augmentation. Objectives Evaluate amount of resultant bone height gain comparatively. Methods Indirect Maxillary Sinus Lift Procedure to be performed under Local Anaesthesia by Hydraulic Sinus floor Augmentation Technique (HSAT) with simultaneous vertical augmentation by PRF (Platelet Rich Fibrin) mixed alloplastic bone graft material Vs Alloplastic Bone Graftl alone with follow up of 6 months.

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S146 Results Results show that bone formation takes place with slightly higher predilection in PRF mixed alloplastic bone graft group, but there there no statistically significant difference in between the two groups. Conclusions Autogenous bone graft material is considered to be the gold standard for bone grafting but PRF mixed alloplastic bone graft can be an innovative and effective way of achieving predictable results as an autogenous bone graft substitute.

EPS00765 Intraoral Welding for Dental Implants or SynCrystallization

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 1. Less time spent for repairing provisional restorations as a result of no or less frequent fracture. 2. Predictable fixation and immobility of implants in the early stages of bone healing. 3. Reduction of treatment time for immediate restoration. Conclusions Conclusion of my case study is, when immediate loading is planned, adequate stability of implants is essential to prevent the risk of micro movements and loss of implants for bone formation at the implantboneinterface (osteo integration site). The problems related to meso structures or supra structures design at surgical stage is not affected.

EPS00767 A modified subperiosteal implant: resurrection of the lost technique

Dr. Krishna Shama Rao, Dr. Chetana, Dr. Uroof Dr. Lily Rajput, Guide-Dr. Sanjeev Kumar, Co-Guide-Dr. Amit Gupta CKS Teja Dental Sciences and Research Institute, Chadalawada Nagar Renigunta Road, Tirupathi 517506, Andhra Pradesh Abstract Background/Introduction Implant initial stabilization became an unsurpassed advantage with respect to rehabilitation with individual implants, because it allows a more balanced dissipation of mastication loads;as a result, a lower risk of implant loss during and after osteointegration can be expected. Objectives The main objective of my case study is to splint all of the implant heads in the arch by welding intraorally a titanium bar by Syn crystallization technique to prevent micro movements and loss of implants in the implant- bone interface. Methods The methods and procedure of Intraoral welding for welding for dental implants includes, after all the blood investigations and radiological findings..the patient is now ready for the treatment..in the edentulous jaw..the number of implants placed was equal to the number of teeth to be rehabilitated or greater in case of posterior sectors, where prosthetic elements was supported by one or two implants. The implant insertion point into osseous bed has been defined according to guidelines of implantology. The angle of implant insertion followed..the principles of Anatomically guided implantology. According to these principles, implant fixtures are inserted on axes that best exploits sites with greatest bone volume. Subsequently in the my study, the implants are splinted directly in the mouth by welding a lingula bar.the production of a caste bar to be fastened to the implants with screws or with placement of a metal reinforced screwed cemented temporary prosthesis, the technique allows the practitioner to splint all of implants heads in the arch by welding a titanium bar intraorally by Syn Crystallization technique. The welding process is electrical, protected by Argon gas supply (syn crystallization). by welding of metallic elements directly in the mouth. After an adequate healing period to allow osteo integration to occur, the bar is removed by sectioning. Following 3 months of post surgical healing, the bar splinting of all implants are removed to test the implant osteo integration.the porcelain fused to metal prosthesis was fabricated and cemented in place..the patient was followed at regular intervals. Results In my study 5 patients came to my department which the patients has undergone intra oral welding for dental implants for improved implant stability with 100 % success rate by syn crystallization technique. The advantages of syn crystallization technique includes:

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I.T.S-C.D.S.R, Ghaziabad, Uttar Pradesh Abstract Background/Introduction Subperiosteal implants had been in existence for over 60 years and had been extensively used for replacement of completely edentulous. But due to high complication rates, including implant loss, exposure, and flap dehiscence, subperiosteal implant has become lost in the mists of time. However the limitations of conventional osseointegrating dental implants, need for solutions to challenging hard-tissue situations have prompted the need for the revival of this age old technique. Objectives To assess the effectiveness of hybrid implant(modified subperiosteal implant) in replacement of missing teeth by: 1. Assessing the patient acceptance by evaluating pain or discomfort after placement of implant and stability of hybrid implants. 2. Evaluating peri implant health status. 3. Documenting the complications arising after placement of the implant. Methods This prospective study design consisted of patients requiring replacement of missing teeth meeting the established inclusion criteria. Clinical measurements at each visit included pain or discomfort, mobility of implant, peri-implant health status, any complications, bone loss around screws and esthetic outcome. Results 10 implants were placed and the patients were followed up for a minimum period of 6 months. No mobility was detected post operatively while screw exposure was noticed in three patients. One patient was lost to follow up. Conclusions The results of this study suggested that this modified subperiosteal implant can be a viable option in replacement of missing teeth in the areas where inadequate bone height and width precludes the placement of endosseous implants.

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EPS00784 To Assess and Evaluate the Efficacy of Basal Implants in Partially Edentulous Maxillary/Mandibular Ridge 1. Dr. Mohit Mangla 2. Dr. Sanjeev Kumar 1. Department of Oral & Maxillofacial Surgery, ITS-CDSR Muradnagar, Uttar Pradesh, India. 2. Department of Oral & Maxillofacial Surgery, ITS-CDSR Muradnagar, Uttar Pradesh, India Abstract Background/Introduction The term ‘‘Basal Implants’’
refers to the principles of utilizing basal bone areas free of infection and resorption, and the employing of the cortical bone areas. Objectives 1. To evaluate the stability of Basal Implants. 2. To evaluate bone density around the basal implant. 3. To assess the patient acceptance after placement of Basal Implants. Methods This prospective study design consisted of ten patients requiring replacement of missing teeth meeting the established inclusion criteria. Lignocaine 2% with 1:200000 adrenaline was used for nerve block. Implant placement was done as described in Principles of BOI1. The patient were recalled after 3 days for final prosthesis followed by 1st, 3rd, 6th and 12th months postoperatively for follow up. Following parameters were recorded for every patient included in the study- 1. Stability of implant was assessed by placing two rigid instruments against the implant and labiolingual force was be applied as described in literature. 2. Patient acceptance was evaluated in the form of pain experienced by the patient and complications noted during and after the treatment. Complications like wound dehiscence, fracture of the implant, fracture of the prosthesis was evaluated. 3. Bone density around the implant was measured by using CBCT. Results At the 12-month follow-up, one out of 20 implants was fractured. The mean HU value 12 months after implantation was 980.879± 107.565HU. No mobility was detected during and after the treatment, resulting in a good stability. No major complication encountered. Patient acceptance and esthetics outcome was good. Conclusions Within the limits of this study, preliminary short-term data (12-year post-loading) suggested that basal implants can be successfully used as a minimally invasive alternative to bone augmentation in resorbed ridges. However, larger and longer follow-ups of 5 years or more are needed.

EPS00799 Hybrid Implant: A Novel Implant System Dr. Anshika Grover and Hitkarini

S147 whose sinus lining are low and thin. Rehabilitation is done with promising positive result. Objectives Hybrid implant is been introduced as an alternative method to conventional implant placement in cases where there is (bone resorption, substantial pneumatization of the sinuses, atrophic maxilla with no requirement of sinus lift up. Methods Patient with missing teeth at the maxillary region. Hybrid implant was placed at the compromised bone. Avoided sinus lifting after proper radiographic examination. Results Good stability, patient comfort with proper follow up with no bone loss. Conclusions Hybrid implant showed promising positive result. With better stability, less pain with proper follow up. Better than Endo osseous implants in terms of less time consuming and less expensive. One time procedure.

EPS00801 Treatment Modalities for Atrophic Maxilla Dr. Avantika Sharma, PG Resident Christian Dental College Abstract Background/Introduction Implant rehabilitation of the severely atrophic maxilla presents a surgical and prosthetic challenge and requires a variety of procedures, which not only differ technically, but also differ in their results. Objectives The placement of implants in the alveolar bone remains a challenge because of the resorption of the residual ridge resulting in insufficient bone volume in one or more dimensions. So need of the hour is to review the various options to rehabilitate atrophic maxilla with/ without bone modification procedures. Methods A thorough knowledge of conventional augmentation procedures such as bone augmentation techniques, guided bone regeneration, alveolar distraction, maxillary sinus elevation techniques with or without grafting and contemporary techniques of implant placement provide effective long-term solutions in the management of the atrophic maxilla. Results Appropriate treatment planning is crucial and various factors need to be considered before placing implants in atrophic alveolar bone. Conclusions The reconstruction of edentulous, atrophic jaws according to functional and esthetic factors not only restores chewing function, but leads to positive psychosocial effects and thus also improves the patient’s quality of life.

Dental College and Hospital Abstract Background/Introduction Hybrid implants is been introduced for replacement of missing teeth. The ultimate goal is to provide one or more artificial teeth which work under the normal oral activities. On Recent advancement a new design is made for replacement of missing teeth to those patients

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EPS00830 Dento-Alveolar Fracture Rehabilitation with Autogenous Bone Grafts and Implants

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Conclusions Surgical robotic system enables surgeons to do just in time image recording, treatment planning, navigation, robot assisted operations for maxillofacial surgery.

Dr. Chandni Mathur

Section: Oral Precancer and cancer Maharishi Markandeshwar College of Dental Sciences & Research Abstract Background/Introduction Dental implants have been successfully used for dental rehabilitation for missing teeth, insufficient bone caused by trauma can compromise esthetics and mastication. Objectives The objective of this treatment was to restore esthetics and masticatory functions after dento-alveolar fracture. Methods Present case highlights: harvesting of autogenous bone graft from the chin region and placement of harvested graft to the dentoalveolar fracture site, anterior region of maxilla and to place endosteal implants. Results The patient’s esthetic and masticatory functions were successfully achieved. Conclusions This poster presentation came to elaborate the dental rehabilitation after dento alveolar fracture.

EPS00837 Robotics in Maxillofacial Surgery Tapati Biswas (1st year PG) Rajarajeswari Dental College and Hospital, Bangalore Abstract Background/Introduction The first surgical robot was introduced in 1985 by Kwoh et al. Robotic-assisted surgery has gained popularity in several surgical specialties and many institutions are now investing in medical robotic technology. Objectives To discuss the use of robotics in oral and maxillofacial sugery. Methods Patients three-dimensional data is taken, 3D position and orientation with ROL are used in the operation sequence graft optionally. Execution control system reads the sequence graft and commands are sent to the user interface manager and interactive skills controller. It is used in two modes-NPR and WPR. Teached movements and interactions are completed in the form of large or small movements. Sequence of movement types, interaction positions and skills are clearly defined. For brachytherapy rigid catheters are implanted. Implanting bone fixtures can also be done. Results Robotic surgery is a minimally invasive technique offering 3D visualisation and magnification upto 10-15 times which enhances surgeons capability to distinguish normal tissues from tumours and helps in preserving normal tissues with minimal morbidity and accelerated functional needs breaking the limits of human hand.

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EPS00111 Dilemmas in N0 Neck for Early Squamous Cell Carcinoma of Oral Cavity Dr. Md Shaik Ismail (Ii Mds), Dr. Ritesh Rajan (Prof and Head) Svs Institute of Dental Sciences, Mahabubnagar, Telangana Abstract Background/Introduction Squamous cell carcinoma of oral cavity is the sixth leading cause of cancer worldwide. Neck node metastases is the single most important prognostic factor in head and neck cancer, particularly in squamous cell carcinoma. Objectives This poster will review and discuss the various protocols and strategies described in the literature and various other institutes for managing N0 neck in squamous cell carcinoma of head and neck region. Methods This is a review of the literature and also includes the most followed recommendations of the renowned institutions. Results The results of the study will be presented according to the standard protocol. Conclusions The management of clinically negative (N0) neck has been controversial, for multiple reasons like variable lymphatic drainage and different and unpredictable patterns of metastasis.

EPS00295 Surgical Management of Squamous Cell Carcinoma: A Case Report Dr. Aneesh Ganguly 2nd Year PG resident Institute of Dental Studies and Technologies Abstract Background/Introduction Squamous cell carcinoma account for about 90% of all head and neck cancers. It may be ulcerative and invasive, fungating and exophytic, or both. The diagnostic evaluation of suspected patients should consist of thorough case history and the physical examination. The histopathological tissue diagnosis and imaging and evaluation of the deep extent of the primary tumor and of the neck nodes help in determining the extent of surgery. Usually, surgical resection of the primary tumor is preferred, including a neck dissection to remove the neck nodes at risk which may be followed by reconstruction. Pectoralis Major Muscle Flap (PMMC) and Delta Pectoralis Flap are preferred for closure and reconstruction in the oro-facial region as it satisfies the reconstructive requirement in 90% of cases owing to its vascularity and ease of harvest.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Objectives A 32-year-old male reported to our department with a chief complaint of swelling on the left side of his face. On preliminary clinical examination which was followed by an incisional biopsy a diagnosis of moderately differentiated squamous cell carcinoma was established. Tumor resection, radical neck dissection followed by reconstruction using pectoralis major myocutaneous flap along with delta pectoral flap was done. Methods Case report. Results The patient underwent radiotherapy post-surgery and a follow-up of 1 year have shown no sign of recurrence. Conclusions Surgical management is the mainstay treatment option for oral cancer. A thorough clinical and radiological diagnosis can pave the way for a pre´cised surgical technique for excision of the tumor. Flap design such as the Pectoralis Major Muscle Flap are very reliable for closure and reconstruction after radical neck dissection owing to its rich vascularity and sufficient bulk of tissue, ease of harvest and close proximity to the surgical site.

EPS00331 Photodynamic Therapy: Recent Treatment Modality for Cancers of Head and Neck Dr. Pooja Kapse Institute of Dental Studies and Technology Abstract Background/Introduction PDT (Photo dynamic therapy) was 1st reported by Raab etal in1990. PDT is an excitation of photosensitizers induced in the body by exposing it to light of appropriate wavelength. Objectives PDT is a Minimal invasive therapy and overcomes the complications of conventional surgical procedures, chemotherapy and radiotherapy that are associated further with tissue impairment and cosmetic defects. Methods PDT is local than a systemic treatment, involving photosensitizers e.g. Photofrin, ALA, Foscan that are preferentially concentrated in neoplastic cells, followed by local illumination of tumor with an appropriate light wavelength to activate the specific drug which interacts with the molecular oxygen and generates the singlet oxygen that is highly toxic and reactive. This singlet oxygen kills the tumor cells by apoptosis or necrosis diffusing 0.02 micrometer tissue. So, tissue penetration depth is desirably restricted by the wavelength of light used to activate the photosensitizers. Results PDT is effective over conventional therapies for the treatment of early (Cis, T1, T2) squamous cell cancers of the head and neck. Conclusions PDT a promising therapy used in association with surgery to increase tumor-free margins that ultimately increases the cure rates. Hence, PDT is used in curative and palliative treatment of refractory head and neck squamous cell carcinoma with minimum recurrence but maximum success rates. Clinical trials & evidences proves PDT to be a good treatment substitute for localized, superficial tumors, and precancerous lesions with excellent & functional cosmetic results that enhances the quality of life of squamous cell carcinoma patients.

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EPS00333 Surgical Interventions in OSMF Dr. Mithun MS Yenepoya Dental College Abstract Background/Introduction Oral submucous fibrosis (OSMF), now labelled as a ‘‘potentially malignant disorder’ which is caused by areca nut or betal quid chewing habit. The progressive irreversible fibrosis of the submucosa causes reduction in mouth opening, Burning sensation while having spicy food. Predictably the release of the fibrotic bands has been the basis of all surgical techniques employed, while medical interventions (Stage I & II) have delt on the suppression of the inflammatory response and prevention of progressive fibrosis. Surgical intervention is recommended for patients with severe reduction in mouth opening (Stage III & Stage IV) the surgical management of this condition involves releasing of the fibrous bands and interpositional grafts to retain the increased mouth opening. Various procedures and graft material have been utilised with differing success rates. Different Surgical modalities include Lasers, Usage of Local Flaps (Intraoral &Extraoral), Grafts, Coronoidectomies/muscle myotomies. This Poster mainly aimed at depicting the various surgical modalities for the treatment for OSMF. Objectives Not applicable. Methods Not applicable. Results Not applicable. Conclusions Not applicable.

EPS00338 Oral Sub Mucous Fibrosis: The Endless Enigma Dr. Divya. R. Kamath Terna Dental College & Hospital, Nerul, Navi Mumbai Abstract Background/Introduction Oral Submucous Fibrosis (OSMF) is a crippling disease of the mouth with high malignant potential. It has high prevalence rate in India and South East Asia. It is a chronic insidious disease characterized by progressive submucosal fibrosis of the oral cavity and oropharynx. The treatment of patients with OSMF depends on the degree of clinical involvement. My poster highlights the etiology, pathophysiology and different treatment modalities in the management of OSMF.

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EPS00368 Incidence & Management of Carcinoma of Tongue: An 8 Year Experience Dr. Kaustubh Kulkarni, Dr. Venkatesh Anehosur SDM College of Dental Sciences and Hospital, Dharwad Abstract Background/Introduction Oral cancer is one of the most fatal health problems faced by mankind today. In India because of cultural, ethnic, geographic factors and the popularity of addictive habits, the frequency of oral cancer is high. Tongue cancer constitute about 42 % of all oral cancers its incidence being 4.7 per 100,000 Males & 1 per 100,000 Females1. Objectives 1. To gauge the incidence of carcinoma tongue and highlight surgical management of the same including reconstruction used at our centre. 2. To analyse the outcome of the type of reconstruction. 3. Account for the disease free survival period. Methods This poster highlights a Retrospective study conducted at our centre consisting of patients of carcinoma of tongue & floor of mouth who underwent resection & reconstruction for the same from 2009-2016. Results A total of 37 Patients with M: F ratio of 2.3:1 and a mean age of 47 years were included, the most common site being the Lateral border of the tongue. All tongue movements improved in radial forearm free flap group than split thickness skin graft group. Radial forearm flap improved speech intelligibility & conversational understandability with a better speech perception. 5 years disease free survival rate was around 54%. Conclusions Aggressive primary treatment including wide excision, appropriate neck dissection & reconstruction followed by post operative chemoradiotherapy & speech therapy to avoid recurrence of the disease and give a good functional outcome is the key to the management.

EPS00379 Early Diagnosis-Highway to a Good Life for Patients with Oral Cancer 1. Dr. Pranav Sathe (PG Student) 2. Dr. Gandhali Limaye (PG Student) Dr. D. Y. Patil Dental College and Hospital, Pimpri, Pune-18 Abstract Background/Introduction Oral squamous cell carcinoma is one the most common variety of cancer seen in the Indian sub-continent and South-east Asia. Most of the cases however present in an advanced stage where surgery is either difficult or impossible. With advances like neo-adjuvant chemotherapy however, times are changing for head and neck oncology and patients who were previously untreatable have a new lease of life. Objectives The objective of this poster is to highlight that the goal and the challenge still remains early diagnosis and prompt treatment so as to prevent advanced stages of the oral squamous cell carcinoma which greatly hamper the life of the patient.

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Methods The author presents a case of an early invasive squamous cell carcinoma of maxilla which was treated with wide local excision, modified radical neck dissection and reconstruction with an implant supported prosthesis after 6 months. Results Excellent post-operative healing of the operated site with restoration of form and function was achieved. Conclusions The author intends to show how early diagnosis is life changing, offers a good prognosis for the patient and makes for an extremely satisfying oncological career for the maxillofacial surgeon.

EPS00380 Ameloblastic Carcinoma-A Rare Odontogenic Malignancy Dr. Aditya Verma Subharti Dental College Abstract Background/Introduction It is a rare malignant lesion with characteristic histologic features and behavior that dictates more aggressive surgical approach than that of a simple ameloblastoma. Objectives To present the clinical features and treatment of a case of maxillary ameloblastic carcinoma. Methods A 29 year adult male was referred to the department of oral & maxillofacial surgery with the chief complain of fast growing swelling on the left side of the face since past 5-6 months. Diffused swelling involving left side of face extending from the alae of the nose involving the zygomatic buttress region and intraorally extending from 24 to 26 region and an ulcero-proliferative mass was also present involving 27 and 28 region. Swelling was firm to hard in consistency. Radiographic features reveal bone erosion and destruction involving left posterior maxilla, involving sinus and extending upto the floor of the orbit. Root resorption seen irt premolars and first molar. Incisional biopsy was performed and confirmed the Ameloblastic Carcinoma. As clinically as well as CT Neck & Chest confirmed no sign of metastasis, surgical treatment was planned for hemi maxillectomy (with local wide excision) under GA and then temporalis based coronoid graft was used for the reconstruction of the orbital floor. Results Patient was kept on regular checkup and after 2 years of follow-up, there was no sign of recurrence. Conclusions Ameloblastic carcinoma is a very rare malignant odontogenic tumor with characteristic histopathological and clinical features, which can be treated with aggressive surgical treatment and surveillance.

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EPS00413 Pro and Cons of Neck Dissection Incisions Dr. Ashif Ikbal Khan Haldia Institute of Dental Sciences and Research Abstract Background/Introduction Neck dissection in its various forms is the standard surgical treatment for clinical and subclinical metastatic cancer to the neck. Objectives This poster is a review of the anatomy of the neck and specific types of neck dissection, indications, advantages and disadvantages in the treatment of metastatic neck disease. Methods The patient should be prepared as for any major operation. All routine laboratory tests must beperformed, including electrocardiogram and chest radiographs. Preoperative evaluation is accomplishedby the anesthesiologist prior to surgery. Premedication is used according to the anesthesiologist’s choice. Prophylactic antibiotics are given according to the usual protocol. General instruments used in functional and selective neck dissection. (A) 1, scissors; 2, knives(#10, #15); 3, needle holders. (B) 1, atraumatic and toothed tissue forceps; 2, suction tips; 3, monopolarforceps. (C) 1, Volkmann retractors; 2, Howarthraspatory; 3, Desmarres vascular retractor; 4, Deschampsligature needle; 5, skin hooks; 6, Farabeuf retractors; 7, Langenbeckretractors. (D) 1, straight Pe’an’s forceps; 2, large and small Duval forceps; 3, large and small Allis forceps. (E) 1, rightangle forceps; 2, large and small curved Pe’an’s forceps; 3, Dandy hemostatic forceps; 4, mosquito forceps. Some popular skin incisions for functional and selective neck dissection. (A) Gluck incisionfor unilateral and bilateral neck dissection. (B) Double-Y incision of Martin. (C) Single-Y incision. (D) Schobinger incision. (E) Conley incision. (F) Mac Fee incision. (G) H incision. The skin flaps have been raised, preserving the superficial layer ofthe deep cervical fascia (right side). US, upper skin flap; SG, submandibulargland; tc, transverse cervical branch from the superficial cervical plexus; SC, sternocleidomastoid muscle; ga, great auricular nerve; Erb’s point. Results We would like to emphasize that it is not the preservation of anatomicalstructures that makes functional neck dissection different from radical neck dissection, but theapproach to the neck through fascial planes. Conclusions The neck is carefully inspected for bleeding points and surgical sponges. Careful hemostasis istime consuming but rewarding. The entire field is thoroughly irrigated with normal saline. Finally, the skin is closed in two layers over a large suction catheter. The platysma is sutured with absorbable buried sutures, and the skin with skin clips. A moderately tight dressing is applied withspecial attention to the supraclavicular fossa because this is the area where most serohematomas develop.

EPS00432 Osteoradionecrosis of the Mandible Dr. Shaikh Shahed Anwar Abstract Background/Introduction Osteoradionecrosis is a slow healing radiation induced ischemic necrosis of the bone with associated soft tissue necrosis of variable

S151 extent occuring in absence of tumor necrosis, recurrence or metastatic disease. It is an avascular necrosis of bone caused by three-H tissue effects of radiotherapy. Infections associated with osteoradionecrosis are secondary infections due to exposure of bone and deep tissue planes. Overall spontaneous incidence is 39 percent. Objectives Aim is to evaluate the surgical management of Osteoradionecrosis. Methods Two cases diagnosed as an Osteoradionecrosis were treated by surgical resection. Results Elimination of infection, multiple fistulae and overall improvement of general health of patient were achieved. Conclusions In early cases of, Osteoradionecrosis conservative approach with local care is effective, another most common treatment option that is radical resection with primary closure, using local flaps is treatment modality in most places of India. While treatment with HBO therapy and reconstruction with vascularized free flap is available at tertiary cancer care center located in metro cities of India.

EPS00440 Assessment of Primary Caregiver’s Burden on Oncology Patients: A Descriptive Study Dr. Anand Amirthraj A Manipal College of Dental Sciences, Mangalore Abstract Background/Introduction Little is known about how the burden of caring for cancer/oncology patients affects primary caregivers. Caregiver burden refers to people’s emotional response to the changes and demands of giving support to another. Caregiver burden is a concept that emphasizes the negative components of caregiving, rather than the positive elements, which may be an important motivation for the caregiver. Some of the challenges faced by family caregivers are documented in the literature. Caregivers report high levels of stress and poor physical and emotional health, as well as career sacrifices, monetary losses, and workplace discrimination. Objectives 1. To assess the burden of primary caregivers of oncology patients. 2. To associate the burden with selected demographic variables. Methods Research design Descriptive survey design Setting Oncology wardKasturba Medical college, Mangalore Population Caregivers of oncology patients Sample Primary caregivers of oncology patients with advanced cancer. Sample size 50 Sampling technique Non probability purposive sampling technique. Results Coming to the questionaire results, the 22 questions were prepared so as to focus on various aspects of the psychological, psychosocial and basic thought process that the caregivers possess while taking care of their relatives. The first few questions were set to bring about an insight into the relationship of the caregiver with the relative (patient) where the response of the caregiver to some of the demands or some of the behavioral factors of the relative were studied, i.e, a positive OR negative response to overdependence on the caregiver, effect on personal and social life of the caregiver, etc. About 36 patients felt that they did not feel embarassed over their relatives behavior, nor did they feel that they were stressed or losing out on personal time because of taking care of the patient. Anger was not a factor seen

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S152 among any caregiver except 3 cases where the caregiver was young and financially compromised which might have been the main problem. Almost 90% of the caregivers were afraid and uncertain of what the future holds for their relative. The remaining 10% were financially and education wise more well to do, more aware and had an idea about what the prognosis of the disease could be. Strain and health was not seen to be a hindrance factor in about 37 patients. The remaining, including the ones over 55 years of age, had health problems of their own and were suffering from the same. Financial expenses were found to be significant in this study with most of the caregivers being below Rs. 5000 p.m slab. But owing to various insurance schemes a little of the burden was found to be taken off from the caregivers mind. Even then almost 95% of the caregivers thought that what they were doing for caring for their relative was not enough and they wanted to do a better job at their treatment. About 20 caregivers felt that they have lost control of their private life since the onset and diagnosis of the patients illness but when questioned about the same, about 10 patients had personal problems of their own in the household which made balancing the jobs difficult. About 98% of the caregivers felt that their relative had full expectations of ONLY him/ her to take care of him/her. Only 2 caregivers thought that they would like to probably hand over the care of their relative to someone else as they thought themselves incapable of taking care of the patient longer. Most of the care givers except the well placed ones, felt little or moderately burdened with the situation. 48 caregivers were of the opinion that they would if they could like to do a better job in their care for their relative. 2 caregivers felt that they had gone out of their way to do what was required and had left the rest to fate. Conclusions We can make out that majority of these caregivers, even though burdened a little, financially and psychologically, share a common platform of concern and love for the suffering relative. Out of the 50 samples, the % of caregivers who were unhappy in taking care of their relatives is not significant at all. This study has given us an important insight into the mind of the caregiver of the cancer patient and also enables the clinician to have a measure of the psychological and socioeconomic situation of the caregivers while combatting this deadly disease.

EPS00467 Interdisciplinary Management of Oral Submucous Fibrosis Dr. Vimi Jain V.Y.W.S. Dental College & Hospital, Amravati Abstract Background/Introduction Complete cure of OSMF, a progressive and refractory premalignant condition, has not been achieved with any of the present treatment modalities. This study attempts to formulate a treatment protocol using interdisciplinary approach. Objectives To evaluate the effect of treatment modality utilizing interdisciplinary adjuncts in management of OSMF. Methods Clinicaly diagnosed cases of OSMF were included in the study, divided randomly into two groups(13 each). Group A patients received intralesional, submucosal injection of hyaluronidase (1500 IU), dexamethasone(8mg) & lignocaine HCL(0.5ml) biweekly for 5

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 weeks (single prick method). Adjuncts employed; Micronutrient supplementation OD, tab curcumin 300mg, alovera & amla juice 15 ml each, Topical curcumin & placentrax based ointment B.I.D., warm saline gargle Q.I.D. & Physiotherapic exercises Group B patients received ONLY intralesional injection in the similar pattern & Physiotherapic exercises. Effects on interincisal distance, burning sensation, tendency of ulceration& taughtness of mucosa were evaluated during the study, at the interval of 1st, 2nd, 4th & 6th month. Results A definite Improvement in interincisal distance was noted (net gain of 10 ± 2 mm), with reduction in burning sensation & taughtness of mucosa in group A. Statistically significant difference (p\0.05) was observed between the groups, in regards to interincisal distance, burning sensation & taughtness of mucosa. Conclusions The use of adjuncts with intralesional injection improved the clinical outcome in treatment of OSMF.

EPS00544 Medical Management of Oral Submucous Fibrosis: Update on Current Evidence-Based Practices Dr. Akash Menon, Post Graduate Dept. of Oral and Maxillofacial Surgery, ABSMIDS, Mangalore Abstract Background/Introduction Oral Submucous Fibrosis is a morbid premalignant condition of the oral mucosa associated with the habit of areca nut chewing. Caused due to an insidious, chronic change in fibroelasticity, OSMF is characterized by a burning sensation in the oral cavity, blanching and stiffening of the oral mucosa, oropharynx, and trismus. High-level evidence supporting any one conservative modality is few and rare in reported literature. Objectives To review current literature on trends in conservative/medical treatment modalities for OSMF. Methods A literature review was conducted on various search engines and relevant articles in indexed journals were analyzed. Results Intralesional steroids such as dexamethasone are the main treatment modality, commonly used with hyaluronidase, a proteolytic enzyme. Antioxidants like Alpha-Lipoic acid and Lycopene (anti-proliferative, antinflammatory) are also commonly used as first line of treatment. Novel therapies include Zinc acetate tablets and Vitamin A. Also, Salvianolic acid-B(antifibrosis, anticoagulation, antitumor activities) used with triamcinolone acetonide represents a promising new mode of management. Turmeric, Immunomodulatory drug Levamisole, Vasodilator Pentoxyfilline, Placental extract, Human interferon gamma, Spirulina, Colchicine, Herbal antioxidants Oxitard and Aloe Vera are also showing positive trends in the management of OSMF. Physiotherapy, local heat delivery and microwave diathermy have an additive role to effective OSMF therapy. Conclusions Selecting the right combination of drugs to effectively counter the progressive fibrosing nature of the disease is a challenge. It requires the clinician to be adept at early diagnosis and customized treatment plans based on the clinical staging.

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EPS00547 Application of Laser in Management of Oral Precancerous Lesions Dr. Shreyas P. Naik, Dr. Vikas Dhupar, Dr. Francis Akkara, Dr. Omkar Shetye Abstract Background/Introduction Laser is a monochromatic, collimated, coherent and an intense beam of light produced by stimulated emission of radiation of a light source. Lasers are classified according to different factors among which is the classification based on laser active medium such as gas, liquid, solid and semi-conductor, which identifies and distinguishes the type of emitted laser beam. Recently, there have been rapid developments in laser technology and better understanding of biointeractions of different laser systems which have broadened the clinical use of laser in dentistry. Objectives To evaluate the safety and efficacy of surgical stripping of oral precancerous lesions using laser. Methods Patients of all ages with precancerous lesions of oral cavity measuring greater than 10mm in diameter were included in the study. The mucosal stripping was carried out using a diode laser. Patients were followed up at 3 days, 1 week and 1 month post operatively. Results No significant adverse events occurred; minor local adverse effects were observed during the procedure. The intra-operative bleeding was minimal. The post-operative pain and swelling was significantly lower compared to that seen with conventional techniques of mucosal stripping. Conclusions Mucosal stripping with laser could be used to achieve regression of oral precancerous lesions. The treatment is safe and well tolerated and the recovery is faster. The high-power laser used in this study allows completion of laser therapy within 2 to 5 minutes. Further studies are necessary to determine the optimal laser radiant exposure and drug application to maximize the response rate.

EPS00565 ‘Surgical Approaches for Different Subsites for Oral Squamous Cell Carcinoma’ Dr. Twinkle Thakker (Postgraduate), Dr. K. Gopalkrishnan (Professor, Omfs), Dr. Venkatesh Anehosur (Professor and Hod, Omfs) Sdm College of Dental Sciences and Hospital Abstract Background/Introduction Oral cancer is the 6th most common cancer worldwide. 90% of the oral cancers are squamous cell carcinomas. There is an increasing emphasis on preservation or restoration of the form and function to improve the quality of life. The oral cavity is divided into various subsites: The lip, anterior two-thirds of the tongue, floor of mouth, gingiva, retromolar trigone, buccal mucosa, and hard palate. Tumors of different subsites demonstrate distinct clinical behavior and lymphatic spread.

S153 Objectives The aim of this study was to analyse the different surgical approaches for the treatment of oral squamous cell carcinomas (OSCC) at different subsites and to analyse the outcomes for the same. Methods A retrospective study conducted on patients with OSCC requiring surgical intervention reporting to our Craniofacial research centre between 2010 to 2017. Total of 225 patients having OSCC of different subsites were included in the study. Results The different approaches for different subsites performed included Peroral, Pull through technique, Lower cheek flap, Upper cheek flap, visor flap, Mandibulotomy and wide excision and resection. The numerical data will be highlighted in the poster. Conclusions The data will be statistically analysed and the complications of various approaches will be highlighted in the poster, hence the preferred approach for OSCC for different subsites will be concluded.

EPS00576 Photobiomodulation: Eliminating the Fiasco of Chemoradiotherapy in Head and Neck Cancer Dr. Parvathy Reghunadhan, Dr. Vani N R Bapuji Dental College, Davanagere Abstract Background/Introduction Chemoradiotherapy is the standard treatment for advanced head and neck cancer. Chemoradiotherapy presents with mucositis, pain, dysphagia, infections, salivary changes, dysgeusia and dermatitis etc. Photobiomodulation (wavelength of 600–1000nm) drives Adenosine Triphosphate production enhancing bioavailability to power the functions of cellular metabolism and transient burst of reactive oxygen species which generate fibroblast growth factor, pro-inflammatory cytokines that are involved in tissue repair. Objectives To assess the effects of Photobiomodulation in management of side effects of chemo-radiation therapy in head and neck cancer. Methods Evaluation of photobiomodulation mechanisms of action, dosimetry, and safety considerations with adequate doses photobiomodulation, the irradiation parameters, including the energy delivered, power density, pulse structure. Results ‘‘Low level laser’’ uses light absorbed by endogenous chromophores, triggering non-thermal, non-cytotoxic, biological reactions through photochemical or photophysical events, leading to physiological changes, enhancing wound healing significantly reducing inflammation, and prevents fibrosis, reduces pain and improves function thereby increasing the loco-regional blood flow that contributed to better local oxygenation. Conclusions Photobiomodulation mechanisms based on its recognized therapeutic effects has no carcinogenic effects on normal cells. Titrating adequate doses and defining the other required photobiomodulation parameters can result in beneficial effects in chemoradiotherapy.

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EPS00597 Radical Versus Supraomohyoid Neck Dissection in the Treatment of Squamous Cell Carcinoma of the Inferior Level of Mouth Dr. Shashank Sree Balaji Dental College Abstract Background/Introduction The presence of lymphatic cervical metastases in patients bearing epidermoid carcinoma (or squamous cell carcinoma) of the lower portion of the mouth predicts an unfavorable prognosis. This explains a constant concern and strategy changes in the treatment of the neck with this malignancy. Initially, this procedure was used in necks with no metastatic lymph nodes (cN0) and in those cases with lymph node metastases up to 2 cm with no rupture of the capsule (pN1).9-17 These studies underlined our proposition to change the extension of neck dissection for the surgical treatment of necks with clinical metastases (cN1) from squamous cell carcinoma in the lower region of the mouth. Objectives Most common carcinoma in oral cavity is squamous cell carcinoma.metastatis in the spread of head and neck disease is the most common factor.most common site larynx, pharynx, hypopharynx.lymph mode metastasis reduces the survival rate of patients with squamous cell carcinoma. Methods A retrospective analysis was made of 460 charts of patients diagnosed with squamous cell carcinoma in the lower region of the mouth. The Research Ethics Committee approved the trial (number 353). Eligibility criteria were as follows: previously untreated patients with squamous cell carcinoma in the lower region of the mouth (tongue, floor of the mouth, retromolar region and the lower gingiva) that underwent radical or selective (supraomohyoid) neck dissection, with a minimum follow-up period of 12 months or until death. 18 Patients were classified according to age, sex, site of the primary tumor, and clinical and pathological staging (TNM 2002). The mean age was 54.5 years, the median age was 53 years (Q25-75% = 47 - 62), the minimum age was 22 years and the maximum age was 87years. There were 406 men (88.3%) and 54 women (11.7%), an 8:1 ratio. The tumor sites were the floor of the mouth (180 cases, 39.1%), the tongue (136 cases, 29.6%), the retromolar region (74 cases, 16.1%) and the lower gingiva (70 cases, 15.2%). Results There were 445 radical neck dissections, distributed according to metastasizing levels. In 273 cases N? that excluded 2Nx, the cases were distributed according to those levels and TNM staging. The distribution of lymph nodes according to the four sites of the lower region of the mouth was sub-classified for the dissections. In supraomohyoid neck dissections (among the total 573), the rates of local, regional and local-regional recurrence for those 106 pN0 cases (82.9%). There was regional recurrence in 27 cases (6.1%) of 445 neck dissections. Of these 7 cases (4.0%) were pN0 and 20 cases (7.3%) were pN?. In those 7 pN0 cases, 5 cases recurred within the dissection area and 2 recurred in the contralateral side of the neck; these 7 were not irradiated. Of the 20 pN? cases, 11(2,2%) occurred in the neck, 2 within the dissected area and 9 in the contralateral side of the neck;. Regional recurrence occurred in 9 cases (7.1%) of 128 supraomohyoid neck dissections, of which 6 cases (7.3%) were pN0 and 3 cases were pN? (6.5%). Recurrence was within the dissected area in 2 of the 6 pN0 cases, and in the contralateral side of the neck in 2 cases; none of these cases were irradiated. In 3 pN? recurrence

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 cases one occurred within the dissected area, another case was ipsilateral, not in the dissected area (no adjuvant radiotherapy was used in these two cases), and a third case recurred in the contralateral side of the neck (this patient underwent postoperative radiotherapy). In 22 pN? patients there were level Ia metastases in 5 cases, Ib metastases in 6 cases, IIa metastases in 8 cases and level III metastases in 7 cases. local (RL), regional (RR) and local-regional (RL?RR) recurrences in this group. There was no statistically significant difference between the absence (pN0) and presence (pN?) of metastases on histology and the diagnosis of isolated regional recurrence as a function of neck dissection. Finally, there was no significance in the incidence of isolated unilateral events in 230 unilateral neck dissections (p=1.0). Radiotherapy was done in 9 cases (5.6%) of recurrence out of 160 neck dissections; 4 cases of recurrence (5.7%) out of 70 were not irradiated. Conclusions The choice of selective neck dissection in levels I to IV in cases of squamous cell carcinoma in the lower region of the mouth associated with palpable metastases at level I is feasible without loss of oncological results.

EPS00627 Pentoxifylline 1 Tocopherol: A Smart Combination to Treat Radiation Induced Fibrosis and Osteoradionecrosis Dr. Vikas Gunishetty, Dr. Padmaraj Hedge A.B. Shetty Memorial Institute of Dental Sciences, Mangaluru, Karnataka Abstract Background/Introduction Osteoradionecrosis and radiation induced fibrosis are well established pathophysiological processes after radiotherapy. They became a prime concern for the surgeons due their devastating nature, by increasing the morbidity of the patient. Despite of many treatment advancements, they still pose a constant challenge to surgeons for treatment. Objectives To review the evidence based literature on the use and outcomes of Pentoxifylline and tocopherol in treating radiation induced fibrosis and osteoradionecrosis. Methods A literature review was done on various search engines and relevant articles were analysed. Results Use of Pentoxifylline and tocopherol have shown promising results both in preventing and treating radiation induced fibrosis and osteoradionecrosis. Conclusions This combination of drugs has a long established positive track record in the management of radiation induced fibrosis and osteoradionecrosis. In the near future, this treatment modality will be widely followed, thereby limiting the effects of radiation induced fibrosis and provide a part of solution to treat its consequences.

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EPS00666 Effective Surgical Treatment modalities for Proliferative Verrucous Leukoplakia (PVL): Our Clinical Experience

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ABS00681 Reconstruction of Squamous Cell Carcinoma of Tongue with Cheek Flap: A Case Report Pynkmenlang War; Divya James; Prof. Dr. Rinku George

Dr. Damyanti Walkey, Dr. Abhay Datarkar, Dr. V.N. Hazarey, Oral & Maxillofacial Surgery Govt. Dental & College, Hospital, Nagpur Abstract Background/Introduction White lesions both physiologic as well as pathologic are relatively frequent in the oral cavity, the most common pathology being oral leukoplakia. There are many variants of Oral Leukoplakia, one of which is proliferative verrucous leukoplakia (PVL). PVL is a rare clinico pathological entity, which is slow growing, long term progressive lesion, but remains an enigmatic and difficult to define. The etiology of PVL remains still unclear. Tobacco use does not seem to have a significant influence on the appearance of PVL. These lesions may occur both in smokers and non smokers. Various case have presented PVL as a disease with aggressive biological behavior due to its high probability of recurrence and a high rate of Malignant transformation. Prognosis is poor for this seemingly harmless appearing lesion of the oral mucosa. The complete excision and definitive treatment modality are need of time. Objectives To evaluate the use of different treatment options in the management of PVL. Methods All patients reporting to Dept.of Oral & Maxillofacial Surgery between June 2015-June 2017 were included in study. Total 28 patients [M-19, F-9] age 25 yr to 58 yrs with leucoplakia lesion on more than one sight in same oral cavity were included in study. Histopathological diagnosis were confirmed on Biopsy. Patients with medically compromised condition & with biopsy showing malignancy were excluded from the study. Patients with single lesion 0.5 cm & above were treated with wide local excision followed by reconstruction. Patient with multiple lesion less than 0.5 cm were treated with laser ablation. Follow up was done 1month, 3 month, 6 month,1year. Results Total 28 [M-19, F-9] patient age 25yrs to 58 yrs with mean age 32.7yrs out of which 10 Patients with single lesion 0.5 cm & above present over buccal mucosa [5], palatal mucosa [2], retromolar region [3] were treated with wide local excision followed by reconstruction with collagen sheet, buccal fat pad. 18 Patient with multiple lesion less than 0.5 cm were present over buccal mucosa & retromolar region, labial mucosa, or combination of either of these were treated with laser ablation. Conclusions To conclude, PVL need special consideration for early management as there are more chances of malignant transformation, Histopathological confirmation is needed wide local excision of the primary lesion along with 1-2 cm safe margin with different adjuvant procedure like reconstruction, laser ablation is must, alveolectomy, as and when required provide the effective treatment modality avoiding the further recurrence.

Saveetha Dental College and Hospital, Chennai; Saveetha Dental College and Hospital, Chennai; Head of Oncology Department, Saveetha Dental College and Hospital, Chennai Abstract Background/Introduction Squamous cell carcinoma of the tongue has tobacco smoking and alcohol ingestion as major risk factors and spans two regions: The anterior two-thirds (oral tongue) is a common subtype of squamous cell carcinoma of the oral cavity whereas the posterior third (base of tongue) is considered part of the oropharynx. Epidemiology and risk factors are similar to squamous cell carcinomas elsewhere in the upper aerodigestive tract, with tobacco smoking and alcohol ingestion being major risk factors. Of note, the role of human papillomavirus (HPV) as an aetiological factor for squamous cell carcinoma is strongest in oral cavity (compared to other regions in the head and neck), with HPV DNA isolated from up to 50% of cases, and thought responsible for the tumour in over half of these. Objectives - To make patient free from disease. - To reconstruct the defect and provide a better quality of life. Methods Patient reported to the department of oral and maxillofacial surgery with a complain of pain in the right inferio - lateral border of the tongue since one month. Initially it was small in size but gradually increased to the present size. Patient also complained of burning sensation while eating spicy food. Biopsy was taken and the diagnosis was given as well - differentiated squamous cell carcinoma of tongue. Treatment Done: Wide local excision, neck dissection and reconstruction with cheek flap. Results Post operatively, patient was stable. The flap was released from the tongue after two weeks. Conclusions Although, a radial forearm free flap was the ideal flap for reconstruction, we were able to give a better quality of life with the cheek flap.

ABS00698 Pectoralis Major Myocutaneous Flap a Versatile Flap in Head & Neck Reconstruction Dr. Devesh Ostwal, Dr. A. Garg, Dr. S.R. Shenoi, Dr. V. Kolte, Dr. K. Bang, Dr. P. Ingole, Dr. N. Budhraja VSPM’s Dental College & Research Centre, Nagpur Abstract Background/Introduction Oral squamous cell carcinoma is one of the most common malignancies, especially in developing countries. Its early diagnosis is relatively easy but it is usually reported at an advanced stage. Reconstruction following head and neck cancer surgery is a difficult task and free flaps are considered as the gold standard for the reconstruction but the resources are limited and require long training

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S156 to master. Pectoralis major myocutaneous (PMMC) flap owing to its good vascularity and easy learning curve for surgeons is still a workhorse at centers with limited resources. Here we discuss about versatility of Pectoralis major myocutaneous flap reconstruction following head and neck surgeries. Objectives To evaluate the versatility of the flap. Methods We have analysed 23 case of malignancy involving alveolus and buccal mucosa and rehabilitation with the help of PMMC flap from July 2016 to July 2017. Results Study is under statistical analysis. Conclusions Awaited.

EPS00709 A Comparative Evaluation Between Different Timings of Removal of Neck Drains Following Oral Squamous Cell Carcinoma Surgery Dr. Nikhil Moriwal, Dr. S. R. Shenoi, Dr. A. Garg, Dr. V. Kolte, Dr. K. Bang, Dr. P. Ingole, Dr. N. Budhraja VSPM’s Dental College and Research Centre, Nagpur Abstract Background/Introduction Neck dissection is a mainstay of treatment for patients with head and neck malignancies for both therapeutic and diagnostic reasons. The purposes of neck drains are to obliterate dead space and to reduce seroma and hematoma formation, thus improving skin apposition and wound healing. This study aims to determine different timings, for better decisions on drain removal and its sequelae. Objectives To compare - Between different timings of removal of neck drains and its sequelae. - Total drainage volume based on type of surgery and subsite of lesion. - Duration of hospital stay following surgery. Methods Patients, who needed to undergo resection of tumor and supra omohyoid neck dissection with closed suction drain inserted were included in the study and divided into three groups A, B and C, depending upon the timing of neck drain removal. Complications associated such as salivary fistula, wound dehiscence with abscess, wound dehiscence without abscess and seroma or hematoma formations were evaluated. Also total drainage volume and duration of hospital stay following surgery was observed. Results Results are awaited as the study is under statistical evaluation. Conclusions Awaited.

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EPS00719 Detection of Cervical Lymph Node Metastasis with Magnetic Resonance Imaging in Head and Neck Squamous Cell Carcinoma and Its Correlation with Histopathological Diagnosis: A Prospective Study of 12 Cases Dr. Anuj Agarwal, Dr. Amit Kumar ITS Dental college & Research Center, Greater Noida Abstract Background/Introduction The presence of cervical lymph node metastasis and its identification is important for the treatment and prognosis prediction of head and neck squamous cell carcinoma. Clinical palpation is not satisfactory for the accurate diagnosis of cervical lymph node metastasis. Magnetic resonance imaging (MRI) has been increasingly used to evaluate the status of cervical lymph node. Objectives The primary objective of this study is to investigate the MRI features of cervical lymph nodes metastasis of head and neck squamous cell carcinomas, and its accuracy to diagnose the presence of metastasis. Methods An Prospective Observational study which included evaluation of 56 nodal levels and 498 lymph nodes in 12 patients with head and neck squamous cell carcinoma were analyzed on MRI and compared with their histopathological diagnoses. Results Of the 498 lymph nodes in 56 nodal levels, 20(4%) lymph nodes were proved pathologically as metastases, level II was the most commonly involved. False-positive and false-negative rates of MRI diagnoses were higher in levels I than in levels III, IV, and V. On MR images, Central nodal necrosis was seen in 20 nodal levels were proved histopathologically as metastatic nodes. Extracapsular nodal invasions in 8 nodal levels, Perineural Invasion seen in 11 nodal levels and Lymphovascular Invasion seen in 10 nodal levels. The diagnostic criteria of metastasis as the minimal nodal diameter of [/= 8 mm or central nodal necrosis. The diagnostic sensitivity was 87.50%, specificity was 75%, and disease prevalance was 66.67%. Conclusions The incidence of cervical lymph nodes metastasis head and neck squamous cell carcinoma is highest in level II. MRI diagnostic criteria of cervical lymph nodes metastasis are nodal size, central nodal necrosis, and irregular contour of lymph nodes were assessed. MRI accomplishes the criteria of the minimal nodal diameter being [/= 8mm for a metastatic lymph node and therefore may diagnose lymph node metastasis with optimum accuracy.

EPS00794 Non Destructive Tissue Analysis for Ex Vivo and In Vivo Cancer Diagnosis Using a Handheld Mass Spectrometry System: THE MasSpec PEN Jialing Zhang, John Rector, John Q. Lin, Jonathan Young Abstract Background/Introduction Tissue assessment and diagnosis are critical in the clinical management of cancer patients and more so during surgical excision for

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 margin evaluation. Conventional methods for histopathological tissue diagnosis are labor- and time- intensive and can delay decision making during diagnostic and therapeutic procedures. Molecular analysis of cancer tissues offers the exciting opportunity to incorporate cancer specific biomarkers into clinical decision making for improved cancer detection and diagnosis, one of them being Mass Spectrometry Imaging. Objectives One of the greatest challenges cancer surgeon faces is determining the delicate boundary between cancerous and normal tissues to achieve negative margins for invasive and carcinoma in situ while optimizing aesthetic outcomes. Thus, accurate negative margin assessment and complete tumour excision are highly desirable for prolonged disease free and overall survival. Methods The MasSpec Pen was designed to operate directly on tissue specimens independently of tissue stiffness and morphology. It was used for ex vivo molecular analysis of 20 human cancer thin tissue sections and 253 human patient samples inclusing normal and cancerous tissues from the breast, lung, thyroid and ovary. Results The mass spectra obtained presented rich molecular profiles characterized by a variety of potential cancer biomarkers identified as metabolites, lipids and proteins. Statistical classifiers built from the histologically validated molecular database allowed cancer prediction with high sensitivity(96.4%), specificity(96.2%) and overall accuracy of 96.3%. Conclusions The results provide evidence that the application of an automated, biocompatible, disposable handheld device, the MasSpec Pen, could potentially be used as a clinical and intra-operative technology for direct, real-time, non-destructive ex-vivo and in-vivo sampling and molecular diagnosis of tissues.

EPS00802 Peninsula of Extra Tissue: Mucoepidermoid Carcinoma Dr. Abdulla kirash Dr. Rahul Kumar Sanklecha Sri Hasanamba Dental College and Hospital Abstract Background/Introduction - Mucoepidermoid carcinoma is the epithelial salivary gland neoplasm of the oral cavity. It accounts for less than 3% of all head and neck tumours. Mucoepidermoid carcinoma of minor salivary gland origin is rare. It is composed of mucous producing, squamous and intermediate type cells. Objectives To present a case of low grade mucoepidermoid carcinoma of palate and discuss the various surgical treatment options. Methods We hereby present you a 65 years old female patient with the chief complaint of ill fitting maxillary denture and swelling on the right posterior part of hard palate since 2 years. The swelling was inspected over the right side of the palate involving the right alveolus. The size of the swelling gradually increased and reached 4 x 3.5 cm size by the end of first year and thereafter the size remained constant. She gave history of self exfoliation of teeth in the same region. Swelling was non tender, soft in consistency, compressible, fluctuant and non pulsatile. The incisional biopsy of the lesion confirmed the diagnosis as low grade mucoepidermoid carcinoma.

S157 Results The lesion was treated by wide surgical excision and healing of the palatal mucosal defect by secondary intention. Conclusions This case report highlights the need for proper diagnosis and treatment plan in the cases of malignant tumors as it can lead to morbidity and mortality.

EPS00803 Maxillofacial Access Osteotomies: Creating a Route to the Inaccessible Dr. Nancy Mathew Christian Dental College, Ludhiana Abstract Background/Introduction A plethora of pathologies occur in the cranial base and deep spaces of the neck, treatment of which poses a surgical challenge owing to the anatomical complexity, difficulty in access and proximity to vital structures. A multidisciplinary approach is often required in these situations. Objectives To discuss various Surgical accesses that aid in removal of inaccessible tumors of craniomaxillofacial region. Methods There is a multitude of surgical accesses for the facial skeleton based on the concept of modular osteotomies.the surgical approaches involving the disarticulation of the craniofacial skeleton aimed at providing increased and more direct exposure of both the pathology and the surrounding structures while avoiding the need to resect the uninvolved structures. Three-dimensional access to skull base tumors is obtained by wide soft-tissue exposure and selective osteotomy and removal of parts of the facial skeleton. Results Any technique of access osteotomy can be done with good esthetic and functional results with proper pre-op planning, instrumentation, and regular follow-up. Conclusions Access osteotomy allows the surgeon a better view and a better access of the surgical field to resect the tumor completely with safer margins. Thus, in the process helping to preserve vital structures, preoperative function and reduce post operative complications.

EPS00813 Assess Speech Quality After Treatment for an Oral Malignancy and Tips to Treat Dr. Ramya Narahari K.L.E Institute of Dental Sciences Bangalore Abstract Background/Introduction Speech outcome after treatment for an oral malignancy often results in articulation difficulties due to tissue loss and structural alteration of various speech organs.

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S158 Objectives The aim of this presentation is toThe aim of this presentation is to understand quality after treatment for an oral malignancy. Methods A specific speech characteristic that influences intelligibility and speech quality is voice-onset-time (VOT) in stop consonants. Results Problems with speech production in patients treated for oropharyngeal cancer often includes nasal resonance and velopharyngeal inadequacy. Conclusions The aim of this presentation is to understand quality after treatment for an oral malignancy.

Section: Reconstruction EPS002 Versatility of Submental Flap in Soft Tissue Defects Dr. Wasim Pathan, Bharati Vidyapeeth

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 is mandatory to restore the oral function and speech. Various methods of immediate reconstruction are implemented by different authors time to time including autogenous non vascularized bone graft, allogenic bone graft or reconstruction plates and others. Each has its own advantages and disadvantages including donor site morbidity, failure and others. The purpose of the present case report is to establish that micro vascular free fibula is a better option to other methods in the immediate reconstruction of mandibular continuity defect. Objectives Anatomical, functional and esthetic rehabilitation of patients after mandibular resection. Methods Revascularization of free fibula graft by microvascular anastomosis of fibular artery with facial artery at the segmental defect site of mandible. Results Remarkable contour, cosmesis and early functional rehabilitation of the patient. Conclusions Microvascular reconstruction with fibula is the better option for defect correction and early rehabilitation in patients with mandibular continuity defect.

Dental College and Hospital, Pune Abstract Background/Introduction The reconstruction of post operative oral and maxillofacial defects frequently presents a challenging dilemma for the surgeon. Various techniques to reconstruct the oral and maxillofacial defects include skin graft, local or regional flap and free vascularise tissue transfer. The locoregional pedicled cutaneous (submental) flap is a simple, less morbid and offers equal if not superior patient outcomes than the other microsurgical flaps. Objectives The submental flap is often served as work horse for soft tissue reconstruction of mandible and due to its greater arc of rotation it can also be used for reconstruction maxilla and skull base defects. Methods This versatile flap was successfully used for soft tissue reconstruction of maxilla and mandible. Results No major complications were noted. In all patients, the results were satisfactory, with acceptable cosmesis. Conclusions The submental artery island flap is safe, rapid, and simple to raise and leaves a well-hidden scar.

EPS0019 Mandibular Reconstruction for Ameloblastoma Using Free Fibula Graft: A Case Report Dr. Debasish Sinha Sree Balaji Dental College and Hospital Abstract Background/Introduction In maxillofacial surgery tumour ablation often causes continuity defect of the mandible which results in anatomical and functional morbidity of the patient. The reconstruction of the mandibular defect

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EPS0065 BRIDGING THE GAP-Osteomyeltis and Temporalis Muscle Flap Dr. Rakshita Malik FODS, SGT University Abstract Background/Introduction Osteomyelitis an inflammatory condition of bone beginning as infection of the medullary cavity, rapidly spreads to Haversian system and involves periosteum of the infected areas, generally seen in mandible due to its higher density; it is not often encountered in maxilla due to its richer vascularity and presence of sinus spaces, which aid in local spread of pus and other exudates. Objectives To Rehabilitate osteomyelitic maxilla following partial maxillectomy with temporalis muscle flap. Methods 47 yr old, male, with uncontrolled diabetes, presented with osteomyelitis of left maxilla wrt 25,26,27 region associated with pain and pus discharge. CBCT revealed sclerotic alveolar bone (necrotic bone) surrounded by radiolucency(osteolysis). Patient’s blood sugar was controlled using insulin. Under GA partial maxillectomy was performed irt 25,26,27 region, curettage done, fresh bleeding achieved & Using alkayat bramley approach, Temporalis Muscle flap dissected & tunneled below Zygomatic arch intraorally for Intraoral reconstruction. Results Primary closure was achieved. No evidence of dehiscence and fistulas was noted after a follow up of 3 months. Conclusions In our experience the myofascial temporalis flap demonstrated to be safe and versatile option, due to both anatomical proximity to the midfacial region and easy transference, this flap is an excellent choice for reconstruction, especially in patients with poor recovery potential; with only major drawback, temporal area hollowing.

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EPS0082 Application of INVERSE PLANNING in Maxillofacial Reconstruction-‘‘Jugaad Technique Dr. Amit Dhawan, Dr. Ramandeep Singh Bhullar, Dr. Tejinder Kaur, Dr. Mehak Malhotra Sri Guru Ram Das Institute of Dental Sciences and Research, Amritsar Abstract Background/Introduction The ultimate goal of maxillofacial reconstruction is to provide functional and esthetic balance along with quality of life. Free fibula provides extensive bone and skin that can be cut and shaped accurately to fit the recipient site, and allows all types of reconstructions for ablative defects of mandible and maxilla. Objectives The aim is to introduce a technique for planning functional maxillofacial reconstruction with dental implants. Methods Preoperative dental casts were made on Hanau Articulator and a fibula analogue was then placed in an ideal functional reconstruction position. Drill holes for the placement of implants were placed through the acrylic base denture or surgical stent. This denture base or stent formed act as a guide to position the fibula transplant during surgery. Results This technique was useful in producing functional and rehabilitative outcomes in cases of both maxillary and mandibular reconstructive surgeries. Conclusions The Jugaad technique’’denture based inverse planning’’is a cost effective method for planning and executing maxillofacial reconstructions using mock surgery on casts and interim dentures.

EPS00104 Adipose: As a Potential Source of Stem Cell in Tissue Regeneration Dr. Abhishek Patley New Horizon Dental College and Research Institute, Bilaspur (Chhattisgarh) Abstract Background/Introduction Adipose tissue has a self- renewal ability, high proliferative capacity and potential of tissue differentiation in vitro and in vivo studies of tissue regeneration. Adipose derived stem cells represent as enticing pool of multipotent adult stem cells because of their relative abundance, ease of isolation and expandability. Objectives To reveal potential of adipose derived stem cells to be prolific source of multipotent stem cells in tissue regeneration. Methods The adipose tissue is grinded and washed in phophate buffered saline (PBS) containing penicillin/streptomycin (P/S). With the addition of collagenase, the digestion phase begins. The tissue is incubated at 37

S159 degree celsius from 30-90 minutes. After this fetal bovine serum is added. Then it is mixed to disintegrate adipose tissue aggregates. After the material is centrifuged, it is possible to seperate adipocytes from the stromal vascular fraction (SVF). After the separation of SVF from the adipocytes is complete, the sample (SVF) is incubated in ice for 10 minutes in lysis buffer. Then the sample is washed in PBS containing P/S and once again centrifuged. Cellular expansion is initiated in appropriate culture medium (e.g. Dulbecos modified Eagles medium). The adipose derived stem cells obtained may be used in various protocols of cell characterization. Results Based on so many in vitro and in vivo research results, cell therapies using adipose derived stem cells are widely promising in various clinical fields, such as facial lipoatrophy reconstruction, cardiovascular tissue regeneration, craniofacial tissue regeneration etc. Conclusions The potential of adipose tissue to be a prolific source of multipotent adult stem cells has garnered a great deal of attention in the field of regenerative medicine.

EPS00126 Residual Deformity Due to Zygomatico-Orbital Fracture Dr. Manoj Kumar. K.P&Dr. Aswathi Vinod KMCT Dental College, Calicut Abstract Background/Introduction Disfiguring post traumatic deformities persist even after the treatment, such deformities after healing are formidable challenges faced by surgeons, apart from psychological impact on the patient. Immediate treatment sometimes leaves secondary defects like depression in malar region or ocular deformities such defects are addressed secondarily by refracturing and realigning the malunited fragments or by camouflage procedures. History of RTA 5 months back with diplopia, enophthalmosis,flattening of right malar eminence & trismus and diagnosed as residual deformity after zygomatico orbital wall fracture. Objectives To correct the level of pupil,flattened malar eminence and to improve mouth opening, to restore function and facial aesthetics. Methods Surgical correction of fractured zygomatic arch, elevation of herniated orbital contents by restoring orbital floor and improving mouth opening. Results Patient was satisfied with aesthetic outcome, and diplopia was corrected. Conclusions In post operative reviews we weren’t satisfied about the aesthetic results though there is marked improvement from the initial fattening of right side of face. Excellent results in mouth opening and correction of diplopia.

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EPS00128 Versatility of Tongue Flap for Repair of Palatal Fistulae Presenting Author: Dr. Saubhik Dasukil Co-Author: Dr. Sujith Shetty, Dr. Saikrishna D JSS Dental College and Hospital, Mysore Abstract Background/Introduction An oroantral/palatal fistula is an abnormal communication between the oral and nasal cavity. It can occur after primary surgical repair of cleft palate or by trauma, cyst, neoplasm, irradiation, or infectious diseases like syphilitic gumma, leprosy, noma etc. Most fistulae greater than 5 mm in diameter requires surgical closure. This study was taken to assess the functional and clinical outcome of closure of palatal fistulae with tongue flap. Objectives 1. Clarify the technique of elevating and insetting tongue flap to fit palatal defect. 2. Study the outcome of tongue flaps in terms of functional and aesthetic results. 3. To study donor site morbidity. Methods In this study, 10 patients having palatal fistula were treated with anterior/posterior based dorsal tongue flap. The patients were evaluated for outcome in terms of flap uptake and efficacy, correction of oronasal regurgitation, speech and articulation, donor site morbidity and aesthetics. Results The study revealed results in support of the technique mentioned, showing good success rate in terms of flap uptake and correction of oronasal regurgitation, significant improvement in speech and articulation with imperceptible donor site morbidity. Conclusions Use of tongue flap for repair of palatal fistulae is a successful technique as it provides appreciable quality and quantity of well vascularized tissue for fistula closure with negligible functional and aesthetic morbidity associated with donor site.

EPS00160 Applications of the Buccal Fat Pad in Oral and Maxillofacial Surgery Dr. Thushara Kumari, Dr. Anand Amirtraj

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Methods Review of literature. Results After the review of litrature it was found that successful management of various oral and maxillofacial defects was done using buccal fat pad. Conclusions Extraction of BFP from the deep facial region is a safe procedure with minimal risk of complications. Due to the unique features of the BFP such as its location, easy accessibility, rich blood supply, high rate of epithelialisation and minimal donor site morbidity, makes it a reliable soft tissue graft.

EPS00162 Intraoral Sites for Harvesting Bone Grafts Dr. Jaya Sarkar K. D. Dental College, Mathura Abstract Background/Introduction Osseous defects occur as a result of trauma, prolonged edentulism, congenital anomalies periodontal disease, etc. A commonly used method for the repair of maxillofacial bony defect is the utilization of autogenous bone grafts from intraoral donor site. Objectives To quantify the amount of bone in terms of area, thickness & volume that can be harvested from the mandibular symphysis, ascending ramus, coronoid process, zygomaticomaxillary buttress, mandibular/palatal tori. Advantages being easy accessibility, low rate of morbidity, less cost. Methods Osteotomy is performed with a surgical bur and completed with a mallet and chisel; bone scraper;piezoelectric device. Results Ramus has the highest average cortical bone surface area and volume harvested, while symphysis has the highest average thickness. Conclusions The use of appropriate surgical technique with sound knowledge of bone biology optimizes ridge augmentation and other surgical procedures, wherein (a)intraoral bone is preferred over extraoral bone, (b)mandibular donor bone is preferred over maxillary bone,(c)donor bone which is contiguous with recipient site is preferred over intraoral bone from second distant location.

Manipal College of Dental Science, Mangalore Abstract Background/Introduction BFP as a pedicle graft has become more common; the relatively easy use and the location of the BFP are anatomically favorable and minimal dissection allows it to be harvested and mobilized; good rate of epithelialization and low rate of failure have made it the preferred option for oral and maxillofacial applications. The repair of oroantral and oronasal defects, the repair of pathological or traumatic defects, the repair of congenital cleft palate defects, use as a biologic membrane for covering bone grafts, and its application in temporomandibular joint surgery are some of its common applications. Objectives Through this poster we aim to highlight the applicability of buccal fat pad for the reconstruction of various Oral and Maxillofacial defects.

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EPS00165 Reconfigurating the TMJ-Diversified Options Dr. Sayantan Ghosh Haldia Institute of Dental Science & Research Abstract Background/Introduction Many physiologic function such as speech and mastication depend on TMJ. Anatomical structural damage of TMJ such as trauma, tumour, resorption and ankylosis require removal of pathologic structure and reconstruction of TMJ. Reconstruction of the TMJ is one of the most challenging procedures because the joint has complex anatomy

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 packed in a small space and unique motion under high pressure. A successfully reconstructed TMJ should reproduce normal joint structure, provide functional articulation and permit adaptive growth and remodelling. Objectives To evaluate the prognosis of different method of TMJ reconstruction in different situation. Methods Selected a patient randomly irrespective of their cast, creed, sex and socio-economic status indicated for TMJ reconstruction. Reconstruction procedure are- Reconstruction using 1. Sternoclavicular graft (SCG), 2. Costochondral graft, 3. coronoid process, 4. Iliac crest, 5. Metatarsopharyangeal joint either vascular or nonvascular, 6. Free fibula, 7. Combination of no. 5 and no. 6, 8. Posterior border of ramus, 9. Distraction osteogenesis, 10. Hydroxyapptite colagen, 11. Aloplastic Tmj reconstruction. Results Reconstruction opinion can be divided into autogeneous or aloplastic and the current state of art is such that there is no single best option for all situations. The ideal reconstruction technique needs to be customized to the individual patient and TMJ defects. Conclusions The myriad of available TMJ reconstruction options reflect the fact it remains on evolving field. Although no gold standard currently exist, the various technique each have their own indication and potential advantage and drawbacks. Current reconstruction technique lie in favour of autogenous replacement in children and alloplastic in adults. The balance seems to be swinging towards alloplasts in older children.

ABS00219 Reconstruction of Maxillofacial Surgical Defects Using Free Fibula Flap: A Case Series Dr. Trupti S. Nikalje, Co- author- Dr. N. N. Andrade Nair Hospital Dental College Abstract Background/Introduction The maxilla and the mandible are major components of human facial appearance and have a great contribution to orofacial function. Thus, post surgical reconstruction is of paramount importance with a graft that is viable and allows prosthetic rehabilitation. Hidalgo first reported the use of a fibula vascularized flap for mandibular reconstruction. The main advantage of the free fibula flap is its ability to provide the largest bone length that allows reconstruction even after complete jaw resections. Objectives Aim: To document our experience using the free vascularized fibular flap for comprehensive reconstruction of discontinuity defects in the jaws, after resection of benign odontogenic tumors. Objectives: To document 1. Indications & contraindications of FFF. 2. Advantages & disadvantages of FFF. 3. Prosthetic rehabilitation techniques. 4. Advances in FFF. Methods Materials & Methods: A total of 10 cases were included in the case series. These patients reported to the OPD, Dept. of Oral & Maxillofacial Surgery, Nair Hospital Dental College, Mumbai with orofacial tumors for which they underwent surgical resection and reconstruction with free fibula flap.

S161 Results In patients, we noticed excellent esthetic results after reconstruction using FFF. We encountered some of the problems such as edema of donor leg, walking difficulties in initial days, unesthetic scar on the donor leg, etc. But apart from that patients were satisfied with the results. Conclusions Thus, we conclude that it has made a significant impact on preserving the patients quality of life.

EPS00225 Orbital Floor Reconstruction Using Biomaterials Dr. Gourab Mandal Haldia Institute of Dental Sciences and Research Abstract Background/Introduction Orbital fractures are often common fractures of the midface. As such, numerous techniques and materials exist for the repair of this region, each with inherent advantages and disadvantages. A comprehensive review of materials used in orbital reconstruction and possible new directions in orbital floor reconstruction are presented. Objectives To evaluate the prognosis of using various biomaterials in orbital floor reconstruction. Methods Selected patients randomly irrespective of their caste, creed, sex and socioeconomic status indicated for orbital floor reconstruction using the following biomaterials: Autograft, Autologous bone, autologous cartilage, autologous fascia, autologous periosteum, allografts, xenografts, collagen membrane, porous hydroxyapatite and calcium phosphate, bioactive glasses. Results The general goal for orbital wall reconstruction is to restore the normal anatomical relations of the internal orbit while avoiding complications of the procedure and implant. Given the large number of graft materials available for orbital fracture repair, it is therefore important to analyze these materials within their respective categories. Conclusions The ideal material for orbital floor fracture repair is one that is resorbable, osteoconductive, resistant to infection, minimally reactive, does not induce capsule formation, has a halflife which would allow for significant bony ingrowth to occur, and is cheap and readily available.

EPS00247 Recent Trends in Mandibular Reconstruction: An Overview Dr. Kamini Dadsena New Horizon Dental College and Research Institute Sakri, Bilaspur, Chhattisgarh Abstract Background/Introduction Mandibular reconstruction has changed significantly over the years and continues to evolve with introduction of newer techniques.

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S162 Mandibular defects may result from trauma, inflammatory disease and benign or malignant tumours. Mastication, speech and facial aesthetics are often severely compromised without reconstruction. The goal of mandibular reconstruction is to restore facial form and function, implying repair of mandibular continuity. Objectives The aim of my poster presentation is to summarize the reconstruction options available for mandible, the various donor sites and current reconstructive options. Methods Many reconstruction modalities have been attempted. These modalities include reconstruction plates with or without pedicled myocutaneous flaps, alloplasts, free grafts, pedicled osteomyocutaneous flaps, and a variety of free vascularized bone flaps. Recent advances like 3D printing, stereolithographic models, and the use of custom-made implants can aid and improve the accuracy of existing reconstructive methods. Other tech. like DO, tissue engineering and robotic surgery drives us in new era of reconstruction. Results Current trends in mandibular reconstruction aim to achieve reestablishment of a viable mandible of proper form and maxillary mandibular relationship while decreasing the need for invasive autogenous graft procurement. Conclusions Mandibular defects following ablative surgery or trauma impact both form and function and require a multidisciplinary approach to optimize functional and cosmetic outcomes and refinements in techniques continue to improve patient quality of life.

EPS00297 Bend it Like Mandible: A New Approach for the Surgical Management of Osteoradionecrosis Dr. Anjali Unnithan, 2nd Mds Student, Dr. Jacob John, Professor

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Results There was normal and natural healing of irradiated tissues and orocutaneous fistula with no trismus and pain. Patient is back to her normal routine with minimal facial deformity. A 1 year follow up was done and there is no complication still now regarding the reconstructive surgical method done for this patient. Conclusions Intraoral plating of recon- plate above the mucosa reduces chances of orocutaneous fistula than plating it under mucosa.

EPS00342 PMMC Flaps the Prefered Option for Maxillofacial Reconstruction Dr. Israel Nathanael Raj Sree Balaji Dental College & Hospital Chennai Abstract Background/Introduction Reconstruction of the head and neck involves the selection of an apt flap. PMMC flap being the most appropriate flap for the reconstruction of lower face and neck region. Objectives To state the importance and success factors in reconstruction of head and neck with pectoralis major. Myocutaneous flap. Methods Review of litereture, and case study involving 9 cases. Results Satisfactory prognosis after pmmc reconstruction. Conclusions PMMC flap is the undenied technique for all lower face reconstructions.

Dept. of Omfs, Azeezia Medical College Abstract Background/Introduction osteoradionecrosis is a chronic, non- healing wound caused by hypoxia, hypocellularity and hypovascularity of irradiated tissue. In regular treatment modality HBO therapy followed by segmental mandiblectomy and reconstruction with a recon plate is a commonly practised treatment option. Formation of orocutaneous fistula with plate exposure is main complication that we can face in this treatment method. Objectives To determine the efficacy of plating the recon plate intraorally over the mucosa to reduce the chance of orocutaneous fistula and to correct the lost segmental part. Methods A case reported to our outpatient department with orocutaneous fistula with necrotic bone and history of irradiation for the management of CA tongue right side. A modification in surgical method has been implemented in this case after resection of the irritated bone and fixing the recon plate from the remaining proximal end of the Condylar region and bending in such a way to establish the mandibular contour intaorally over the mucosa, recreating vertical ramus height. The plate is again bend horizontally over the alveolar mucosa to recreate the alveolar process and then adapted to the mandibular symphysis region. prosthetic rehabilitation done by placing dentures with buccal flanges above to the horizontal part of recon plate.

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EPS00345 Reconstruction in Oral and Maxillofacial Surgery Dr. Priyanka Tripathi and Dr. Girish Giraddi GDC&RI Bangalore Abstract Background/Introduction In past resection of oral tumours had been associated with significant disfigurement and loss of function. As a result demand for functionally successful and esthetically pleasing. Reconstruction of oral and maxillofacial soft tissue defects after benign and malignant pathology can be achieved using various techniques including regional and distant flaps. These flaps provide both functional and cosmetically pleasing results. Objectives The present study aims to review types, indications and surgical techniques of reconstruction using various regional and distant flaps of defects in oral cavity. Methods Review of techniques of oral soft tissue reconstruction of patients treated in department of Oral and Maxillofacial surgery, Government Dental College and Research Institute, Bangalore.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Results Various techniques of reconstruction gained from our experience and learning in treating patients with malignant tumors. Conclusions Incidence of malignancies in Head and neck region is rising.the natures of illness mandates aggressive treatment that is resection…Tumour resection results in poor quality of life both functionally and esthetically. Therefore following resection there must be reconstruction. Regional and Distant flaps provide optimal results both functionally and esthetically.

EPS00359 Utility of Superiorly Based Masseter Muscle Flap for Postablative Retromaxillary Reconstruction Dr. Sagar Ajay Naidu Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital Dr. Sagar Ajay Naidu Institute-Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital Abstract Background/Introduction Resections in the posterior component of the oral cavity usually lead to severe functional compromise and lower quality of life for patients. The anatomic and physiologic rehabilitation of the defect to a reasonable outcome with low morbidity and mortality remains the founding basis of any surgical reconstruction. Objectives Evaluation of Masseter muscle flap for retromaxillary reconstruction for its structural and functional integrity. Methods Study type- A retrospective study from 2006 to 2015 was performed. Method- Patients underwent surgical resection with neck dissection depended on grade of the tumor. Reconstruction was performed in all cases using the regional masseter muscle flap and advancement of the palatal flap into the defect. The necessary findings and observations were tabulated. Results 76 patients who presented at the hospital having retromaxillary malignancy, amongst them 53 patients underwent resection of retromaxillary malignancy with masseter muscle reconstruction, 48 showed a satisfactory outcome. Postoperative infection was noted in 5 patients and 2 of these patients needed debridement. Postoperative wound contracture with muscular spasm and decreased mouth opening in the early postoperative period were a general observation. In all patients, the vitality of the flap was excellent, with epithelization and adequate mouth opening within 3 weeks. Postoperative speech, swallowing, and facial esthetics were satisfactory and acceptable. Conclusions The masseter muscle flap is a promising reconstruction alternative for retromaxillary reconstruction because of advantages such as regional access, ease of harvesting, optimum bulk, flexibility, pliability for larger defects, and minimum postoperative morbidity.

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EPS00360 Donor Site Morbidity After Free Fibula Flap Transfer for Reconstruction of Maxillofacial Defects Dr. Himani Joshi S.C.B. Dental College & Hospital Abstract Background/Introduction The vascularized free fibula flap (VFFF) was first described by Taylor in 1975 and popularized by Hidalgo in 1989. The fibula(calf bone) is a leg bone located on the lateral side of the tibia, it transmits 6-16 % of body weight. It has got attachments to major muscles like flexor hallucis longus. The distal part of fibula helps in stabilising ankle joint. 10 cm of lower part of fibula is very important for stability of ankle joint. Study of perforators & vascular supply of fibula is desirable. It is currently used to reconstruct bone defects, particularly during limb reconstruction and in maxillofacial reconstruction following benign & malignant jaw tumour ablation. Larger fibular flaps are preferably taken from left side as it is non-dominant. Though it has several advantages, the procedure can lead to disrupt lower limb’s function. Complications like dorsiflexion of great toe & stress fracture of tibia can occur, albeit rarely. The muscles in the antero-lateral and posterior (lower) leg play an important role during gait as their main function is to control the joint stabilization within the foot from the compressions created by tendons abrupt change in alignment. Objectives To examine the early post-operative donor site morbidity and the presence of any long term deficits of donor leg function associated with removal of vascularized free fibula flap for mandibular reconstruction. Methods patients who underwent free fibula flap reconstruction are followed up regularly and the findings are recorded. Results complications like delayed wound healing, weakness of flexor hallucis longus muscle, transient peroneal nerve palsy, dorsiflexon of great toe and gait abnormalities rarely stress fracture of tibia are noticed, Conclusions though free fibula flap is associated with several morbidities but most of them resolve within a period of 4-6 months, so it provides us a versatile reconstructive option of correction of various maxillofacial defects.

EPS00412 Pectoralis Major Myocutaneous Flap: The Workhorse Flap for reconstruction of Oro-Facial Defects Mustafiziur Rahaman, Dr. R Ahmed Dental College & Hospital Abstract Background/Introduction Ablative surgeries in orofacial region due to cancer results in large soft tissue defect that requires reconstruction. Although free flap using microvascular technique is the standard of care, its use is limited by the availability of expertise and resources in developing world. As a result Pectoralis major myocutaneous flap, which is versatile and less

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S164 technique sensitive method of reconstruction of soft tissue defect, is still a handy tool in surgeons armamentarium. It still remains the workhorse for head and neck reconstruction in developing countries thanks to its ease of harvest, and minimal requirements in term of instrumentation. The present poster depicts the ability and result of pectoralis major myocutaneous flap in reconstruction of soft tissue defect in ablative surgery in oral cancer. Objectives to evaluate effectiveness of pmmc as reconstruction of facial defects. Methods 3 patients with buccal sqamous cell carcinoma were undergone wide local excision of primary tumor along with neck dissection. The defect caused by the primary resection was reconstructed with pectoralis major mayocuteneous flap. Results The defect was successfully reconstructed with pmmc with slight decrease of the mouth opening. Conclusions PMMC can be used for reconstruction of facial defect in oncologic ablative facial surgery.

EPS00428 3D Printing in Oral & Maxillofacial Surgery: Systematic Review of Its Utilisation, Merits, Demerits Dr. Syed Ahmed*, Dr. Rahul Laturiya*, Dr. Priyanka Samel* *MIDSR Dental College, Latur, Maharashtra, India Abstract Background/Introduction Introduced in Oral and Maxillofacial Surgery (OMFS) in 2012 with a 3D printed mandible, 3D printing in OMFS now occupies 24.12% of all 3D printed models in Surgery. Objectives To review surgical and non-surgical applications, prospects, merits, and demerits of 3D printing in OMFS. Methods Electronic searches (PubMed, Medline, Cochrane) were conducted. Key words used were oral, maxillofacial, surgery, 3D printing, and reconstruction. Systematic search and analysis of full text papers and articles dating from beginning of time till July 2017 in English language were done as per Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Results The uses of 3D printed models include surgical templates, for handson experience, personalised prostheses amongst others. Merits include decreased surgical time, easier surgical protocol, and predictable results. Demerits include unwanted artefacts, high costs incurred, and need for strict quality assurance protocol. Conclusions 3D printing has merits, myriad applications, and bright prospects in regular OMFS practice, but needs aggressive research to tame its demerits.

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EPS00430 Recent Advances in Reconstructive Oral and Maxillofacial Surgery Dr. Shameekcha Mishra College of Dental Sciences, Davangere Abstract Background/Introduction Reconstruction following head and neck surgery has become a very tedious task, more so recently due to patient’s expectations regarding their quality of life after surgery, and hence, the need for functionally and aesthetically high-quality reconstruction is now greater than ever. Objectives The main aim and objective of this poster is to create awareness about the recent advancements and ongoing researches in the area of reconstructive surgery. In the last decade, researches were more concentrated on the improvement of pre-operative planning. Now, as a result of advancements in the computer technology, the researches have extended beyond the scope of planning and moving towards surgical procedure itself. Methods Review of literature. Results Development of navigation, three-dimensional imaging, stereolithographic models and use of custom -made implants can aid and improve the accuracy of existing reconstructive techniques. Robotic surgeries allow access to the certain benign and malignant tumors in stage T1 and T2 in oropharynx without the need for mandibulotomy and helps in reconstruction of defect. Tissue engineering and distraction osteogenesis avoid the need for autologous tissue transfer, thereby avoiding donor site morbidity and providing conservative method of reconstruction. Facial allotransplantation allows the transfer of whole anatomical units to be replaced along with completion of reanimation in a single procedure. Conclusions All the above-mentioned innovations have their share of advantages and disadvantages and we as oral and maxillofacial surgeons should imbibe the newer techniques and strive to achieve the best outcomes for the welfare of the patient.

EPS00464 Histopathological Differences of the Pedicle Artery in Commonly Used Free Flaps: The Influence of Age, Gender, and Side Dr. Anurag Basak Abstract Background/Introduction The evolution and advancement of microsurgical techniques in reconstructive surgery have improved functional and aesthetic outcomes. Often, failure is the result of a multitude of factors. Occlusion of nourishing vessels from thrombosis is an important cause and has been reported to be as high as 10 to 12%. Objectives This study examined the condition of the arterial wall of commonly used free flaps for histologic changes and the impact of age, gender, and anatomic side. The authors’ hypothesis was that vessels from different donor regions would show different atherosclerotic changes.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Methods Light microscopic examinations of vessel walls were performed on specimens of the nourishing artery of commonly used free vascularized flaps. The condition of the vessel wall was evaluated1. The peroneal artery (PA), radial artery (RA), inferior epigastric artery (IEA), deep circumflex iliac artery (DCIA), and circumflex scapular artery (CSA) were examined. Differences of histologic changes in the arterial wall and the effect of age, gender, and body side were investigated. Results All examined vessel specimens displayed mostly Class II changes. PA showed the greatest atherosclerotic changes, followed by the RA, IEA, DCIA, and CSA. Age had a meaningful effect on PA and RA. Anatomic side was important for PA and DCIA, whereas gender had a minor influence on vessel condition. Conclusions The vessel wall of different flaps showed different atherosclerotic changes depending on age, anatomic side, and gender. These differences should be considered in flap selection.

EPS00491 Complication of Free Fibula Flap in the Mandibular Reconstruction Dr. Pooja Shroff VYWS Dental College and Hospital, Amravati Abstract Background/Introduction Reconstruction of mandibular defects after tumor resection is one of the most challenging problems faced by oral&maxillofacial surgeons. The fibula provides the longest segment of bone with 20 to 30 cm available for harvest.the use of the FFF for reconstructing mandibular continuity defects in patients may be associated with postoperative complications. Osteoradionecrosis is a delayed complication from radiation therapy which causes chronic pain, infection and constant deformity after necrosis. Adjuvant or neo-adjuvant radiotherapy (RTH) increases susceptibility to hypovascularity and subsequent infections and too much manipulation of the pedicle during anastomosis may cause thrombosis due to infection. Objectives To evaluate the complication of free fibula flap in mandibular reconstruction after the radiation therapy. Methods In 2 cases free fibula graft were used for reconstruction of defects caused because of resection of benign and malignant tumors. Results This 2 cases showed complication such as Osteoradionecrosis, Multiple fistulae and Skin dehicence. Conclusions Vascularized fibular free graft offers the patient a great deal of benefit, however this graft as a concomitant high risk of complications and outright rejection of soft and hard tissue of free flap. Great attention to details must be paid to prevent postoperative complications.

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EPS00500 Tissue Expander Dr. Pooja Patel, Guided by Dr. Amit Mahajan K M Shah Dental College and Hospital Abstract Background/Introduction The ability of our tissues to stretch and expand gradually over time has been observed and documented, both in physiological and pathological situations, throughout medical history. The phenomenon of tissue expansion is observed in natural all the time. The same properties of the human skin to stretch and expand and yield extra skin if placed under continuous stress over a prolonged period of time has been utilized for reconstructive purpose in oral and maxillofacial surgery and plastic surgery. Objectives Tissue expansion is an alternative to reconstruction by providing donor tissue of the same color and texture and similar thickness and sensation with minimal scar formation and minor donor site morbidity. Methods The physiological phenomenon is observed daily in medical practice. Skin, mucosa and muscles progressively expand over an underlying hematoma or a slowly growing tumor. The use of silastic tissue expanders extends this natural principle by utilizing the property of human skin to stretch and expand over a period of time under constant stress with actual increase in the amount of skin available, along with increased vascularity in the expanded skin. Results As per the literature this technique shows good results with less minimal complications and when it compare with tissue graft it shows better result in quality, vascularity, elasticity and texture. As per the present literature, tissue expansion requires more study for facial reconstruction. Conclusions This is a proven technique to increase the amount of local tissue available for transfer with the same quality of color and texture which is importance in facial reconstruction.

EPS00517 Electric Burn in Perioral Region: A Rare Case Report of a 10 Year Old Boy and an Update Dr. Rahul Thanvi, Dr. Ajit Joshi Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital Abstract Background/Introduction Electric perioral burns are rarely reported in the literature. Perioral electric burns represented less than 2% of the total burn. The present case is reported of oral commissure burn due to electric current. There was mild swelling and pain over the perioral region. This report signifies the perioral electric burns in children would be a reconstructive challenge and may affect the standard of living psychologically. Objectives To understand the principles of the injury and possible treatment options. To achieve acceptable functional and cosmetic outcomes with proper surgical management.

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S166 Methods Curettage and debridement of necrotic slough was performed meticulously, followed by identification of blood vessels and copious irrigation was performed. Results Patient was followed up for 6 months postoperatively. The corner of the mouth was involved in the perioral electric burn that caused mild microstomia secondary to surgery. Patients parents were advised for the treatment of microstomia and secondary scar revision but they were satisfied with the result and didn’t turn up for further cosmetic revision. Conclusions Electric perioral burn requires peer review and criticism as there are less reported cases and few treatment modalities available. Further studies should be carried out for its surgical and perioperative management, so that its aesthetic and reconstructive challenges will conclude to a better understanding and treatment protocol for optimal function and aesthetic.

EPS00535 Tissue Engineering Dr. Jaseema Farwin M.D.S Department of OMFS 1st Year, Madha Dental College and Hospital, Chennai Abstract Background/Introduction Tissue engineering is a rapidly advancing discipline that combines attributes of biochemical and biomaterial engineering with cell transplantation. Objectives As a reconstruction of normal architecture of face is always a challenging task, tissue engineering aids to create bioartificial tissues and organs. Methods review articles. Results literature of articles. Conclusions tissue engineering is an emerging remedy in reconstruction.

EPS00549 Various Reconstruction Modalities for TMJ Reconstruction Dr. Abhijit Das Jaipur Dental College Abstract Background/Introduction The temporomandibular joint is responsible for the mandible movements and consists a set of bones, muscles and ligaments. It is a subject to various diseases such as congenital, acquired (traumatic), local and systemic diseases and can lead to signs and symptoms such

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 as pain, including in head and neck areas, abnormal jaw movement and clicking or crepitus sounds, classified as temporomandibular disorders. Objectives The aim of this poster will be to facilitate our knowledge about the various reconstruction modalities of the TMJ, which includes the condyle, the coronoid fossa and the condylar capsule. Methods various reconstruction modalities have been shown in the poster after a thorough literature research. Results autogenous costochondral graft is an effective procedure for TMJ reconstruction. Conclusions The complex etiopathogenesis and the variability of symptoms complicate the adoption of standardized diagnostic and therapeutic approaches, as suggested by the number of treatment modalities that have been proposed, such as occlusal splints, physiotherapy, behavioral and physical treatments, drugs and surgery. But, surgical approach to the disorder of the TMJ is reserved to certain number of cases who do not respond to traditional and conservative therapies. For these situations, joint reconstructive surgery becomes necessary.

EPS00572 Weber-Fergusson Incision Modified to Include Reconstruction: Borle’s Novel Approach Dr. Divya Chadda, Dr. R. Ahmed Dental College and Hospital, Kolkata Abstract Background/Introduction The Weber–Fergusson maxillectomy incision was first described in 1842 as a transfacial approach to the midface for the resection of maxillary tumours. This was modified multiple times to improve the access in and around that area. Objectives To increase the awareness regarding this novel approach which made it possible to perform both resection and reconstruction in the same incision with the help of case reports performed in our institution. Methods Modified Weber Fergusson incision was extended (Borle’s extension) from the lateral canthus of the eye to the temporal region in the shape of a question mark to harvest temporalis muscle flap. Results No second incision was required for harvesting temporalis muscle flap. Postoperatively, there was no facial nerve injury and the quality of the scar was satisfactory. Conclusions Modified Weber Fergusson incision with Borle’s extension ensures a sufficient visual field, yields a satisfactory esthetic outcome, and is relatively safe, suggesting the potential use of this method when the reconstruction of maxillectomy defect is planned with temporalis muscle flap.

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EPS00578 Submental Flap in Reconstruction of Orofacial Defects

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EPS00618 Use of Temporalis Myofascial Flap in Maxillary Reconstruction

Dhavalkumar Jamubhai Palas Dr. Anuj Mathur Mahtma Government Dental; College, Thiruvananthapuram-Kearala 695011 Gandhi Dental College Jaipur Abstract Background/Introduction The microsurgical techniques with free flaps are the ‘‘Gold Standard’’
in the immediate reconstruction of post-cancer defects of the head and neck. However, procedures are complex, requiring a high degree of specialisation, and has complications and morbidity. The submental flap is an alternative reconstruction technique in the maxillofacial field in cases where the microsurgical reconstruction is not indicated. Objectives To explore the feasibility, advantage and disadvantage of the submental island flap in the repair of Oral & maxillofacial defects. Methods Review of online articles based on submental flaps for reconstruction of various oral and maxillofacial defects. Results Submental flap is a good alternative to other reconstructive method for oral and maxillofacial surgery, it excludes microsurgical procedures which require high degree of specialisation. Conclusions The submental flap constitutes a valid alternative for the reconstruction of orofacial defects, especially in elderly patients or patients that, due to deteriorated general condition require less aggressive treatments and reduced surgical times.

EPS00612 Emerging Biomaterials in Trauma Dr. Shraddha Baburap Patil Midsr Dental College Latur Abstract Background/Introduction Injuries of the facial skeleton pose unique and complex challenges to the maxillofacial trauma surgeon. Over the past few decades, significant advances in biotechnology have provided materials and tools to more efficiently, predictably and reliably reconstruct and rehabilitate patients who have suffered such injuries. Objectives 1) To find replacement constructs that can replicate both in form and function of any lost or missing native tissue. 2) the ideal characteristics of such constructs must mimic native tissues regarding weight, density, strength, and modulus of elasticity. Conclusions Although cumbersome at times, an understanding of material science and emerging biomaterials for those treating maxillofacial trauma is an essential and ever-evolving facet of the surgeons armamentarium. New and exciting technology in such a field is rapidly expanding as an era of demand for improved outcomes and less morbidity is entered. In particular, the arena of bioengineered tissue is making large strides in the forward direction of clinical applicability. All being avidly studied and are expected to make positive changes in the operative management of the trauma patient.

Abstract Background/Introduction Ameloblastoma is a benign odontogenic neoplasm of the mandible and maxilla. 1,2 However, it is reported that maxillary ameloblastoma behave more aggressively and have a poorer prognosis compared with mandibular amelo- blastoma. 3 the painless and slow growth of the lesion and the thin bone of the maxilla are the main factors involved in delay in recognizing a maxillary ameloblastoma. 4 Conser- vative treatment of an ameloblastoma usually results in recurrence and possible malignant transformation. 5 Radical excision of the tumor followed by adequate reconstruc- tion can improve survival and provide more satisfactory functional and cosmetic results. 6 However, reconstruction of multifaceted maxillary defects is a challenge to therecons- tructive surgeon, as it requires provision of adequate anatomical structural support to separate the oral and nasal cavi- ties, and to obliterate the dead space in the maxillary sinus. Here, we report on a recurrent maxillary ameloblastoma that was successfully treated with radical excision and simulta- neous reconstruction using temporomyofascial flap for the maxillary antrum, oral and nasal cavities. Objectives Reconstructing maxilla to its functional and anatomical form. Methods The temporalis muscle was exposed through a coronal inci- sion. The technique of flap elevation and transposition is the same as described by Wolfe. 14 the zygomatic arch and the coronoid process were divided as the flap was used to cover maxillectomy defects. The two laminas of the deep temporal fascia were separate from the zygomatic arch up to the area of fusion. Attachment of the deep temporal fascia to the muscle was reinforced by few absorbable sutures, and the muscle is covered with a skin graft. The temporalis muscle is then used to reconstruct the oral cavity. The entire muscle is rotated into the infratemporal region, on to the size of the palatal defect. Deep sutures are used to secure the flap, and resorbable sutures are placed intraorally to oppose the flap and the remaining palatal mucosa. Any remaining posterior temporalis muscle is secured to the lateral orbital rim to fill the temporal fossa. The scalp incision is closed. Results Class I AND Class II Maxillary defects can be well managed by soft tissue myofascial grafts. Conclusions The temporalis muscle was exposed through a coronal inci- sion. The technique of flap elevation and transposition is the same as described by Wolfe. 14 the zygomatic arch and the coronoid process were divided as the flap was used to cover maxillectomy defects. The two laminas of the deep temporal fascia were separate from the zygomatic arch up to the area of fusion. Attachment of the deep temporal fascia to the muscle was reinforced by few absorbable sutures, and the muscle is covered with a skin graft. The temporalis muscle is then used to reconstruct the oral cavity. The entire muscle is rotated into the infratemporal region, on to the size of the palatal defect. Deep sutures are used to secure the flap, and resorbable sutures are placed intraorally to oppose the flap and the remaining palatal mucosa. Any remaining posterior temporalis muscle is secured to the lateral orbital rim to fill the temporal fossa. The scalp incision is closed.

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EPS00625 Tissue Expanders in Oral and Maxillofacial Surgery Dr. Neha Borkhade, Dr. Geetanjali Mandlik, Dr. Gokul Venkateshwar Dr. D. Y. Patil School of Dentistry, Nerul, Navi Mumbai Abstract Background/Introduction Reconstructive maxillofacial surgery demands constant surgical innovation in order to meet the challenging management of congenital defects, acquired defects and residual deformities in oral and maxillofacial region. Tissue expansion technique induces a controlled in situ skin and mucous membrane growth by stretching it beyond its physiological limit & the mechanotransduction pathways are invoked by which there is increase in mitotic activity and collagen synthesis. Objectives IN TREATMENT OF Cleft lip and palate repair Vertical ridge augmentation Post traumatic or post operative alopecia - Male pattern baldness - Expansion of forehead skin before total nasal reconstruction - Expansion of post auricular skin before external ear reconstruction - Expansion of cheek or neck skin to allow scar revision and burn excision. Methods 1) Self filling osmotic tissue expander, consisting of osmotic active hydrogen which contain vinylpyrrolidone & methylmethacrylate. Once implanted it absorbs body fluids which leads to gradual swelling of the device to a pre-determined volume and size 2) Silicon tissue expander, A device consisting of silicon elastomer inflatable expander with remote injection dome. The expander and injection dome are for subcutaneous or submuscular implantation. Results clinical trial with large sample size and long term observation is required. Conclusions It is a novel method to increase the amount of local tissue available for reconstructing the defect with the same quality of colour and texture which is of paramount importance in facial reconstruction.

EPS00638 Current Role of CT Angiography in Fibula Flap: A Rare Case Study of Peroneal Arteria Magna Dr. Sayali Takalkar, Dr. Maina G, Dr. Mukul P, Dr. Charu G., Dr. Gokul V D. Y. Patil University School of Dentistry, Navi Mumbai Abstract Background/Introduction although doppler imaging could be used to predict exact location of perforator, angio-computed tomography (CT) is necessary in patients needed for reconstruction with free flap from lower extremities. A reported case of Peroneal arteria magna. Objectives this study is to evaluate necessity of angio-computed tomography (CT) as a planning tool in free flap surgeries from lower extremities. Methods 20 patients with mandibular benign pathology (ameloblastoma) undergoing free fibula flap for reconstruction within 25-45 years of age group over a period of 3 years were included in study. After pre-

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 operative colour doppler showed appropriate result to harvest free fibula flap. Out of these, 1 case was diagnosed with peronea arteria magna in which free fibula flap couldn’t be used and reconstruction was done with recon plate. Results doppler imaging is not reliable as Peroneal Magna couldn’t be evaluated and hence, ct angiography must be used. Conclusions CT angiography is a valuable imaging tool for preoperative assessment of donor site vascular supply for lower extremity flaps. It can also reduce intra-operative dissection time and minimizes surgical error in the identification of vascular anatomy.

EPS00701 the Submental Flap in reconstruction of Maxillofacial Defects Prof. Dr. I.B kar, Assoc. Prof. Dr. Niranjan Mishra, Dr. Abhipsa Mishra S.C.B. Dental College and Hospital Abstract Background/Introduction The microsurgical techniques with free flaps are the ‘‘GOLD STANDARD’’ in the immediate reconstruction of post cancer defects in head and neck area. The submental flap is an alternative reconstruction techniques in the maxillofacial field in cases where the microsurgical reconstruction is not indicated. The submental flap was intoduced in 1993 by Martin et al, who first reported the advantages of this flap, applied for postoperative repair of oral facial defects, with respect to highly consistent colour and flexibilitycompared with the head and neck skin, simple harvesting, high innervation and easy suturing at donor site with small scar. Objectives The Submental island flap is becoming increasing popular as an alternative reconstruction techniques.the objective of this e-poster is to show the applied anatomy, various modifications, indications, advantages and disadvantages of the Submental flap in the field of Oral and Maxillofacial Surgery. Methods A literature review was performed, we paid attention to the submental region anatomy, especially to submental artery and vein., surgical techniques for various variants of this flap, indications, merits and demerits of this flap in maxillofacial reconstruction procedures were assessed. Results The Submental Flap has proven to be a reliable alternative in reconstruction of composite oral cavity defects for its thinness, pliabilty, and versatility in design. This Flap can be easily raised and is of excellent choice in patients with a high ASA risk score and elderly patients. Complex defects resulting from surgical excision of facial cancer requires reconstruction using micro vascular free tissue transfer.tissue transfer from areas distant from the face can involve many problems and less often provide a good cosmetic match. The Submental Flap helps surmount in this problem. Cervical skin has similarities with face skin and as a regional flap, it eliminates microsurgical risks. Conclusions With advances in anatomy and surgical techniques, Submental flap is increasingly used to repair various types of head and neck defects. This flap has a wide of rotation hence is easy to rise and has low donor site morbidity. It is a safe, simple and predictable method for reconstruction of oral cavity.

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EPS00730 3D Reconstruction of a Craniofacial Defect

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EPS00745 Uses of Nasolabial Flap in Soft Tissue Defects in Orofacial Region

Sameep M. Bumb Nidhi Gupta SDCH Pune B. H. U., Varanasi Abstract Background/Introduction The use of cranial implants is well documented.the types of materials used is dictated by several factors, the most important of which are size and location of the defect. This technique is particularly useful for cranial defects in esthetic areas or for defects previously considered difficult to restore. Objectives To Reconstruct An Unaesthetic Defect in Left Temporal Region of A Patient Due To Neurofibromatosis Type 1. Methods Titanium Prosthesis Was Made Using 3d Printing Technique. A Hemicoronal Incision Was Taken. Titanium Prosthesis Was Fixed, Residual Defect Was Filled With Iliac Crest Bone Graft And Reconstruction Was Achieved. Results One Month Follow Up of the Patient Showed No Complication And It Showed Acceptable Aesthetic Results. Conclusions Aesthetic Corrections In the Craniomaxilofacial Defects Can Be Made With the Help of Prosthesis Made By Cad Cam Technique And Stereolithographic Models As It Is Difficult To Harvest Autogenous Bone Graft of Such A Huge Size. Also To Prevent Donor Site Morbidity. With the Aid of Cad Technology, All Currently Used Alloplastic Materials Are Suited Even for Large Skull Defect Cranioplasty.

EPS00743 Options in Mandibular Reconstruction Dhanashree Deshpande ABSMIDS Abstract Background/Introduction Mandibular reconstruction is done in defects of mandible resulting from trauma, infection, osteoradionecrosis and most commonly due to ablation surgery of oral cavity and lower face to restore the function, form and esthetics of face to be as close to normal as possible. Various techniques have been reported to be developed over the period of time to obtain optimal results. Objectives To review current literature or the various options available in mandibular reconstruction. Methods A literature review was conducted on various search engines and relevant articles in indexed journals were analyzed. Results The current standard of care for mandibular reconstruction consists of free flaps of bone with or without soft tissue and skin. The vascularized free flaps allow long term reliability and stability alongwith ability to osseointegratein one primary stage. The current available free flap choices are fibula, radial forearm, scapula, anterolateral thigh flap, PMMF. Recent advances in medical modeling is considered as new tool. Conclusions:Every technique has their own advantages and disadvantages, however, the optimal reconstruction depends not only on donor site but also on time of surgery and method of reconstruction.

Abstract Background/Introduction Nasolabial flap is the most common and oldest method soft tissue for reconstruction of oral cavity. Objectives Nasolabial flap uses in soft tissue defects after trauma, excision of soft tissue. Methods Case of lower lip reconstruction, case of oronasal communication, case of oral submucous fibrosis. Results Satisfactory. Conclusions Nasolabial flap is a versatile flap with advantage of rich blood supply.

EPS00755 Stem Cells in Oral and Maxillofacial Surgery Dr. Salma Sultana From Kamineni Institute of Dental Sciences Abstract Background/Introduction Stem cells have enormous potential to alleviate sufferings of many diseases that currently have no effective therapy. The research in this field is growing at an exponential rate. Stem cells are master cells that have specialized capability for self-renewal, potency and capability to differentiate to many cell types. At present, the adult mesenchymal stem cells are being used in the head and neck region for orofacial regeneration. CASE REPORT: Ameloblastoma is a histologically benign tumor, but it shows a tendency of locally aggressive behavior. To our knowledge, this is the first report of a successful reconstruction performed for treating a mandibular defect by using autologous human bone marrow mesenchymal stem cells in a patient with plexiform ameloblastoma. In this article, we report the result of the mandibular reconstruction with autologous human bone marrow mesenchymal stem cells and autogenous bone graft, followed by the placement of osteointegrated dental implant and prosthodontic treatment in a patientwith plexiform ameloblastoma. Objectives reconstruction with autologous human bone marrow mesenchymal stem cells and autogenous bone graft, followed by the placement of osteointegrated dental implant and prosthodontic treatment in a patient with plexiform ameloblastoma. Methods Under general anesthesia, the patient’s right mandibular defect was exposed via intraoral approach. The cortical block bone was harvested in the opposite buccal area. It was fixed using plates and screws as a scaffold for the formation of a bone tray. Then, AHBMMSCs (4.8 107 cells/1.6 mL) were injected into the scaffold. Differentiated autologous osteoblasts (RMS Ossron; Sewoncellontech, Seoul, South Korea) were mixed with fibrin glue (Greenplast; Green Cross, Yongin, South Korea) in a 1:1 ratio and applied (Fig. 2). At a

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S170 postoperative 3-month follow-up, AHBM-MSCs were injected again into the mandibular defect area for the acceleration of bone formation. Results Good results of mandibular reconstruction with autologous human bone marrow mesenchymal stem cells (AHBM-MSCs) and autogenous bone graft, followed by a placement of an osteointegrated dental implant and prosthodontic treatment in a patient with plexiform ameloblastoma. Conclusions Surgeons are tirelessly working to reconstruct continuity defect in maxillofacial region for more than a century. Enormous progress has made especially over the last 40 years. Technique such as microvascular autogenous graft procedures have proved better options for reconstructing large and complex defects, but morbidity associated with harvesting bone graft is a major disadvantage. Alternatively, use of tissue engineering showed exciting promising results at preclinical level and in the limited clinical trial. Yet refinement of the technique and identification of the ideal scaffolding are necessary before wider clinical application. Further studies are required to produce an evidence based practice in tissue bioengineering clinically. This could have significant impact on the reconstruction of maxillofacial defects due to bone loss following trauma or cancer resection.

EPS00789 Comparison of Bite Forces in Patients of Maxillofacial Pathologies Who Undergone Resection of Mandible and Reconstruction with Either Recon Plates or Free Fibular Flap Dr. Anshul Jain I.T.S.CDSR, Muradnagar Abstract Background/Introduction Occlusal bite force is dependent upon the integrity of the muscles of mastication, TMJ, mandible, dentition, and the status of the surrounding hard and soft tissues. Surgical resection of a portion of the mandible, muscles of mastication, and some teeth can cause an imbalance of the remaining muscles of mastication, altered and restricted mandibular movements and a decreased forceful mandibular closure. Mandibular reconstruction is important to maintain esthetic and functional integrity of the maxillo facial structures. Objectives The comparative evaluation of bite forces of patients treated using Recon plates or Free Fibular Flap who has undergone resection of mandible for maxillofacial pathologies. Methods The study was divided into two groups. Group I included patients who had undergone reconstruction of mandibular defect with recon plates and those reconstructed with Free Fibular Flap were taken in Group II. Bite forces on non-operative site are measured and compared post operatively using bite force measurement machine. Results Results shows that patients who has undergone mandibular reconstruction with Free Fibular Flap have higher bite force capability than those reconstructed with Recon plates. Conclusions Within the limitation of study, it was concluded that the free fibular flap can be considered as a reliable option for reconstruction in comparison with Recon plate as the patient can bear more bite forces postoperatively.

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EPS00793 Comparison of Titanium Mesh Vs Prolene in Orbital Floor Reconstruction Dr. Haris Ali Bhat Abstract Background/Introduction Treatment of traumatic orbital injuries has long beena formidable challenge to the maxillofacial surgeon. Surgical technique have become more aggressive, with primary surgical repair directed at restoring bony orbital volume and contour while repositioning herniated orbital tissues. Numerous materials - both naturally occurring and synthetic substances - are available for reconstructing damaged orbital walls to restore orbital volume. Autogenous materials remain the gold standard to which other materials are compared yet Alloplasts have gained popularity for orbital wall reconstruction for their ease of use and elimination of the need for a second operation and its associated morbidity. Objectives This paper seeks to address the controversy regarding application of two very commonly used alloplastic materials—Titanium mesh and Prolene through a series of cases. Methods Titanium mesh has good biocompatibility and is easily adjustable. It is easy to trim and mould exactly to the orbital contour. Because of the mesh structure, connective tissue can grow around and through the implant, preventing its migration. It can be reliably fixed with screws in areas such as the infraorbital border and can be sterilized in autoclaves. Prolene mesh is composed of high-density micropores connected to each other, which allows fibrovascular tissues to advance into the implant. This structure provides certain rigidity to the polyethylene and allows it to automatically fixate to the adjacent tissues. It is strong yet flexible and easy to contour and shape using scissors or a scalpel, and it can be contoured into the desired shape. Results Both materials showed satisfactory results with certain limitations as well. Conclusions Autogenous materials remain the gold standard to which other materials are compared yet Alloplasts have gained popularity for orbital wall reconstruction for their ease of use and elimination of the need for a second operation and its associated morbidity.

EPS00812 Partial Maxillectomy: A Challenge To Reconstruct Priyanka Das Jesabel Krishnadevaraya College of Dental Sciences Abstract Background/Introduction Reconstruction of lost tissues of the body has remained an enigma since time immemorial. Holy Grail of tissue regenerative material is still a mirage. Although, autogenous cancellous bone is considered as a ‘‘gold standard’’
of bone replacement; it poses certain degree of donor site morbidity. To counter this, array of biomaterials have been utilized with variable degree of success. In this case report we have used a new alloplast Polycaprolactone for guided tissue regeneration.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Objectives In this case report, we have used Polycaprolactone scaffold for guided tissue regeneration, to check its efficacy in bone regeneration. Methods Here we are presenting a case report of Maxillary implant supported fixed prosthesis in patient who underwent partial maxillectomy due to ameloblastoma:followed by guided tissue regeneration using Polycaprolactone scaffold along with platelet rich plasma and demineralised bone matrix. Followed by implant placement and prosthetic rehabilitation. Results Polycaprolactone scaffold is certainly a good alternative to conventional bone grafting materails and techniques and that it 1) Eliminates the need for an autogenous;donor site; 2) Is available in unlimited quantity and consistent quality; 3) Has a highly porous and honeycomb-like architecture that facilitates the infiltration of new osteoid and bone trabeculae; 4) Does not evoke an undesirable prolonged inflammatory response. Conclusions Edentulous patients with maxillectomy defects presents a significant challenge for prosthetic rehabilitation and the adaptive capabilities of the patient as retention is highly compromised. hence, the option of using endosseous implant is highly effective and important to increase retention of prosthesis. Poly-e-caprolactone is a novel, synthetic, biodegradable polymer that helps in regeneration of bone with desirable outcomes and following advantages: Controlled and slow degradation profile Highly porous scaffold for easy infiltration of bone. Honeycombed structure facilitate biophysical stimulation Excellent ease of shaping, contouring and customization.

Section: TMJ Surgery ABS0021 TMJ Ankylosis Dr. Piyush Kumar Chhabra

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EPS0037 Arthrocentesis of Temporomandibular Joint: Single Versus Double Needle Technique Gourab Das & Sardar Patel PG institute of Dental & Medical Sciences Abstract Background/Introduction Arthrocentesis is the method of ?ushing of temporomandibular joint (TMJ) by placing needles into the upper joint compartment using ringer’s lactate or physiological saline under LA-the process is referred to as lysis and lavage. There are two techniques-single needle and two needles. Objectives The aim of the study was to compare the effectiveness of five weekly two needle arthrocentesis in the same protocol performed with a single needle technique in patients with inflammatory degenerative disorders of the temporomandibular joint. Methods Patients with TMJ osteoarthritis were randomly assigned to the two needles or single needle protocol and followed up for 6 months after treatment. Several outcome parameters, such as maximum pain at rest and maximum pain on chewing, subjective chewing efficiency, limitation in jaw function, jaw range of motion in mm, were recorded at baseline and multiple follow up assessments. Results Both treatment groups recorded significant improvement with respect to baseline levels in almost all outcome variables. The rate of improvement was not significantly different between the treatment protocols in any of the outcome variables. Conclusions The present investigation did not support the existence of significant differences in the treatment effectiveness for inflammatory degenerative TMJ disorders of a cycle of five weekly arthrocentesis performed according to the classical two needles or the single needle technique.

Buddha Institute of Dental Science and Hospital Abstract Background/Introduction Tempro mandibular joint ankylosis is a pathologic condition where the mandible is fused to the fossa by bony or fibrotic tissue. This interfers with mastication speech, oral hygiene. Trauma is the most common cause of tmj Ankylosis, followed by infection. Objectives To create gap and movement of tmj. Methods Surgical condylectomy. Results and Conclusions Any pathology that afflicts the tmj and mouth opening hence carries a mental sigma. Tmj not only hinders the the integrity of cranio facial skeleton, but also affects the normal growth.

EPS0047 Supratemporalis Approach for Temporomandibular Surgery Dr. Koyel Bhowal, 1st Year Pgt Guru Nanak Institute of Dental Sciences and Research. [email protected]. Contact No-8900139250. Postal AddressB-9/6, Mangalik Co Op Housing Society, Baghajatin, Kol-94. DistSouth24 Pargana, State-Westbengal. Country-India Abstract Background/Introduction Preservation of the functional integrity of the facial nerve (FN) is a critical measure of success in temporomandibular joint (TMJ) surgery.the Supratemporalis approach provides an additional layer of protection (the deep layer of the temporalis fascia and the superficial temporal fat pad) to the temporal and zygomatic branches of the FN and thus, is the safest method to avoid FN injury. Objectives The facial nerve remains at risk of injury with the preauricular approach, the incidence of facial nerve paresis ranges from 1 to 32%

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S172 following this surgery. The aim of this approach to prevent facial nerve injury in temporomandibular joint surgery. Methods The temporal skin incision made 45 degree to zygomatic arch. The flap consisting of skin, subcutaneous tissue, superficial temporalis fascia, subgaleal fascia and deep temporalis fascia. Results Facial nerve injury were observed in the traditional preauricular approach and no facial nerve injuries were observed in the supratemporalis approach. Conclusions The supratemporalis approach prevented facial nerve injury and did not increase the frequency of other complications.

EPS0069 Arthrocentesis for Chronic Temporomandibular Joint Pain Dr. S. Ravi Raja Kumar, Mds Prof& Hod St. Joseph Dental College [Author]., Dr. P. Venu Sameera Pg [Presenter] Abstract Background/Introduction Temperomandibular joint arthrocentesis is a form of minimally invasive surgical treatment in patients suffering from chronic temporomandibular joint pain with limited mouth opening. It consists of washing the joint with suitable irrigants for the removal of chemical inflammatory mediators and changes in intra articular pressure. Objectives To evaluate the efficacy of TMJ arthrocentesis for relieving TMJ pain with limited mouth opening in patients who had proved refractory to conservative management. Methods A 15 year old female patient presented with reports of pain in right and left TMJ, bilateral clicking sounds.mild deviation to left side, and limited mouth opening. As treatment modality, arthrocentesis on right and left TMJ was done with traditional two needle technique under aseptic condition. Holmlund-Hellsing line was drawn from tragus of ear to lateral canthus of eye. One needle placed 10mm forward along this line and other 2mm below it. Joint lavage done with Ringer Lactate solution followed by intrajoint steroid injection. Bilaterally impacted upper molars were removed simultaneously and a soft splint was given to patient followed by post operative antibiotics and analgesics. Results Significant improvement was seen in the immediate post operative period along with reduction in pain, increased mouth opening. Conclusions Arthrocentesis is a valid treatment option for Chronic Temperomandibular Joint pain with limited range of motion in patients where other conservative modalities have failed.

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EPS0092 Management of Temporomandibular Joint Dr. Vishalakshi Srivastava Career Post Graduate Institute of Dental Sciences & Hospital, Lucknow Abstract Background/Introduction The ankylosis of tmj is a challenging problem for both patient and surgeon. a variety of techniques for treatment of tmj ankylosis have been described in literature. There are three basic techniques currently employed gap arthoplasty, interpositional arthoplasty, joint recunstructions, however no single method has produced uniformly succesful results.limited range of motion and reankylosis are most frequently reported complications. Objectives The purpose of this study was to evaluate and compare the techniques of gap arthoplasty and interpositional arthoplasty using temporalis fascia to achieve maximum interincisal mouth opening for treatment of ankylosis. Methods Cases with clinicoradiological diagnosis of tmj ankylosis were selected and treated by gap arthoplasty and interpositional arthoplasty using temporalis fascia and patient were followed for one year. Results There is no significant difference in post operative mouth opening in both the cases. Conclusions From the result there is no significant difference between the patient treated with gap arthoplasty and interpositional arthoplasty the overall out come of the treatment depends upon active physiotherapy patient cooperation and regular follow up.

EPS0095 Temporomandibular Joint Arthrocentesis Dr. Tejinder Kaur, Dr. Amit Dhawan, Dr. Sarika Kapila SGRD Institute of Dental Sciences and Rresearch Abstract Background/Introduction Arthrocentesis of the temporomandibular joint is regarded as a simple, non- invasive, inexpensive and highly effective procedure for patients suffering from multitude of temporomandibular disorders. Restores mobility of joint by reestablishing joint lubrication and fluidity. Objectives To highlight the efficacy of a non-invasive and most predictable treatment that can be readily available to the patient and the full restoration of function with improvement of the quality and quantity of life. Methods Two points are marked over the skin of the affected joint indicating the articular fossa and eminence. Followed by injection of a local anesthetic to block the auriculotemporal nerve. A19-gauge needle is then inserted into the superior compartment at the articular fossa followed by injection of Ringer Lactate’s solution to distend the joint space. Another needle is inserted into distended compartment to enable a free flow of solution through superior compartment.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Results This technique is useful in increasing maximum mouth opening decrease in pain level and inflammation of joint by massive irrigation and lavage of joint space. Conclusions This technique is easy and reproducible. It is highly effective providing significant improvement in maximum mouth opening and lateral movement.

EPS00144 Role of Arthrocentesis in Internal Dearrangement: A Pilot Study Dr. Vishakha Lal Institute of Dental Sciences, Bareilly Abstract Background/Introduction Internal derangement is defined as an abnormal relationship of the articular disc to the mandibular condyle fossa and articular eminence. Clinically internal derangement are characterized by interference of restriction of joint function during mandibular movement. Joint noise, especially clicking, is a common finding. The conservative means of treatment are medication, bite appliances, physiotherapy and manipulation of joints. When it fails to provide a solution, surgical intervention such as surgical disc repair and re-positioning are used. One of the most acceptable minimal invasive surgeries is arthroscopic lavage/arthrocentesis if the superior joint compartment. Objectives Is to investigate the condition of TMJ relative to the effectiveness of arthrocentesis under sufficient hydraulic pressure in patients with chronic closed lock. Methods We performed arthrocentesis as a treatment. The changes in the maximum mouth opening, joint pain and clicking sound were examined to determine the effectiveness of the treatment before the treatment and after the treatment. Results After 2 months follow up maximal mouth opening of patient increases, joint pain at mouth opening and clicking sound were reduced. Conclusions Arthrocentesis is a simple, less invasive, inexpensive and highly efficient procedure which can be performed under local anaesthesia for the treatment of internal derangement.

EPS00148 Ladder for TMJ Ankylosis: Management Chhattisgarh Dental College & Research Institute (C.G.) Chhattisgarh Dental College & Research Institute (C.G.) Abstract Background/Introduction TMJ Ankylosis can be accompanied by various degrees of functional and esthetic problems such as reduced mouth opening, malocclusion, facial asymmetry and respiratory problem. The surgical procedures may include release of ankylotic mass, mandibular lengthening & correction of chin.

S173 Objectives To evaluate the effect of sequential treatment of TMJ Ankylosis by gap arthroplasty, mandibular lengthening by distraction osteogenesis & chin correction by genoplasty. Methods We included 6 cases between the age group of 14-18 yrs, all of them having unilateral TMJ Ankylosis. Sequence of treatment was gap arthroplasty, intraoral distraction osteogenesis & genoplasty. Results All patients had TMJ Ankylosis secondary to trauma. The amount of mouth opening (33-35mm) & distraction range from (16-20mm). The most common post operative complication was development of open bite which could be corrected with help of intraoral elastics. Conclusions Our study suggests that gap arthroplasty, distraction osteogenesis & genoplasty can be considered as a sequential treatment for TMJ Ankylosis. This protocol is better for gross facial asymmetry, TMJ function & correction of occlusal cant. However, there is still some controversy over proper sequencing of management for the ankylosis patients.

EPS00171 Use of Temporalis Fascia as an Arthoplasty in Tmj Ankylosis: Prospective Study Dr. Neelakamal Hallur, Dr. Aaisha Siddiqua, Dr. Syed Zakaullah, Dr. Ashwin Shah, Dr. Chaitanya K., Dr. Shereen Fatima Al Badar Dental College and Hospital Gulbarga Abstract Background/Introduction Ankylosis is defined as ‘‘Inability to open due to either a fibrous or bony union between the head of the condyle and the glenoid fossa’’. It causes disturbances of facial growth and acute compromise of the airway, which invariably results in physical and psychological disability. Objectives The present study was conducted to evaluate the use of temporalis fascia as an interpositional arthroplasty material in TMJ ankyloses with respect to improvement in post-operative mouth opening. Methods This study was conducted on 10 patients who were diagnosed with tmj bony ankylosis and where operated under general anaesthesia using fiber-optic naso tracheal intubation, AL-KAYAT BRAMLEY incision, aggressive resection of ankylotic mass, ipsilateral/contralateral coronoidectomy, interpositional arthroplasty using temporalis fascia flap, early mobilization and aggressive physiotherapy was performed. Evaluation of functional outcome and recurrence was assessed by preoperative, intraoperative and postoperative mouth opening for a period of one year. Results In this study mean pre-operative mouth opening was 4.0mm ? 2.86mm and mean post-operative mouth opening was 35.1 ? 6.76mm after one month, 35.8 ? 6.85mm after six months, and 36.6 ? 7.71 mm after one year. Comparison of pre and post-operative mouth opening was done using student t-test which showed significant difference in mouth opening. Conclusions In this study we had 100% success rate with no case of recurrence. This study concluded that interposition of temporalis fascia in tmj ankylosis produced good results in mouth opening and jaw function and is reliable method to prevent recurrence of ankylosis and achieve long term good results.

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EPS00181 TMJ Arthrocentesis: A Case Report Dr. Kalyani Gelada, Bharati Vidyapeeth Dental College and Hospital, Pune Abstract Background/Introduction Temporomandibular joint dysfunction (TMD) is a clinically significant condition which can be a source of acute or chronic orofacial pain and dysfunction including limitation of mandibular movement, pain with mandibular function and joint sounds. Usually there are two types of treatment given, surgical, which includes arthroscopy, acupuncture, arthrocentesis in TMD and non surgical, includes physical therapy, pharmacotherapy, NSAIDS, local anesthetics, TMJ injections, muscle relaxants, antidepressants, occlusal appliance therapy and occlusal adjustments. Arthrocentesis is joint lavage which washes out the inflammatory mediators, thereby, relieving pain. Arthrocentesis is a relatively simple office procedure which allows expansion of the joint space, lysis of adhesions and lavage via blind input and outflow catheters. However, surgeons can be faced with some clinical difficulties with two needles during the procedure such as displacement of the needles during the irrigation and difficulty of inserting the outflow needle in the right place. To combat this difficulty, TMJ lavage with double needle in a single canula has been documented in the literature. However it was not in routine use probably because of the lack of presentation. The purpose of this presentation is to describe this instrument and state the advantages of the technique. Objectives The purpose of this study is to demonstrate a temporomandibular lavage instrument with double needles in a single canula that make the procedure easier for surgeons. Methods Comparison between two surgical procedures for TMJ lysis and lavage was performed. Results The upper joint space was successfully lavaged with 50 mL of 0.9% saline solution. Maximal mouth opening and lateral jaw movement increased and jaw functions improved immediately after the procedure. Conclusions A simple alternative to classical arthrocentesis with two needles that it is easy to use and enables to perform lysis and lavage with a single puncture.

EPS00194 Abstract Topic: TMJ Surgery

Condylar Fractures: Current Trends and Controversies Dr. Dhritiman Pathak, Dr. Gaurav Singh, Dr. Madan Mishra, Sardar Patel Post Graduate Institute of Dental and Medical Sciences Abstract Background/Introduction The incidence of condylar fractures is high, but the management of fractures of the mandibular condyle continues to be controversial.

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Although it is widely accepted that the treatment out-comes of open reduction and internal fixation are superior to those of conservative treatment for grossly displaced condylar fractures. Historically, maxillomandibular fixation, external fixation, and surgical splints with internal fixation systems were the techniques commonly used in the treatment of the fractured mandible. Treatment depends on the age of the patient, the co existence of other mandibular or maxillary fractures, whether the condylar fracture is unilateral or bilateral, the level and displacement of the fracture, the state of dentition and dental occlusion. Objectives To evaluate current treatment modalities of mandibular condylar fracture. Methods A review of world English literature search concerning current treatment modalities of mandibular condylar fractures was performed and evaluated. Results Despite of all the controversies most surgeons have advocated open treatment based their decision, on the position of the fractured condylar process and the degree of displacement and dislocation. Conclusions A trend is emerging in the surgical literature confirming superior functional results following open reduction and internal fixation of condylar fractures. Radiographically, a better anatomic reduction of the condylar process was seen in the patients treated with ORIF. New technology to facilitate transoral ORIF has offered the promise of eliminating some of the adverse sequelae associated with ORIF through a transfacial approach.

EPS00195 Arthrocentesis of Temporomandibular Joint: Single Versus Double Needle Technique Dr. Akshay Kumar, Dr. Gaurav Singh, Dr. Amit Gaur, Sardar Patel Post Graduate Institute of Dental and Medical Sciences Abstract Background/Introduction Arthrocentesis is a minimally invasive surgical intervention of the temporomandibular joint. It is indicated for patients with joint disc displacement with and without reduction, disc adherences with mouth opening limitations, synovitis/capsulitis, painful articular noise during mouth opening/closing, as well as a palliative in acute cases of rheumatoid arthritis. Objectives To compare single-needle arthrocentesis of the temporomandibular joint (TMJ) with the conventional two-needle arthrocentesis. Methods Patients with TMJ osteoarthritis were randomly assigned to the twoneedle or single-needle protocol and followed up for 6 months after treatment. The present investigation did not support the existence of significant differences in the treatment effectiveness for inflammatory degenerative TMJ disorders of a cycle of five weekly arthrocentesis performed according to the classical two-needle or the single-needle technique. Results Both treatment groups recorded significant improvement with respect to baseline levels in almost all outcome variables. The rate of improvement was not significantly different between the treatment protocols in any of the outcome variables.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Conclusions Both techniques are equally effective at reducing pain and increasing the maximal mouth opening. The single needle technique was easier to perform and required a shorter operative time.

EPS00196 Condylar Fractures: Current trends and Controversies Dr. Dhritiman Pathak, Dr. Gaurav Singh, Dr. Madan Mishra Sardar Patel Post Graduate Institute of Dental and Medical Sciences Abstract Background/Introduction The incidence of condylar fractures is high, but the management of fractures of the mandibular condyle continues to be controversial. Although it is widely accepted that the treatment out-comes of open reduction and internal fixation are superior to those of conservative treatment for grossly displaced condylar fractures. Historically, maxillomandibular fixation, external fixation, and surgical splints with internal fixation systems were the techniques commonly used in the treatment of the fractured mandible. Treatment depends on the age of the patient, the co existence of other mandibular or maxillary fractures, whether the condylar fracture is unilateral or bilateral, the level and displacement of the fracture, the state of dentition and dental occlusion. Objectives To evaluate current treatment modalities of mandibular condylar fracture. Methods A review of world English literature search concerning current treatment modalities of mandibular condylar fractures was performed and evaluated. Results Despite of all the controversies most surgeons have advocated open treatment based their decision, on the position of the fractured condylar process and the degree of displacement and dislocation. Conclusions A trend is emerging in the surgical literature confirming superior functional results following open reduction and internal fixation of condylar fractures. Radiographically, a better anatomic reduction of the condylar process was seen in the patients treated with ORIF. New technology to facilitate transoral ORIF has offered the promise of eliminating some of the adverse sequelae associated with ORIF through a transfacial approach.

EPS00212 Management of TMJ Ankylosis: A Comparison Between Gap Arthroplasty and Interpositional Arthroplasty Using Temporal Fascia Post Graduate Institute of Dental and Medical Sciences Post Graduate Institute of Dental and Medical Sciences Abstract Background/Introduction Temporomandibular joint ankylosis is a debilitating condition. It is the fusion of articular surface of glenoid fossa and condyle with bony or fibrous tissue. It may be caused by trauma, infection, degenerative joint disease, prolonged maxillo-mandibular fixation, inflammatory conditions like rheumatoid arthritis and polyarthritis. Objectives

S175 The purpose of this study was to evaluate and compare the two available techniques of gap arthroplasty to achieve maximum interincisal mouth opening for the treatment of TMJ ankylosis and the objective was to select postoperative regimen and better technique to minimize reankylosis. Methods Twenty patients with TMJ ankylosis were included in the study and selected patients were of age in range from 5 to 25 years and divided in two groups. In group I patients, gap arthroplasty was performed and in group II patients, interpositional arthroplasty with temporalis fascial flap was performed and both groups was compared on varies parameter such as interincisal opening (mm), swelling, infection, facial nerve weakness, pain, wound dehiscence. Regular follow up was done for 1st, 2nd week, 1, 3, 6 month and 1 year postoperatively. Results There is no statistically significant difference observed in both the group when compare for postoperative mouth opening, pain and swelling. None of the cases in both the groups had wound dehiscence, infection and facial nerve weakness at any time interval. Conclusions We conclude that there is no significant difference between the patients treated with interpositional arthroplasty and gap arthroplasty. The overall outcome of the treatment depends on patient’s cooperation, active physiotherapy and regular follow-up.

EPS00222 Efficacy of Pterygoid Disjunction in the Treatment of Internal Derangement of Temporomandibular Joint Dr. Gajendra Bagri RUHS College of Dental Science, Jaipur Abstract Background/Introduction In our study of the technique of Pterygoid Plate Disjunction, decompression of the joint takes place indirectly. The joint space is not encroached upon, but since the pterygoid plates from which both the pterygoid muscles originate are detached, the spasm in these muscles is presumably relieved. The anterior and upward pull on the condyle is reduced, which in turn reduces the pressure on the retrodiscal lamina and alleviates the pain. Since the joint space is under less pressure, there is a better chance for the marginally displaced disc to return to its normal position. It can be deduced that the joint becomes lax and the movements become smoother, thus inducing less strain in the posterior lamina. Objectives The purpose of this study is to study the effectiveness of pterygoid plate disjunction in the management of the TMJ pain and dysfunction in patient with internal derangement of temporomandibular joint. Methods All the patients with internal derangement of temporomandibular joint having anterior disc displacement with reduction with complaints of pain and limited opening of mouth, of all age group reporting to the Department of Oral & Maxillofacial Surgery, GDC Jaipur 8 patients were included in the study. Results In our study, All the patients are satisfied at the 6 months follow up. Conclusions It is concluded that, disjunction and displacement of the pterygoid plates is minimally invasive and can be done as a day care procedure. No intensive physiotherapy or intermaxillary fixation is required.

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ABS00239 Prospective Evaluation of EMG Activities of Masseter and Temporalis Muscle in TMJ Ankylosis Patients: A Case Series Dr. Pawan Kumar, Dr. Virendra Singh PGIDS Rohtak Haryana Abstract Background/Introduction Ankylosis is defined as a chronic limitation of motion. Jaw movement is limited as a result of the fibrous or bony fusion of a temporomandibular joint. Electromyography is considered as a tool to measure the muscle activity In the present study the electromyographic activities of masseter and temporalis muscles in patients with unilateral TMJ ankyloses were measured on the affected and normal side before and after surgery and the clinical significance of the change in EMG activity evaluated. Objectives To evaluate the change in EMG activity of masseter and temporalis muscle in TMJ ankylosis patients on the affected and normal side before and after surgery. Methods In 10 patients of unilateral TMJ ankylosis Electromyography of Masseter and Temporalis muscle of operated site and contralateral site was done before surgery, 1 week, 1 month, 3 month and 6 month interval after surgery. Amplitude levels (peak to peak) before surgery and after surgery were compared statistically under maximum clenching state. For measuring EMG of masseter muscle the needle was inserted 2.5cm above and in front of angle of mandible and for Temporalis muscle needle is inserted 2.5cm behind the lateral margin of orbit and above the upper border of zygomatic arch. Results EMG activity of the Masseter and Temporalis muscle at the operated site was reduced at 1 week after surgery as compared to pre-operative value. There was increase in EMG activity at regular follow ups after 1 week. After physiotherapy there was better increase in EMG activity on operated sides in 1 month, 3 month and 6 month follow-up are statistically significant (p\ 0.05). Conclusions EMG study plays a key role in measuring the activity of muscles and it helps in determining the duration of physiotherapy required after surgery of TMJ Ankylosis patients.

EPS00241 Efficacy of Arthrocentesis with and Without Injection of Sodium Hyaluronate in Treatment of Internal Derangement of Temporomandibular Joint Presenting Author: Surabhi Sarkar; Co-authors: Shyam Sundar, Sujeeth Shetty, Saikrishna D JSS Dental College and Hospital, Mysore Abstract Background/Introduction Internal derangement of the TMJ is the most commonly encountered TMD with symptoms of pain, joint sounds, restricted mouth opening and impaired jaw functions. One of the various treatment methods is

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 the intra-articular injection of sodium hyaluronate which is a minimally invasive technique and has shown to be safe and effective. Objectives To compare the efficacy of Temporomandibular joint arthrocentesis with and without injection of sodium hyaluronate in treatment of internal derangement. Methods In this prospective study 20 subjects who had been clinically diagnosed with internal derangement of TMJ were selected and randomly divided into 2 groups. Group-A subjects got only arthocentesis treatment and Group-B was treated with arthocentesis with intra-articular injection of sodium hyaluronate. For each subject, pretreatment and post-treatment (1 week and three months follow-up) level of pain, maximum interincisal opening (MIO) were recorded along with lateral excursive movements, joint noises and deviation. Results In Group A; mean preoperative pain was 2.6. On 3 months follow-up the mean was 1.2. Mean MIO was preoperatively 42.0mm and postoperatively 42.0mm. In Group B; preoperative pain was a mean of 4.4 and postoperative 0.6 on 3 months follow-up. Preoperative MIO was 34.2mm, postoperative mean of 39.4mm. Conclusions Both treatment modalities achieved improved results of mouth opening and jaw functions with reducing pain but the addition of injection of sodium hyaluronate fetched better outcomes than arthrocentesis alone.

EPS00248 the Efficacy of Prolotherapy in Temporomandibular Joint Dysfunction Dr. Hardeepsinh Mori Govt. Dental College & Research Institute Bangalore Abstract Background/Introduction One of the most common causes of orofacial pain is the Temporomandibular Joint Disorder (TMD), a collective term used to describe a group of disorders causing temporomandibular joint (TMJ) pain and dysfunction. Prolotherapy is a short for ‘‘proliferation injection therapy’’. The basic principle of Prolotherapy is to inject a substance that will cause a low-grade inflammatory process within the joint, drawing in fibroblasts that strengthen the attachments of tendons and ligaments. The process stabilizes the joint, improves the range of motion in a hypomobile joint, helps prevent dislocation in a hypermobile joint and relieves pain. Objectives Prolotherapy is an injection-based complementary treatment, which has shown promising results in the different musculoskeletal disorders. The aim and objective of this study is to determine the therapeutic efficacy of dextrose prolotherapy on pain, range of motion, and function in patients with TMJ disorders. Methods After obtaining consent, the procedure will be explained to the patient and each of the patients who will meet the above said criteria will be selected. Injection site will be prepared and wiped with alcohol. one inch, 30-gauge needle will be used. The injection solution consists of 0.75mL of 50% dextrose, 0.75mL of bacteriostatic water, and 1.5 mLof 2% lidocaine into a 3-mL syringe for each TMJ. The result will be a dextrose concentration of approximately 12.5%. Our standard program will be to repeat the injections three times, at two-week,

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 four-week, and six-week intervals. This total four injection appointments over twelve weeks. Results Data obtained will be subjected to statistical analysis and conclusion will be arrived at. Conclusions Data obtained will be subjected to statistical analysis and conclusion will be arrived at.

EPS00253 Application of Computer Assisted Surgical Navigation in Temporomandibular Joint Ankylosis Dr. Tejinder, Dr. Jasmine, Dr. Amneet Sri Guru Ram Das Institute of Dental Sciences and Research, Sri Amritsar Abstract Background/Introduction Temporomandibular joint (TMJ) ankylosis involves fusion of mandibular condyle to the base of skull, which can cause speech impairment, difficulty with mastication, facial disfigurement, airway compromise and psychological stress. Objectives Rehabilitating the mandibular movement and function, preventing reankylosis and promoting mandibular growth are the main treatment objectives. Treatment for TMJ ankylosis includes interpositional arthroplasty, gap arthroplasty and reconstruction of joint using autogenous or artificial materials. Methods In patients with TMJ ankylosis, the irregular ankylotic bone has no clear margin with normal anatomic structures. There is high risk of haemorrhage resulting from damage of internal maxillofacial artery, duramater exposure, nerve injuries and cerebrospinal fluid leak. The intraoperative real-time display of the surgical position and its relationship with the surrounding structures can significantly increase the accuracy of operation and reduce the risks especially for high risk operations such as gap arthroplasty. Acquired images of TMJ(MRI or CT scan) can be loaded into an intraoperative navigation system to guide joint space manipulation. Radiography is not performed intraoperatively, changes in soft tissues such as those caused by synovitis or changes in disk position may not be detected by CT scans or MRI. Thus; only bony structures in relation to TMJ act as reference. Results 1. Decrease of error in access; 2. decrease of risk of damaging intraarticular tissue and structures by instrumentation; 3.more accuracy in detecting and treating intra-articular disease. Conclusions In conclusion, use of computer based, image guided navigation system is of great benefit for TMJ gap arthroplasty because of reduced surgery time, promoted surgical security, minimally invasive access and reduced risk to surrounding vital structures.

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EPS00260 Novel Technique for Harvesting the Sternoclavicular Graft Dr. Sujata Mohanty, Dr. Rudra Deo Kumar, Maulana Azad Institute of Dental Sciences Abstract Background/Introduction Originally introduced for mandibular reconstruction more than 40 years ago, the sternoclavicular graft (SCG) has gained widespread popularity for the reconstruction of the ramus-condyle unit (RCU) owing to its anatomic and histological likeness to the normal mandibular condyle. Conventional longitudinal osteotomy design for its harvest has been fraught with considerable complications at the donor site including fracture clavicle and major neurovascular injury. In an attempt to alleviate these ill effects, a new technique for procuring the sternoclavicular graft is presented. Objectives A new technique for procuring the sternoclavicular graft is presented in an attempt to alleviate the ill effects of conventional longitudinal osteotomy design for its harvest. Methods A split-thickness cortico-cancellous graft was harvested form the sternal end of the clavicle along with the articular disk with the osteotomy cut oriented parallel to the coronal plane, with limited soft tissue dissection. Donor site complications were assessed in terms of incidence of clavicle fracture, neurovascular injury, pleural tear and radiographic healing as seen in the six-month postoperative chest radiograph. Results 17 patients suffering from unilateral temporomandibular joint ankylosis underwent SCG harvesting for RCU reconstruction following osteoarthrectomy. No adverse events were seen in the intra and postoperative period in any patient and satisfactory radiographic osseous healing was observed after six months. Conclusions The proposed harvest technique for SCG results in reduced donor site morbidity and favorable healing and greater patient comfort.

EPS00275 Surgical Management of TMJ Dislocation (Iatrogenic): A Rare Complication of OSMF Management Dr. Meghali Diwaker, Dr. Bibhu Prasad Mishra I.T.S Dental College & Hospital, Greater Noida, I.T.S Dental College & Hospital, Greater Noida Abstract Background/Introduction Dislocation of the temporomandibular joint is not an uncommon condition. It may be unilateral or bilateral and can be acute, recurrent and rarely chronic. There are various reasons causing TMJ dislocation like iatrogenic, spontaneous, systemic diseases, trauma, anatomical factors and use of certain pharmacological drugs. Iatrogenically it can occur during intubation/laryngoscopy procedures or during dental and throat procedures. In this case report we are presenting a TMJ dislocation case due to OSMF management complication which is a very rare entity and has not yet been reported in the literature.

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S178 Objectives • the patient reported to our department with the chief complaint of inability to close his mouth and difficulty in speaking and chewing since 1 month. As it already was a treated case of OSMF, treating this case was a challenge for us as we had to bring about closure of the mouth to prevent dislocation of joint and simultaneously we had to maintain a mouth opening to prevent fibrosis of mucosa and recurrence of OSMF. Also the sufficient vertical height had to be maintained. • So the main objectives were: o Repositioning of condyle into glenoid fossa and prevention of recurrence. o Closure of mouth and to restore normal physiological functions. o Maintaining a minimum mouth opening of 35 mm. Methods The treatment planned was planned under GA in the following manner: • Reflection of surgical site with Alkayet Bramley incision. • Condylectomy on the dislocated side and condylotomy on the other side. • Reconstruction with temporalis fascia flap. • Post operative Aggressive physiotherapy. Results The surgical procedure was carried out as planned. The dislocation was corrected by performing condylectomy on the affected side. The post operative oedema was controlled by the placement of drains on both the sides operatively. We were successful in achieving the mouth opening of 35 mm. By post operative day 2 the mouth opening achieved was 33 mm. The patient is still under aggressive physiotherapy. The patient is very much satisfied by the results as he can now both open and close his mouth. Conclusions TMJ is one of the most peculiar area of oral and maxillofacial region. Any anatomic and functional disturbance in TMJ should be treated in earlier stage. TMJ dislocation cases can be treated easily at acute stages otherwise fibrosis of joint space will transform the condition into chronic stage which is more difficult to treat and require surgical intervention.

EPS00277 Efficacy of Dermis Fat Graft as Interpositioning Material in the Management of TMJ Ankylosis

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Conclusions It is true that the use of th edermis fat graft is a safe and effective procedure in the management of TMJ Ankylosis.

EPS00306 Post -Traumatic Adult TMJ Ankylosis: A Case Report Dr. Pratiksha Dwivedi 1st Year PG Student Institute of Dental Studies and Technologies Abstract Background/Introduction Limited mouth opening can be caused by bony or fibrous ankylosis of the TMJ as a sequel to trauma, infection, autoimmune disease or failed surgery. It is a disabling condition leading to malocclusion, alter eating habits and speech problems, OSA and poor oral hygiene. Post-traumatic ankylosis in adults can be caused by ossification of hematoma, maltreated facial fractures, systemic diseases such as ankylosing spondylitis and rheumatoid arthritis. The basic treatment used on adult patient is condylectomy with gap arthroplasty. Objectives This poster presents a misdiagnosed case of condylar fracture leading to ankylosis over a period of 4 years in an adult and its management. The mean maximal incisal opening (MIO) in the preoperative period was 8 mm and in the postoperative period it was 32 mm. Methods A 26 year old male reported to the department with chief complaint of difficulty in mouth opening following RTA 4 years back. On the basis of clinical and radiographic examination, the case was diagnosed as TMJ ankylosis and gap arthroplasty was performed followed by maxilomandibular fixation and vigorous oral physiotherapy. Results Gap arthroplasty followed by physiotherapy shows good results in posttraumatic TMJ ankylosis. The patient on a regular follow up of one year postoperatively maintained a mouth opening of 30 mm. Conclusions The findings of case supports the use of gap arthroplasty with physiotherapy in adult post traumatic TMJ ankylotic patients.

Dr. Ritesh Kumar Govt. Dental College and Hospital, Jaipur, Rajsthan Abstract Background/Introduction TMJ ankylosis is one of the most incapacitating and common problem in developing countries.gap arthroplasty and interpositional arthroplasty are the treatment options and various interpositional material like temporalis muscle fat and fascia, costal cartilage, masseter muscle, silastic sheet, Dermis fat graft etc. Objectives This study purpose is to determine the efficacy of dermis fat graft in the management of TMJ ankylosis. Methods All the patients with TMJ ankylosis, according to shaneys classification of all age group & unilateral or bilateral, reporting to the department of OMFS, GDC Jaipur were included in the study. Results In our study 10 patiets of TMJ ankylosis wre treated by gap arthroplasty and interpositioning the dermis fat graft taken from groin region.post operative mouth opening of 3.15 cm mean were obtained during the 12 month followup period which indicate the effictiveness of procedure and no patient has recurrence of ankylosis.

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EPS00329 Surgical Approaches to Temporomandibular Joint Dr. Aniket Kakade Terna Dental College & Hospital, Nerul, Navi Mumbai, Maharashtra Abstract Background/Introduction Surgical access to the temporomandibular joint is an exacting procedure. It requires technical skill and a thorough knowledge of anatomy of the area. Temporomandibular joint has got close proximity to the main trunk of the facial nerve with its branches in the temporal and facial areas. It has also got close proximity to the auriculotemporal nerve and the abundant vascular supply. The incisions used in temporomandibular joint (TMJ) surgery represent a compromise between the need for adequate access and the desire to achieve a cosmetically acceptable postsurgical scar. This poster depicts the various approaches and incisions to Temporomandibular joint surgeries, Indications for the selection of the incision and technique of each incision.

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ABS00334 Comparision of Approaches for Rigid Fixaton of Subcondylar Fractures of Mandible Presented By Dr. M. Anil Kumar, Dr. G. Harsha, Mds, Momsrcps (Glasg) (Prof&Hod) Abstract Background/Introduction The most common manibular fractures is the condylar fracture, involving neck & subcondylar fractuers.the frequency of condylar fractures accounts for more than a third of all mandibular fractuers. Objectives The parameters evaluated are: injuries to the seventh cranial nerve(facial nerve paralysis), mouth opening, lateral and protrusive movements of jaw, pain, occlusion, an assessment of the surgical scar. Methods A prospective randomized case control study conducted on 30 patients reporting to the dept of oral and maxillofacial surgery at mnr dental college and hospital, sangareddy, comparing three incisions i.e preauricular, risdons incision and retromandibular incisions which where divided into 3 groups. Results Group A: immediate postoperatively 4 patients had facial nerve paralysis and at 2 to 3 months postoperative followup no facial nerve paralysis seen group b: facial nerve paralysis not seen immediately group c: immediate postoperatively 1 patient had paralysis. Conclusions To conclude, comparision of the complications could not ascertain the superiority of any approach over the other since the outcomes were not statistically significant.

EPS00335 Treatment Protocol in Temporo Mandibular Joint Disorders Maj Abhishek Mishra AFMC Pune Abstract Background/Introduction Temporomandibular disorder (TMD) is the general term used to describe the manifestation of pain and/or dysfunction of the temporomandibular joint (TMJ) and its associated structures. Objectives presentation of various types of TMDs and its managements protocol. Conclusions The etiology of TMD is presumed to include trauma, parafunctional habits, malocclusion, joint overloading, arthritides, psychological factors, and ergonomic positioning of the head. The dilemma for the clinician is exacerbated by the broad spectrum of results and claims that use a seemingly endless variety of surgical and nonsurgical strategies. There are absolute indications where surgical intervention would be of primary benefit, and the questions would be whether there is still a role for nonsurgical therapy in these patients, and if so, when it should be instituted and for how long.

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EPS00355 Comparison of Clinical Treatment Outcomes in Tmj Dysfunction Between Conventional and Ultrasound Guided Arthrocentesis a Quasi Experimental Study Dr. Jayalakshmi Jayakumar, Dr. S. Mohan Government Dental College Kottayam Abstract Background/Introduction Temporomandibular joint disorder (TMD) is term used to describe the manifestation of pain and dysfunction of temporomandibular joint. Internal derangement (ID) is a functional disorder of the temporomandibular joint (TMJ) most frequently caused by anterior and medial displacement of the articular disc, which can cause various degrees of pain and dysfunction. Patients who do not respond to nonsurgical therapy may require more invasive procedures such as arthrocentesis and arthroscopy. TMJ arthrocentesis aims in releasing the articular disc and to remove adhesions between the disc surface and the mandibular fossa and hence identification of the upper joint space is important for successful lysis and lavage. Objectives Aim of the study is to compare the clinical outcome of ultrasound guided TMJ arthrocentesis with conventional arthrocentesis in individuals with TMJ dysfunction at third day, after one week and one month post operatively. Methods Twenty temporomandibular joint internal derangement patients who were not responsive to conservative treatment modalities were included in the study. Patients were divided into two groups. Group 1 underwent conventional arthrocentesis and group 2 underwent ultrasound guided arthrocentesis. Difference in the degree of mouth opening and pain on movements were compared between both groups after three days, one week and one month of the procedure. Results Difference between pre-operative and post-operative inter-incisal distance and VAS score were significant in both the groups. When Group 1 and Group 2 patients were compared Group 2 showed significant reduction in VAS score only at the third day follow up of the procedure. There was not significant inter-group difference in improvement of mouth opening. Conclusions Based on this study we conclude both conventional arthrocentesis and ultrasound guided arthrocentesis are effective in management of TMJ dysfunction. Ultrasound guide in arthrocentesis is not resulting significant difference improvement of symptoms when compared to the conventional arthrocentesis.

EPS00374 To Evaluate the Effectiveness of Platelet Rich Fibrin with High Condylectomy in Internal Derangement of Tmj Dr. Nikunj Makwana Abstract Background/Introduction Internal derangement of the temporomandibular joint (TMJ) may be defined as a disruption within the internal aspects of the TMJ in which there is a displacement of the disc from its normal functional

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S180 relationship with the mandibular condyle and the articular portion of the temporal bone. Objectives The purpose of this study is to evaluate the effectiveness of platelet rich fibrin with high condylectomy in the management of the TMJ pain and dysfunction in patient with internal derangement of TMJ. Methods All the patients with internal derangement of temporomandibular joint having anterior disc displacement without reduction with complaints of pain and limited opening of mouth, of all age group reporting to the Department of Oral & Maxillofacial Surgery, GDC Jaipur 20 patients were included in the study. Results Inter-incisal mouth opening at one month Postoperative follow up mean was 25.05, and Post Operative six month was 28.5 and at 12 month follow up mean inter incisal mouth opening was 31.85. Pre operative pain mean value was 9.2 with standard deviation 1.005 and at one month follow up 1.7 at six month was 0.4 and at twelve month follow up was 0. Conclusions There was significant increase in mouth opening post-operatively using the procedure of high condylectomy with PRF placement into joint space. Most of the patients were asymptomatic after 1 year of follow up.

EPS00393 Arthrocentesis of TMJ: A Review of Lysis & Lavage Techniques & Modifications Dr. Hemant Yadav Abstract Background/Introduction In 1960s arthrocentesis of large joints, the knee in particular, became a recognized treatment. Physicians carried on to develop various techniques of lysis and lavage for other joints, such as the hip, shoulder, tarsus, and wrist. It was then found that the mechanical lysis of adhesions & lavage of the temporomandibular joint (TMJ) was often successful in treating various internal derangements. Objectives Aim of this poster is to review described techniques of lysis & lavage of the TMJ & to discuss their possible advantages & disadvantages. Methods There were 8 different methods for the lysis & lavage of the TMJ & a modification reported in various books & journals were referred for this review. Results There were 8 different methods for the lysis & lavage of the TMJ published in 8 papers, & modification reported in a book. These were: arthroscopic lysis and lavage, two-needle arthrocentesis using an irrigation pump, modified two-needle arthrocentesis, the doubleneedle cannula method, single-needle arthrocentesis, use of a single Shepard cannula with two ports & two lumens, two-needle arthrocentesis, single-puncture arthrocentesis, & two- needle arthrocentesis with new anatomical landmarks. Conclusions The modified two-needle technique, single needle technique, & single-puncture technique with the dual-needle device, may be useful for lysis & lavage of the TMJ to treat joints with fibrosis or advanced arthrosis.

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EPS00405 Retrospective Study on Open and Closed Reduction Methods for Management of Condylar Fractures Author: Dr. Shruti Gunashekhar, Co-Authors: Dr. Abhay. T. Kamath, Dr. Chithra. A Abstract Background/Introduction This retrospective study evaluated the complications with the use of various methods to treat condylar fractures. Amongst all the mandibular fractures, the most common site being the condyle. The study primarily focused on the treatment benefits to the patient and compared the relative risk involved with both the treatment modalities like pre treatment, intra treatment post treatment outcomes. The success rates were compared with other published data. Analysis of the epidemiology and treatment of condylar fractures reveals the incidence, etiology, patient gender and age, oral health, time between injury and treatment, patterns of treatment (open and closed methods complications (Swelling, pain, hematoma.ecchymosis, bleeding, malocclusion, trismus, crepitations, paraesthesia, deviation of the mandible), and long-term follow-up of the condylar fractures. Objectives To compare the efficacy of management of condylar fracture using open and closed reduction. Objectives:To evaluate the effectiveness of the treatment. To evaluate the epidermiology and complications associated with the treatment. To assess the outcome based on the treatment. Methods A protocol for the retrospective study of treatment methods of condylar process fractures was developed that included absolute and relative indications and contraindications. To evaluate the results of this protocol, about 10 patients treated with CRMMF and about 10 treated by ORIF were recalled after a minimum of 6 months and examined for gender, race, diagnosis, age at injury, time since operation, and cause of the fracture. Each group was assessed for maximum interincisal opening, right lateral excursion, left lateral excursion, protrusive movement, deviation on opening, scar perception, motor function, sensory perception, contour perception, occlusion, and perception of pain. Nonparametric data were compared for statistical significance with a chi-square analysis and parametric data with an independent samples t-test (P \.05). Results No statistically significant differences existed between the ORIF and CRMMF groups for gender, race, diagnosis, or cause. Moreover, no differences existed for age at injury, maximum interincisal opening, right lateral excursion, left lateral excursion, protrusive movement, deviation on opening, or occlusion. Differences were noted between groups for time since operation, scar perception, and perception of pain. Using the protocol outlined, there were no differences between the ORIF and CRMMF groups for ranges of motion, occlusion, contour, and motor or sensory function. The ORIF group was associated with perceptible scars. The CRMMF group was associated with chronic pain. Conclusions Both treatment options for condylar fractures of the mandible yielded acceptable results. However, operative treatment, irrespective of the method of internal fixation used, was superior in all objective and subjective functional parameters.

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EPS00443 Temporomandibular Joint Replacement Surgical Guidelines with Alloplastic Graft Dr. Harikrushna Vekariya Jaipur Dental College, Jaipur Abstract Background/Introduction The TMJ replacement system is implanted in the jaw to functionally reconstruct a diseased and/or damaged TMJ. The TMJ replacement system is a 2-component system comprised of mandibular condyle and glenoid fossa components. Both components are available in multiple sizes as right and left side specific designs and are attached to the bone by screws. Objectives To evaluated total TMJ replacement with alloplastic prostheses. Methods 1)Exposure of the Ramus 2)Exposure of the Zygomatic Arch 3)Exposure of the entire joint 4)PDQ Retractors to prepare for osteotomy 5)Dissection medial to condylar neck 6)Ramal exposure 7)Dissecting around the mandibular branch of the facial nerve 8)Masseter reflection 9)Ramal exposure 10)Begin osteotomy with 1mm fissure burr 11)T-bar osteotome to finish osteotomy 12)Two-step osteotomy Phase II 13)Reciprocating rasp flattens fossa eminence 14)Sizing and Implantation of Fossa Component 15)Inter-maxillary fixation 16)Fitting and Placement of the Mandibular Component 17)Final Screw Placement. Results Postoperatively, patients about their normal everyday activities related to their articulating prostheses (for example, capacity to chew their favorite foods, talking, yawning, among others). Conclusions Correct indication and ideal surgical planning are critical as therapy for TMJ alterations. This way, multiple procedure which make the diagnosis unfavorable are avoided.

EPS00485 Autogenous Reconstruction of Osteomyletic Condyle Associated with Parotitis Using Hyperplastic Coronoid: A Case Report Presenting Author: Chirag Nakum Co-authors: Saikrishna D JSS Dental College and Hospital, Mysuru Abstract Background/Introduction Osteomyelitis is inflammation of bone cortex and marrow which develops after chronic infection. When untreated, leads to compound fractures that fail to heal. Secondary chronic osteomyelitis of jaw (SCO) occurs due to spread from a contiguous foci of infection (direct bacterial inoculation which gain access by contaminated fracture or tissue) without vascular insufficiency, often seen after trauma or surgery. Inoculation of infection at condyle may lead to its extension into parotid glands causing parotitis, characterised by pain, swelling and trismus in severe conditions. Objectives

S181 This report presents a case of collateral chronic osteomyelitis of jaw (SCO) secondary to trauma followed by chronic suppurative parotitis causing ankylosis of TMJ as result of coronoid hyperplasia. Methods Radiological evaluation using OPG and CT revealed presence of radiolucent areas combined with progressive osteosclerosis, lytic lesions (radiolucency) and laminations of periosteal new bone. Bacterial contamination of bone tissue was determined by FNAC. Succeeded by surgical procedure which included complete resection of affected condyle followed by reconstruction of condyle using the hyperplastic coronoid process. All procedures were carried out under antibiotic coverage. Results Post OP- Mouth opening increased from 11mm to 28mm without infection. Conclusions Osteomyelitis of condyle is rare, may lead to suppurative parotitis due to direct extension. This case was successfully treated with aggressive surgical debridement, reconstructive surgery and intravenous antibiotic therapy. Chronic parotitis should be monitored cautiously because it can involve deeper layers of gland and infiltrate TMJ resulting in ankylosis.

ABS00522 Efficacy Temporomandibular Joint Arthrocentesis With Injection of Sodium Hyaluronate and Dexamethasone in Treatment of Internal Derangment: A Prospective Clinical Trail Dr. Amit Kumar, Dr. Anuj Agarwal ITS Dental College & Hospital, Greater Noida, U.P. Abstract Background/Introduction Internal derangement of the TMJ is one of the most common forms of TMDs. It may be defined as a disruption within the internal aspect of TMJ, in which there is a displacement of from its normal function relationship with the mandibular condyle and articular portion of temporal bone. The triad of symptoms – clicking, locking and pain. Hyaluronic acid (HA) is a polysaccharide of the family of glycosaminoglycans. HA has been shown to improve and restore normal lubrication in joint, provide nutrition to the avascular articulating disc, and stabilize the joint. Objectives The objective of this study is to evaluate the treatment outcome of temporomandibular joint arthrocentesis with the follow up interval of pre-operative, post-operative, 1st week, 1st month and 4th month. The patients are evaluated for: • Maximum mouth opening (in mm using scale) • Maximum pain at rest (Visual Analogue Scale) • Maximum pain on chewing (Visual Analogue Scale) Methods The study includes 25 patients reporting to the Department of Oral And Maxillofacial Surgery with the cheif complaint of pain in join. Detailed examination and investigation are done and all patients diagnosed with temporomandibular joint internal derangment will be selected for the study. A total 100 ml of ringer lactate solution is use to lavage the joint. Manipulation of patient jaw in vertical, protrusive and lateral excursion to help free the disc further and break adhesions. 1ml of hyaluronic acid mixed with dexamithasone (4mg) is injected into the joint.

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S182 Results A total 25 patients, 16 males and 9 female received intra-articular injection of 1ml sodium hyaluronate and dexamethasone after arthocentesis in 36 joints. Post operatively this technique increased maximal mouth opening, lateral movements, and function, while reducing tmj pain and noise. Conclusions We conclude that patients with either disk displacement with reduction and closed lock benefitted from arthrocentesis. However, arthrocentesis with Sodium Hyaluronate injection seemes to be superior to arthrocentesis alone.

EPS00532 Surgical Management of TMJ Ankylosis and Assesments Chandana Jyothsna Guided by Dr. Anand Abstract Background/Introduction TMJ ankylosis is a situation in which mandibular condyle is fused to glenoid fossa by bone or fibrous tissue which is caused mainly by condylar fractures resulting in restriction of jaw mobility and causes and disturbances in facial and mandibular growth. Objectives Purpose of this poster is to present an easy and versatile methods like gap arthroplasty, interpositional arthroplasty using costochondral grafts, alloplastic joint reconstruction materials for treatment of TMJ ankylosis to decrease post operative complications such as reankylosis. Methods A total of 10 cases (unilateral and bilateral) ankylosis of TMJ underwent surgical release after performing gap arthroplasty through pre auricular approach, costochondral grafts or temporalis facial flap was transposed to gap and used as interpositional material Early mobilisation, physiotherapy and strict Follow up are essential to prevent postop adhesions. Results There were no signs of recurrence in any patients and gained maximum inter incisal opening. Conclusions Surgical treatment of TMJ ankylosis with gap arthroplasty, interposition of temporalis facial flap and costochondral grafting is an effective and easy procedure for preventing of reankylosis.the autogenous nature and close proximity to joint are the main advantage of temporalis facial flap when compared with other interpositional materials.

EPS00563 Temporomandibular Joint Ankylosis: Our Protocol Dr. Satya Priya Shivakotee Abstract Background/Introduction Ankylosis is a Greek terminology, meaning stiff joint. Hypomobility of joint can lead to partial or complete inability to open mouth. TMJ ankylosis is very distressing structural condition that retards mandibular growth, effects aesthetics and results in limited mouth opening. Facial asymmetry is the classic feature in unilateral cases.

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 The chin deviates toward the affected side. Vertical height of the affected side is shorter when compared with the unaffected side. The main causes of TMJ ankylosis are trauma and infection. Trauma associated ankylosis constitutes 13 to 100% of ankylosis cases and infection constitutes 10 to 49 % of ankylosis cases.the most commonly used treatments include gap arthroplasty and interpositional arthroplasty and joint reconstruction with autogenous and alloplastic materials. Objectives The present study was done to evaluate the efficacy of interpositional arthroplasty with temporalis muscle and fascia (myofascia) flap in preventing the re-ankylosis, to evaluate the growth of mandible, and to assess Al-Kayat and Bramley’s incision for its versatility in allowing muscle transfer and excellent exposure of the joint. This poster is a case series of the surgical treatment for patients with TMJ ankylosis under GA, which is being followed at our department. The case series were treated with resection of the ankylotic mass using AlKayat Bramley incision and Interpositional arthroplasty with temporalis myofascial flap. Methods 2 patients with ankylosis were treated with interpositional arthroplasty with temporalis myofascia flap. Maximum Interincisal Opening (MIO) was measured at different periods, i.e. preoperative, intraoperative, immediate post operative, 1 month post-operative, 6 month post-operative, 1 year post-operative. Results A statistically significant difference of 35mm was obtained between pre-operative and post-operative interincisal opening after a period of one year follow up. Conclusions The temporalis myofascia flap is an efficient interpositional material. It is a biologic, autogenous tissue, so there is no question of any rejection. It is a pedicled flap, so it maintains its viability. It can be procured by the same incision used for exposure of the joint. It is easily mobilized and made to cover the complete area of the glenoid fossa. Thus it acts as a barrier and prevents the chances of reankylosis to a greater extent. Also the mandibular growth continues as normal after the temporalis myofascia interposition.

EPS00605 Recent and Comprehensive Surgical Management of Tmj Ankylosis Prof. Dr. A.Thangavelu, MDS, DNB, Dr. R. Dhivya Rajah Muthiah Dental College and Hospital Abstract Background/Introduction TMJ forms the cornerstone of cranio facial intergrity. Ankylosis of TMJ is a dysfunction of the joint, very often the disease is diagnosed too late in spite of many symptoms!! Objectives Treat problems like impairment in speech, difficulty in mastication, poor oral hygiene, malocclusion, facial deformity, the role of interpositional materials are discussed in detail with review of litreature. Methods Removal of ankylotic mass with placement of various inter-positional materials like free fat dermis, temporalis etc. Results Functional rehabilitation, acceptable mouth opening.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Conclusions Cases are discussed with long term follow up, this poster highlights recent and comprehensive management of tmj ankylosis.

ABS00644 The Retromandibular Anterior Parotid Transmassetric Approach in the Management of Condylar Fractures: Our Clinical Experience Dr. Divya Gada, Dr. Mukul Padhye, Dr. Charu Girotra, Dr. Gokul Venkateshwar Abstract Background/Introduction Introduction: Mandibular condylar fractures are very common. There is a general agreement that an intra-capsular requires conservative treatment but ORIF for extra-capsular fracture is controversial. Extra oral approaches have different advantages and disadvantages. There is a possibility of transient facial nerve parasthesia, salivary fistula or infection post operatively. Objectives AIM: To evaluate the incidence of facial nerve paralysis during the open reduction internal fixation of condylar fracture by this approach. Methods In our series of cases for treating condylar fracture with open reduction internal fixation we have used retromandibular anterior parotid transmassetric approach. Where in the superficial muscular subcutaneous system were dissected anterior and superior aiming to the fracture, the parotid myofascia was pulled backward, with blunt dissection the masseter muscular fibers were gently divided in a fashion that parallel is the facial nerve fibers. Through the dissection of the masseter muscle, the mandibular periosteum was reached incised and elevated until the fracture stumps appeared. The fracture fragments were reduced and fixed with titanium plate. The drain was kept for 48 hrs and aggressive physiotherapy was given post operatively. Parameter assessed: Facial nerve palsy, postoperative pain and swelling, postoperative mouth opening. Results There was no facial nerve palsy observed, post operative mouth opening was adequate with minimum pain and swelling. Conclusions:: Though various approaches can be used for subcondylar fractures like pre-auricular, submandibular, retromandibular transparotid, but anterior parotid transmassetric approach seems to be a safer approach since the injury to braches of facial nerve is minimized.

EPS00674 Total Alloplastic Temporomandibular Joint Reconstruction: A Holistic Approach for Management of Tmj Ankylosis Dr. R.S. Neelakandan, Dr. Arun M. Krishnan Abstract Background/Introduction Temporomandibular joint (TMJ) ankylosis involves the fusion of the mandibular condyle to the glenoid fossa, the skull base. It is a serious and disabling condition that may cause problems in mastication, digestion, speech, appearance and hygiene. It can also cause disturbance of facial and mandibular growth associated with acute airway

S183 compromise. Alloplastic reconstruction eliminates the need for a second surgical site with the associated morbidity and minimizes the effects of connective tissue/autoimmune disease, ankylosis, etc, which can cause destruction of autogenous tissues used in TMJ reconstruction. Objectives To review various alloplastic joints available for reconstruction and to introduce our indigenous total joint prostheses in the management of extensive primary and recurrent TMJ ankylosis. Methods Prospective study of 9 patients (6 bilateral & 3 unilateral) TMJ ankylosis (15 joints) patients who underwent alloplastic reconstruction of temporomandibular joint following arthroplasty with our custom made prosthesis. Results all our unilateral & bilateral TMJ ankylosis cases, there was significant improvement in mouth opening, also reduction in the pain while mouth opening and jaw function and there was a change in diet pattern of patient from liquid to solid food. There was no re-ankylosis noted during our study. Conclusions Holistic approach of joint release and secondary deformity correction among contemporary surgeons has lead to great dilemma with regards to treatment planning. In an attempt to carry out both the procedures simultaneously there is loss of vector control of the distal segment and the risk of pseudoarthrosis at the osteotomy site. This combined problem could be overcome by the use total alloplastic joint prosthesis which offers a firm posterior stop for the proximal segment and negates aggressive physiotherapy.

EPS00695 A Novel Approach for Low Level Condylar Fractures: Modified Tragus Edge Approach vs Retromandibular Transparotid Approach a Comparitive Study Dr. Deepak Mehta (Ab Shetty) Abstract Background/Introduction Mandibular fractures are extremely frequent in facial trauma, and 19–52% involve the condyle. Condylar fractures are classified according to the anatomic location (intracapsular and extracapsular) and degree of dislocation of the articular head. Objectives To determine the better surgical approach for low level Condylar fractures. Methods The time required and the complications developed with both the approaches were compared. Results There are advantages and disadvantages with both approaches, but the disadvantages with retromandibular transparotid approach are comparatively less. Conclusions The retromandibular transparotid approach provides good exposure and facilitates accurate reduction and fixation of the subcondylar fragment with positive outcomes, good cosmetic results, and rare major complications. Most facial nerve injuries are transient in nature after this approach.

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ABS00707 God Gave Us Extra Ribs for a Reason! Prof. Dr. Senthil Nathan, Dr. Abdul Wahab, Dr. Madhulaxmi, Dr. Viveka P, Saveetha Dental College and Hospital Abstract Background/Introduction Ankylosis of the temporomandibular joint (TMJ) is an intracapsular union of the disc condyle complex to the temporal articular surface that restricts mandibular movements. Being a serious disability that has an adverse effect on mastication, digestion, speech, appearance and hygiene, and causing disturbance of facial and mandibular growth and acute compromise of the airway invariably resulting in physical and psychological disability, diagnosis and treatment of TMJ ankylosis should be done as early as possible and specifically tailored to the age and growth status of the patient. Objectives To increase the mouth opening by resection of ankylotic mass, hence improving the quality of life of the patient. Methods Surgical resection of ankylotic mass and placement of costochondral graft; with bilateral coronoidectomy. Results Sufficient mouth opening was achieved intra-operatively and maintained post operatively by continuous physiotherapy. Conclusions TMJ ankylosis can be treated effectively surgically and reconstructed to achieve both form and function adeptly using costochondral graft.

EPS00713 Autologous Blood Injection for Treatment of Recurrent Tmj Dislocation: A Case Report Dr. Kishan Ravaliya, Narsinhbhai Patel Dental College & Hospital, Visnagar, Gujarat Abstract Background/Introduction Dislocation of the temporomandibular joint occur when the head of the condyle moves anteriorly over the articular eminence into such a position that it cannot be returned voluntarily to its normal position. Recurrent Temporomandibular joint (TMJ) dislocation is characterized by a condyle that slides over the articular eminence, catches briefly beyond the eminence, and then returns to the fossa. There are well-documented surgical and conservative treatments for chronic recurrent dislocation of the TMJ, and the injection of sclerosing solution around the articular capsule and/or into the articular cavity has benn proposed as a nonsurgical treatment, and Autologus blood injection around the articular capsule and/or into the articular cavity also recently used. 1973 Schulz was the first to report experience with it to treat recurrent condylar dislocation. The rationale of ABI is that blood is injected into the pericapsular tissues and the superior joint space. The bleeding into the pericapsular tissues as a result of the introduction of a needle will create a bed for the formation of fibrous tissue. The role of ABI into the superior joint space is not fully understood, but it may lead to the formation of intercompartmental adhesions. Importantly, restrained mandibular movement is the key to the success of the procedure. recently injection of autologous blood

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 (ABI) around the articular capsule/or into the articular cavity has been described. The procedure is easy, and causes no foreign body reaction. Objectives Evaluate the efficacy of autologous blood injection in the treatment of chronic recurrent dislocation of the temporomandibular joint (TMJ). Methods Here, we present the management of recurrent temporomandibular joint dislocation by autologous blood injection in an 35 year old mentally retarded male patient came to OMFS dept. Local anesthesia was given to the auriculatemporal nerve. The articular fossa was assumed as located at a point 10 mm anterior to the tragus of the ear and 2 mm inferior to the tragal-canthal line. Five mL blood was withdrawn from the patients’ anticubital fossa. Four mL blood with a 21- gauge needle was injected in the articular cavity and 1mL was injected in the pericapsular tissue. After the completion of the injection, an elastic bandage was applied and left for 24 hours to constrain the joint movements. Results After the treatment, although the right & left condylar process had settled just beneath the articular tubercle, the dislocation had improved and the patient was able to close his mouth without difficulty. Conclusions In conclusion, it can be stated that the technique of autologous blood injection for treatment of recurrent TMJ dislocation is a simple, safe and cost effective procedure. This conservative approach can be tried prior to performance of more invasive surgical intervention.

EPS00733 Role of Arthroscopy in Management of Internal Derrangement of Temporomandibular Joint Dr. Shweta Wadekar, Dr. D. Y. Patil Dental Hospital, Navi Mumbai Abstract Background/Introduction Internal derangement of the temporomandibular joint (TMJ) is common. The patients with displaced discs are usually treated conservatively, and treatments include mandibular manipulation and bite splints. Most patients with articular disc displacements either improve spontaneously or can be managed efficiently with appropriate conservative measures. Open arthrotomy of the TMJ has been widely advocated for treatment of internal derangement with closed lock when conservative treatment has failed. More recently, arthroscopic surgery of the TMJ has increased in popularity because it is less invasive than open surgery, is associated with few complications, and requires a shorter hospital stay. Objectives Arthroscopy allows surgeons to diagnose and treat intra-articular conditions directly with a minimally invasive technique that reliably reduces pain and increases the mandibular range of movement. Methods Here we present an arthroscopic surgical approach to correct displacement of the anterior disc without reduction of the TMJ and with limitation of mouth opening. This includes arthroscopic inspection of the superior compartment, lysis of adhesions formed between the disc and the fossa, and release incision anterior to the attachment tissue of the disc to reposition the ectopic disc.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Results Arthroscopy useful in management of closed lock jaw. It reduces pain and increases mandibular range of movement, and the disc may move normally. Conclusions Arthroscopic surgical procedures are safe, minimally invasive, and effective in the treatment of pain in the TMJ and improving the range of movement. Most of the positions of the displaced discs were improved. Compared with open operations, the risks are minimal and complications are rare. The rate of recovery is rapid, and the success rate is high. This is an effective treatment for anterior displacement of the disc without reduction of the TMJ.

EPS00760 To Compare the Efficacy of Concentric Needle-Single Puncture Technique with the Conventional Two Needle Technique for Temporomandibular Joint Arthrocentesis Dr. Amit Kumar, Dr. AmitGupta and Dr. Harsha Jain ITSCDSR muradnagar Ghaziabad U.P. Abstract Background/Introduction Temporomandibular disorders are a heterogeneous group of musculoskeletal and neuromuscular conditions involving the temporomandibular joint complex. TMJ arthrocentesis is performed under local anesthesia for lysis and lavage of the superior TMJ space and release of the joint, which improves function, increase range of motion, and decreases the pain in these disorders. Objectives To compare the efficacy of concentric needle-single puncture technique with the conventional two needle technique for temporomandibular joint arthrocentesis. Methods Patients reporting to the Department of OMFS with chief complain of pain and clicking sound in temporomandibular joint were included in this study. Twenty joints were randomly selected and divided into Group A (concentric needle technique) and group B (two needle technique) for arthrocentesis under local anesthesia using Ringer’s lactate solution Measured Parameter • Mouth opening • Postoperative pain relief • the operative time in minutes. • Pain at rest • Efficacy of chewing • Limitation of jaw functions • Tolerance of treatment • Effectiveness of treatment. Results The results show significant difference in operating time between concentric needle technique and two needle technique arthrocentesis. There was also significantly better mouth opening at 3 months in Group A but no significant difference in Post Operative Pain, Pain at Rest, Pain on Chewing, Effectiveness of Chewing, Limitation of Jaw Function, Tolerance and Effectiveness between the two groups. Conclusions Concentric needle technique is better as it is less time taking and minimally invasive as compared to the two needle technique.

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EPS00795 Management of TMJ Ankylosis in Old Patient a Case Report Dr. Ashish Gupta Krishnadevaraya College of Dental Science Abstract Background/Introduction TMJ ankylosis is usually treated in early years of life, ho wever the treatment may get delayed in some instances due to various reasons. Here we report a case of 65 year old lady edentulous with bilateral tmj ankylosis, challenges faced in rehabilitation of this patient. Objectives To rehabilitate patient with minimal challenges. Methods Distraction followed by interpositional gap arthoplasty. Results Satisfactory result with sufficient mouth opening. Conclusions Surgical management in TMJ ankylosis results in adequate mouth opening but active and vigorous physiotherapy in both immediate and later post operative days can only prevent reankylosis.

Section: Craniofacial research EPS00187 Maxillofacial 3D Planning-A Vision Based 3D Capture System Dr. Saibal Bhattacharyya Awadh Dental College & Hospital, Jamshedpur Abstract Background/Introduction The human face is 3-dimensional and dentofacial surgeons deal with the physical relationship among the parts of the human dentofacial structures. These 3-dimensional physical relationship change through the course of growth, development and treatment. Therefore, analysis of the results of corrective surgery in 3-dimension is requred and idelly it should also be possible to visualize the expected results of planned surgery postoperatively. Various technique of mesuring facial morphology have been reported including Direct Anthropometry, Laser Scanning system, Facial Plaster model, Moire Stripes and Liquid Crystel Range Finder. Recent innovation in Computarized Stereophotogrammetry (C3D) provide a useful technique for 3D recording of the face. We describe a Vision-based 3-dimensional facial data capture system designed for the planning of Maxillofacial Surgery. Objectives The aim of this poster is to provide a detail information about the newly developed three-dimensional(3D) imaging system in recording facial morphology.

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EPS00390 Role of Multi-functional Theranostic Nano-particles in Head and Neck Oncology: A Systematic Review Dr. Janice John Govt. Dental College, Nagpur Abstract Background/Introduction Head and neck cancers represent the sixth most common cancer globally and are diagnosed with biopsy, treated by surgery, irradiation and chemotherapy. This results in delayed diagnosis, healthy tissue destruction, adverse drug reactions, ineffective drug concentrations, drug resistance and higher mortality. Nanotechnology has revolutionised cancer management with the detection of salivary biomarkers, high contrast tumor imaging, targeted drug delivery to mutant cells, monitoring of treatment progress, in brachy-therapy and break-through pain management. Objectives The aim of this review is to describe nanoparticles, methods to functionalize nanoparticles, their applications in head neck oncology and to outline therapeutic commercialization. Methods Database search was done on Pub-med, Cochrane library, International Journal, British Journal and Journal of oral and maxilla-facial surgery from inception till August 2017, using key words ‘nanotechnology’ and ‘head and neck cancers’. Results The search yielded 160 relevant articles. Nano-electromechanical system, and optical nanobiosensor help in diagnosis. Quantum dots enable gene sequencing and detection of DNA methylation. Cadmium nanoparticles facilitate accurate cancer excision. Nano-emulsions containing genistein serve as pre and post-operative maintenance therapy. Conclusions Nano-technology is a nascent science and requires clinical trials to determine safety and efficacy, to improvise drug-delivery modules, drug dosing and to translate research concepts into personalised cancer therapy.

EPS00463 Bioartificial Nerve Graft for Peripheral Nerve Regeneration Dr. Samyak Vakil Abstract Background/Introduction More than any other form of trauma, nerve injuries complicate successful rehabilitation. Under the right conditions, however, axon extensions can regenerate over gaps caused by injury, reconnecting with the distal stump and eventually re-establishing functional contacts. Peripheral-nerve injuries that result in long gaps require surgical implantation of a bridge or guidance channel between the proximal nerve end and the distal stump in order to restore full function. Objectives To evaluate autogenous nerve grafts and artificial tubes as conduits for the repair of continuity defects in the peripheral nerves.

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Methods Successful regeneration can take as long as six months from the time of injury to functional recovery. Following injury, fluid accumulates within the lumen of the conduit and the distal nerve stump undergoes Wallerian degeneration. When contact with neurons is lost, Schwann cells in the distal segment change their genetic programming from producing myelin-associated proteins to synthesizing growth factors such as nerve growth factor, brain-derived neurotrophic factor, and neurotrophin- 3. Results The function of the bioartificial nerve graft is to stimulate axon growth and guide it toward the distal target in a timely manner. The conduit itself acts as a physical guide as well as offering protection for the newly formed tissue. By modeling the transport of nutrients and growth factors within the conduit, the design can be optimized with respect to porosity, wall thickness, and Schwann cell seeding density so that growth factors are concentrated within the lumen while ensuring that sufficient nutrients are provided for the cells until the neovasculature is formed. Conclusions Significant recent advances are the use of biodegradable channels, controlled release of trophic factors and conduits seeded with Schwann cells. All of these discoveries are making their way into the clinic and showing great potential in nerve regeneration.

EPS00550 Access Osteotomies-Transfacial Approaches to the Skull Base Tumors Dr. Preetika Gupta-Sinhgad Dental College and Hospital, Pune Abstract Background/Introduction One of the most challenging and difficult problems of a surgeon is to treat a neoplasm of the cranial base. The requirement to obtain disease-free margins without significant morbidity is often a daunting task. The cranial base is surrounded by structures that are vital for life and normal function. Many cranial base lesions are slow growing and non-metastasizing, which makes them amenable to surgical treatment. These same characteristics often make these lesions resistant to radiation therapy. Objectives This poster describes case of lateral approach to the orbit and anterior cranial base to access the removal of neoplasm (pPNET-Peripheral Primitive Neuroectodermal Tumor) of lateral orbit in 28years old male patient that the oral and maxillofacial surgeon performed with neurosurgeon. Methods Fronto Temporo Orbito Zygomatic Craniotomy and Zygomatic Osteotomy. Results Tumor was successfully excised and Patient underwent chemotherapy postoperatively. Conclusions The last two decades have seen tremendous advances in neurosurgery, otolaryngology, and craniomaxillofacial surgery. These advances include rigid fixation and bone grafting techniques, which make surgical treatment of these neoplasms possible.

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EPS00616 Role of Stem Cells in Oral and Maxillofacial Surgery Dr. GURMEJ SINGH Punjab Government Dental College Amritsar Abstract Background/Introduction In this present world of medicine, loss of tissue due to trauma, disease or congenital abnormalities is a major health care problem. when this occurs in the craniofacial region, severe physiological and psychological consequences occurs which directly or indirectly affect individual’s life. Therefore it is mandatory to reconstruct craniofacial area to its aesthetic and functional level. Objectives Objectives of this poster presentation are to address the determined recent research efforts in role of stem cells in oral and maxillofacial surgery like repair of craniofacial defects, salivary gland regeneration after radiation therapy, in the treatment of lichen planus and regeneration of dentine, pulp and teeth. Methods For this purpose data were gleaned from a literature search of available medical and dental databases. The search phrases included the main set Tissue engineering in Oral & Maxillofacial Surgery, Regenerative Medicine in Oral & Maxillofacial Surgery with defined subsets such as Craniofacial bone tissue engineering, TMJ tissue engineering and many more. Results This poster will therefore present the significant advancement that have been made in the application of stem cells in oral and maxillofacial surgery, as well as its future potential. Conclusions The future dentistry will be more of regenerative based, where patients own cells can be used to treat diseases. Stem cell therapy has got a paramount role as a future treatment modality in dentistry. On the other hand, stem cells should be differentiated to the appropriate cell types before they can be used clinically, otherwise it might lead to deleterious effects. Longer patient follow up is needed to study the life time of regenerated tissue.

EPS00624 Role of Stem Cells in Craniomaxillofacial Surgery Dr. M. Sowmya Guided By Dr. Kishore M Vishnu Dental College Abstract Background/Introduction In Craniofacial Surgery the hard and soft tissue defects that are caused due to congenital deformities, trauma and pathologies affect the life supportive processes, delivery of senses, social interaction and aesthetics of the patient. To correct the architecture and function of these defects a new modality of Regenerative Medicine has evolved using Stem cells. The stem cells can regenerate fully functional tissues of skin, muscle, cartilage, bone and Neurovascular tissue without secondary donor site defect and provided novel therapies for the surgeon. Objectives To focus the advantages of stem cells in Craniomaxillofacial surgery.

S187 Methods Poster will be prepared using the needful pictures representating the advantages of stem cells. Results Advantages of stem cells in Craniomaxillofacial surgery. Conclusions This poster focuses on reported clinical advantages of stem cells in Craniomaxillofacial surgery.

ABS00751 Evaluation of Changes in Cerebral Hemodynamics in Cranioplasty Patients Using Magnetic Resonance Perfusion Dr. Chandan Misra Army Dental Centre (Research & Referal), Delhi Abstract Background/Introduction Cranioplasty is defined as the surgical repair of a residual calvarial bone defect secondary to decompressive craniectomy either due to trauma or stroke. The primary aim of cranioplasty to give protection to the brain and also for cosmetic rehabilitation. However marked improvements in the neurological status and in terms of daily routine physical activities after cranioplasty have been shown in several studies. The generally accepted explanation is that this improvement might be due to a reduction of local cerebral compression effects by atmospheric pressure. Eliminating the effects of atmospheric pressure might lead to increased cerebral blood flow(CBF), thus leading to neurological improvement. Literature review reveals very few studies in cranioplasty patients correlating clinical symptoms with cerebral hemodynamics using imaging modalities. Therefore, the present study has been undertaken to evaluate the changes in cerebral hemodynamics in patients undergoing cranioplasty with the help of MR perfusion. Objectives The present study is undertaken with the aim to evaluate the changes in cerebral hemodynamics in patients undergoing cranioplasty using Magentic Resonance (MR) Perfusion. The secondary objective is to establish a correlation between changes in neurologic status measured via global disability parameters and cerebral hemodynamics post cranioplasty. Methods This prospective study was conducted on patients reporting to the Department of Oral and Maxillofacial Surgery, Army Dental Centre (R & R) for cranioplasty post decompressive craniectomy for intractable intracranial hypertension. Cerebral hemodynamics was studied by MR perfusion using the parameters of cerebral blood flow, cerebral blood volume and mean transit time before and after cranioplasty and the results were compared with the possible neurological and neuropsychological parameters. All these patients were assessed preoperatively by global disability parameters viz. Barthel index and Modified Rankin Scale followed by MR perfusion imaging to assess the neurological status and cerebral hemodynamics before cranioplasty. The same parameters were evaluated four weeks after the procedure and compared to establish a correlation between the cerebral hemodynamics, its possible impact on neurological outcome and as a prognostic factor. Results Our study showed a statistically significant improvement only in CBF in ipsilateral frontal lobe. For the remainder we found an

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S188 improvement in clinical and cerebral perfusion parameters from the first to the last examination with significant improvement in CBV in ipsilateral parietal lobe and MTT in contralateral frontal lobe. This improved cerebral hemodynamics is in sync with with the improvement in neurologic status as measured by the global disability parameters suggesting a definite correlation between the two factors. The neurological improvement after cranioplasty may be due to the increase in CBF velocities at all vessels including the ipsilateral and contralateral side resulting from elimination of the effects of atmospheric pressure on the brain. Conclusions Neurological improvement after cranioplasty can be explained by improvement of cerebral hemodynamics irrespective of the material used for rehabilitation of the defect. The inference of our study is in concurrence with various previous literature reports based on CBF changes after cranioplasty obtained utilizing Magenetic resonance perfusion imaging which is a noninvasive, radiation hazard free imaging modality. In our study, we propose to reemphasize the theory that cranioplasty is carried out not only for preserving normal appearance and physical barrier but also for neurological improvement.

EPS00790 3D Printing Pil-Young Yun; Joseph Krajekian Abstract Background/Introduction Medical applications for 3-D printing are expanding rapidly and are expected to revolutionize health care. Recent advancements in science and technology have resulted in important changes in the field of surgery. Objectives Creation of customized prosthetics, implantable devices and medical models - Pharmaceutical drug dosage forms delivery and discovery. Bioprinting tissue and organ; Methods Use of 3D-printed rapid prototyped models before oral cancer surgery or orthognathic surgery for treatment planning and simulation has been established to assure more precise and safe surgeries2. Moreover, surgical stents are fabricated using computed tomography (CT) images in the field of dental implantology3. It is necessary to move forward and adopt this technology in the fabrication of complex forms of molds in order to provide individualized medical services. For example, easier production of customized and reconstruction plates and morphologic reconstruction of bony defect areas are possible uses of 3D printing in fracture surgery or reconstructive surgery. The 3D printing technique can also be utilized in other areas of oral and maxillofacial surgery. For example, it would be very helpful to be able to design and fabricate a customized non-absorbable barrier of titanium mesh. Results 3D printing is an evolving field. It has shown compliment the surgery and enhance the surgeon’s perspective. Conclusions It is necessary to move forward and adopt this technology in the fabrication of complex forms of molds in order to provide individualized medical services. This would ultimately benefit the patient. Increased precision of the technique will also result in a wider range of applications for 3D printing. In conclusion, the role of 3D printing in oral and maxillofacial surgery should be a focus of interest since the technique could offer endless developmental possibilities.

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Section: Oral Pathology: Benign ABS0018 A Dentigerous Cyst in Impacted Mandibular Canine: A Case Report Dr Abhishek Kumar & Bidsh Patna Abstract Background/Introduction A dentigerous cyst is the most common developmental odontogenic cyst and is frequently noted as an incidental finding on radiographs. The most common teeth affected are impacted mandibular third molars and permanent maxillary imapacted canines. Objectives To enucleate the cystic lesion and to restore normal oral health. Methods Surgical enucleation of cyst under general anesthesia. Results Good prognosis after enucleation. Conclusions This case involves an unusual clinical and radiographic presentation of a dentigerous cyst. It shows a new variant of presentation.

EPS0020 Cemento Ossifying Fibroma Dr. Manisha Anand B.I.D.S.H Abstract Background/Introduction The cemento ossifying fibroma is classified as the fibro osseous lesions the jaw. It represents as progressively growing lesions that can attain enormous size with resultant deformity, if left untreated. The cemento ossifying fibroma is a central neoplasm of bone as well as the periodontium. Objectives To excise the fibroma. Methods Excision. Results Good. Conclusions These lesions are thought to arise from the periodontial ligament and are composed of varying amounts of cementum bone and fibrous tissue. The recommended treatment is excision, due to good delamination of the tumor.

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EPS0046 The Enigma of Dentigerous Cyst in Maxilla

Objectives Differential diagnosis and surgical management of the destructive lesion. Methods Excision biopsy. Results Actinomycosis. Conclusions Not all destructive lesions are carcinomas ‘‘If you think you’ve seen it all take another look’’.

Dr. Anoop Kumar Dixit Career Post Graduates Institute of Dental Sciences & Hospital, Lucknow Abstract Background/Introduction Dentigerous cyst are most common developmental odontogenic cyst arising from the crown of impacted, embedded or unerupted teeth. Involved mostly mandibular third molar and max canine 70% in the mandible and 30% in maxilla, in this presentation cases of dentigerous cyst and there treatment at different location in maxilla. Objectives To evaluation of clinical presentation of dentigerous cystic lesion in maxilla, their relation to radiological picture and treatment planning and patients needbased treatment. Methods The case with clinico-radiological diagnosis of dentigerous cyst in maxilla were selected and treated surgically and diagnosis was corelated to eventual histopathological diagnosis. The patients were followed for 1 to 2 year. Results The patients were on regular followup for long period and were asymptomatic. Conclusions The choice of therapeutic approach for a dentigerous cyst should not be randomly selected but customized to patient need, based on the size and location of the cyst, patient age, affected dentition, status of root completion of associated tooth, clinical course, histopathological presentation, relationship with the surrounding structure and patient compliance for a particular treatment.

EPS0063 The Chameleon of the Maxilla Vipul Varma Iind Year Post Graduate Sri Ramachandra University Faculty of Dental Sciences Chennai, TN Abstract Background/Introduction Actinomycosis is a chronic granulomatous infection caused by Actinomyces species which may involve only soft tissue or bone or the two together. Actinomycotic osteomyelitis of maxilla is relatively rare when compared to mandible. These are normal commensals and become pathogens when they gain entry into tissue layers and bone where they establish and maintain an anaerobic environment with extensive sclerosis and fibrosis. The portal of entry may be pulpal, periodontal infection, and so forth which may lead to involvement of adjacent structures as pharynx, larynx, tonsils, and paranasal sinuses and has the propensity to damage extensively. The chronic clinical course without regional lymphadenopathy may be essential in diagnosis. The management of actinomycotic osteomyelitis is surgical debridement of necrotic tissue combined with antibiotics for 3–6 months. This E-poster report a case of 34 year male who developed an extensive, destructive lesion in the left maxilla with restricted mouth opening in 6 months, following a rare aetiology, the relevant literature, clinical course and its successful resolution.

EPS0070 A Case of Surgical Management of OSMF Dr. Arshad Khan Career Post Graduates Institute of Dental Sciences & Hospital, Lucknow Abstract Background/Introduction OSMF is a chronic condition characterized by progressive stiffening of oral mucosa with the resultant inability to open the mouth. It is a pre malignancy condition of the oral cavity with the major etiological factor being the consumption of areca nut. Objectives To evaluation of clinical presentation of OSMF and their relation to radiological picture and treatment planning and patient need best treatment. Methods Case with clinico-radiological diagnosis of OSMF was selected and treated surgically with collagen sheet and PRF placed. The patient was followed for 1 year. Results The patient was on regular follow up for the long period with normal three finger mouth opening and asymptomatic. Conclusions OSMF described in the present case was difficult to manage in part caused by the continuous tobacco consumption and poor oral hygiene maintenance. In addition she was found to be a poor family background and this made monitoring and condition difficult. Various treatment modalities and are used as for the stage of disease. The case deals with surgical intervention grafting and habit breaker.

EPS0076 Management of Odontogenic Keratocyst involving Lower Jaw: A Case Report K. Sandeep St. Joseph Dental College Abstract Background/Introduction Odontogenic Keratocyst is a distinct entity of jaw cysts exhibiting Keratinization of their epithelial lining. Various treatment modalities have been described to manage Odontogenic Keratocyst. This poster highlights a case of OKC involving lower jaw that has been managed by Enucleation, Peripheral Ostectomy and Chemical Cauterization using Carnoy’s Solution.

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S190 Objectives To Manage a case of Odontogenic Keratocyst in the lower jaw by Enucleation, Peripheral Ostectomy and Chemical Cauterization using Carnoys Solution in order to avoid its recurrence. Methods After the conformation of the diagnosis with incisional biopsy, Case was posted under GA, Crevicular incision is given from 45 to 37 region and pathological site was exposed. The bony perforation seen at the previous incisional biopsy site was widened using bone rongour. Then the cystic lining was removed along with the impacted 43 and 44. Then Peripheral Ostectomy was done with a vertical cuts distal to 45 and 36 and then with a horizontal cut by maintaining the lower border. Carnoys solution is applied on the residual bony margins. Layer by layer closure done using 3-0 Vicryl. Results Post operatively patient followed for 6 months with no recurrence and complications till date expect for paresthesia in the lower lip. Conclusions As the OKC has high recurrence potential, multiple modalities have to be applied during its surgical management i.e, Enucleation, Peripheral ostectomy, Chemical Cauterization and Resection etc., Also, A long term follow up is mandatory.

EPS0083 Rare Lesions of Maxillary Anterior Alveolar Palatal Complex

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 lesions. Lipoma, rarely, occurs in the oral cavity and it corresponds to less than 4.4%, of all benign oral soft tissue tumors. Here, we are reporting a case of lipoma that occurred in the soft palate, which is extremely rare. Objectives Lipoma in soft palate should be surgically excised at the earliest as it can lead to dysphagia and dyspnoea. Methods MRI neck reveals well defined, nodular, fat signal intensity lesion of right side of soft palate suggestive of Lipoma. Tumor excision was done under GA. Results Patient’s complaint of dysphagia was addressed and no signs of recurrence after 6 months follow-up. Conclusions This case of Lipoma of the soft palate justifies the inclusion of this lesion as a rare possibility in the differential diagnosis of swellings of the soft palate and also adds a note on clinician awareness for the same.

EPS0089 Intramuscular Hemangioma of Masseter Muscle, Treated with Surgical Excision: A Case Report Dr. Manoj Kumar K.P, Dr. Mohammed Faisal

Dr. Mihir T. Dani, Dr. Mohan Baliga

KMCT Dental College

Abstract Background/Introduction The maxillary anterior alveolar palatal complex is an unique entity which compromises of maxilla, the alveolar process and the anterior palate, its unique anatomic location predisposes this area to varied number of disease, some presenting in the area are rare & require specific attention in their management, these are osteogenic sarcoma, glandular odontogenic cyst and desmoplastic ameloblastoma. Objectives Through this poster we aim to highlight these rare occurrences of such lesions so that appropriate identification and management of such lesions are possible. Methods From the archives of the department. Results Successful management of such lesions has been done. Conclusions Tumors in the anterior maxilla are common yet a challenging clinical entity owing to a broad differential diagnosis. A clear understanding of the varying clinical presentation, facial anatomy & pathological etiologies helps narrow down the differential diagnosis considerably.

Abstract Background/Introduction Intramuscular hemangioma, is a type of vascular tumor occurring within skeletal muscle. Most Intramuscular Hemangioma are rarely located in head and neck region. Hemangiomas of skeletal muscle represent 0.8% of benign vascular neoplasm. Of these 13.8% occur in the head and neck region. Studies show that intra-muscular haemangioma mostly present before the age of 30. Involvement of the masseter has a definite male predominance. Intramuscular hemangioma arise as abnormal embryonic sequestrations. Surgical excision was performed and histopathology confirmed the diagnosis. Objectives Intramuscular Hemangioma in cheek result in unaesthetic facial appearance need to be surgically excised. Methods FNAC, USG was performed suggestive of inflammatory lesion. Surgical Excision was done under G.A and histopathological diagnosis confirmed intramuscular hemangioma. Results A regular follow up was done and cosmetic results were satisfactory. Conclusions Hemangiomas are rare in the head and neck region. It should be considered in the differential diagnosis of masses in these regions. Initial diagnosis is usually parotid tumor, hemangioma being rarely suspected.

EPS0088 Lipoma in Soft Palate: Report of a Rare Case Dr. Manoj Kumar K.P, Dr. Aswin M KMCT Dental College Abstract Background/Introduction Intraoral lipomas are benign mesenchymal neoplasms that originate in mature adipose cells with differential diagnosis of other soft tissue

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EPS0090 Epidermoid Cyst in the Floor of the Mouth Mimicking Plunging Ranula: A Case Report Dr. Manoj Kumar K.P, Dr. Tina Abraham

S191 diagnosis as was observed in the case, where in the patient reported with mere dental slight pain and swelling but thorough evaluation lead to diagnosis of Gorlin-Goltz syndrome followed by prompt treatment of the patient. So as to reduce the long-term sequele and mortality imposed by Gorlin syndrome, early diagnosing and treatment should be the mainstay for patient benefit.

KMCT Dental College Abstract Background/Introduction Epidermoid cysts are benign, slow-growing and painless lesions that can occur anywhere in the body, predominantly in areas where embryonic elements fuse together. Occurrence of only 7% in the head and neck area, with the oral cavity accounting for only 1.6%. Majority of them occur in sublingual region. They can cause symptoms of dysphagia and dyspnoea and have a malignant transformation potential. Found in any age group but show preponderance between 15-35 years of age with no gender predilection. Objectives Sublingual epidermoid cyst causing unaesthetic facial disfigurement should be diagnosed and treated at the earliest. Methods Excisional biopsy was done under GA. Histopathology report reveals Epidermoid cyst. Results A regular follow up was done and there were no signs of recurrence so far. Conclusions Epidermoid cyst of the oral cavity is an uncommon entity. Ample understanding and vigilance about this slow growing painless mass is essential not only because of the symptoms it produces but also due to its malignant potential.

EPS00101 ‘‘Gorlin-Goltz syndrome’’: A Rare Multiple OKC Anomaly Dr. Pradeep Kumar Das, FDS SGT University Abstract Background/Introduction Gorlin–Goltz syndrome is an autosomal dominant inherited condition comprising the principle triad of basal cell carcinomas, multiple jaw keratocysts, and skeletal anomalies. It is an uncommon hereditary condition caused by mutations in the PTCH1 gene causing a wide range of developmental abnormalities. Objectives Management of 2 blood brothers with Gorlin-Goltz syndrome. Methods 2 brothers with multiple odontogenic keratocyst (Gorlin–Goltz syndrome) in both maxilla and mandible undergone surgical enucleation of all multiple OKC’s with chemical cauterization with Cornoy’s solution. Results Primary closure was achieved. No evidence of recurrence were noted after a follow up of 6 months. Conclusions Thorough clinical, histopathological and radiological examination supplemented with appropriate investigations reveal the concerned

EPS00103 Life Threatening Arterio-Venous Malformation of Mandible: Lacunae in Diagnosis and Treatment Maj Vinay Singh Parihar Army Dental Centre (R&R), Delhi Cantt Abstract Background/Introduction Intraosseous Arteriovenous Malformations (AVMs) in the head and neck region are very rare and potentially life-threatening. Management is challenging due to their unpredictable behaviour and high recurrence rate. Objectives This poster reviews an unusual case of high flow AV malformation which presented as a cystic lesion and underwent series of complications prior to successful treatment. Diagnostic dilemmas and management will be presented. Methods Six years old male presented with intraoral swelling. History revealed right ECA ligation for torrential bleed during intraoral biopsy. Radiologically it was an osteolytic lesion with serous aspirate. Incisional biopsy suggested Dentigerous cyst. Hence enucleation carried out under GA. HPE confirmed Dentigerous cyst. Swelling recurred after two months. Aspirate revealed blood and CT-angio was suggestive of intraosseous AVM. He was subjected to embolization by interventional radiologist. Post embolization there was huge swelling which regressed and then increased more aggressively within associated soft tissues. MR-angio showed multiple feeders from both carotids. He was then taken up for segmental resection of right mandible under carotid control. Intraoperatively he survived massive blood loss and hemodynamic collapse. Results Postoperatively draining sinus developed which infected repeatedly but healed with minimal scarring. Conclusions AVM can present concomitantly with cystic lesions. Prompt diagnosis with multidisciplinary approach prevents complications. Embolization of all possible feeders of high flow lesions is not the definitive treatment and should be followed by aggressive surgical excision of the lesion. Incorrect sequencing and incomplete treatment can cause aggressive recurrence of lesion. Multiple silk suturing and SSI may help by causing fibrosis of the residual lesion.

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EPS00149 Conservative Approach for Large Cyst & Tumours: Still an Option

EPS00169 Intramasseteric Spindle Cell Hemangioendothelioma: A Rare Case Report with Review of Literature

Dr Sagar Bhure, Co Author: Dr. Shivamurthy D.M, Dr. Rajdeep Singh, Dr. Rohan Gupta

Dr Abhivyakti Tewari, Dr Madan Mishra and Dr Gaurav Singh SPPGIDMS, Lucknow

Chhattisgarh Dental College & Research Institute, RJN (C.G.) Abstract Background/Introduction Treatment of large cyst and tumours like Odontogenic keratocyst (OKC) and unicystic ameloblastoma still remain controversial, whether to go for conservative or radical approach. The aim of our study is to see the outcome of conservative approach. Objectives The objective of our study is to establish the outcome of conservative management in patients with mandibular odontogenic keratocyst and unicystic ameloblastoma. Methods Our study includes 6 patients between age group 15 to 30 years out of which 4 patients with odontogenic keratocyst and 2 patients with unicystic ameloblastoma, all the patients were confirmed with histopathological diagnosis and were treated conservatively by marsupialisation and enucleation along with adjunctive therapy like chemical cauterization. Results All the lesions were present in mandible, and the average follow-up of cases was 2-3 years. All cases monitored with panoramic radio graph and clinical evaluation, no recurrence was reported in any of the case. Conclusions Large cyst and tumours in young patients treated by radical approach can lead to facial deformity and impaired function. So, conservative approach can be done in a view of maintaining the integrity of jaw and function particularly in young patients.

EPS00153 Case of Unicystic Ameloblastoma-Mural Variant Dr. S. Harshad Abstract Background/Introduction Unicystic ameloblastoma is a distinguishable entity of ameloblastomas, characterized by slow growth and being relatively locally aggressive. Three histological types are recognized according to the degree of ameloblastomatous epithelial extension, namely, luminal, intraluminal, and mural types. Objectives This classification has a direct bearing on their biological behavior, treatment, and prognosis. However, there is difficulty in determining the most appropriate form of treatment for unicystic ameloblastoma. Conservatively managing the lesion to retain the function and esthetics of the patient. Methods Managed by decompression to shrink the size of the lesion and later surgically managed by enucleation. Results No recurrence in 4 year follow up. Conclusions Conservative management of the lesion should be the primary treatment objective for preserving the function and esthetics of the patient.

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Abstract Background/Introduction Spindle cell hemangioendothelioma (SCH) was first described in 1986 by Weiss and Enzinger as a vascular neoplasm, characterized by cavernous blood vessels and spindled areas reminiscent of Kaposi’s sarcoma. SCH typically presents as a single tumor or multiple nodules involving the dermis and subcutaneous tissues of the distal extremities. The head and neck region is rarely involved with extremely rare muscular involvement, this being the first case of intramasseteric SCH. Objectives This report attempts to add this rare case to the pre-existing data along with the review of literature. Methods A clinically and radiographically misdiagnosed case (FNAC, contrast CT, HR USG, angiogram and MRI) of intramasseteric vascular malformation reported with a history of gradual enlargement of the swelling over the past two and a half years, which increased in size in reclined position and regressed in erect position and compression. Due to incomplete resolution of the lesion with intralesional Sodium tetradecyl sulphate, patient underwent surgical excision under General Anaesthesia and healing was uneventful. Results Based on the histopathological report, the final diagnosis was made as, intramasseteric spindle cell hemangioendothelioma. The review of current literature showed that, to date only seven cases of SCH of the head and neck have been reported. Conclusions STH poses a great challenge to the clinician in making a final diagnosis. Surgical excision and histopathological examination is the only way to solve such a mystery.

EPS00199 A Case Report of Mandibular Odontogenic Myxofibroma Dr. Luke Kale Sinhgad Dental College and Hospital Pune Abstract Background/Introduction Odontogenic myxofibroma present a small portion of odontogenic tumors. It arises from mesenchymal portion of tooth germ either dental papilla or follicle of PDL. It is a non encapsulated benign mesenchymal tumor of ‘stellate’ cells within a mucoid ground substance. It is rare in children under 10 years of age. Reported mostly in mandible for general population. Although rare in pediatric population it should be included in differential diagnosis of radiolucent as well as mixed radiolucent and radiopaque lesions of both jaws.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Objectives To present the occurrence of a lesion rarely presented in the pediatric age group and to discuss the treatment modalities associated with this lesion. Methods Discussion of an operated case along with its post-operative follow up period of 1 year. Results Treatment done in our case was met with excellent results and patient has no complications in 1 year follow up. Conclusions Occurrence of Odontogenic Myxofibroma should be considered in the differential diagnosis of tumors of the oral cavity even in Pediatric patients.

EPS00223 Ameloblastic Fibro-Odontoma (AFO) a Rare Odontogenic Tumor Dr Fazeel Ahmed/Dr Akshay Shetty Sri Rajiv Gandhi College of Dental Science Bangalore-32 Abstract Background/Introduction Ameloblastic fibro-odontoma (AFO) is a rare odontogenic tumor. It is commonly associated with a painless swelling and an associated absence of eruption of a tooth, AFO presents as a mixed radiopaque and radiolucent lesion in the younger population with a predilection for the posterior region. Histologically, it shows the characteristics of an immature complex odontoma with irregularly arranged enamel, dentinoid, cementoid-like structures and ectomesenchymal tissue. First described by Hooker in 1967, AFO has since been extensively studied in literature. However due to its rare occurrence, the available literature has remained restricted to mainly single case reports. Objectives The ameloblastic fibro-odontoma (AFO) is an uncommon odontogenic tumor occurring in childhood with limited reported data on recurrence. Methods Based on a world-wide literature survey of published cases of ‘‘mixed odontogenic tumours’’. Results Some investigators have hypothesized that Ameloblastic Fibroma (AF), Ameloblastic Fibro dentinoma (AFD) and AFO could represent a single entity in different stages of development: AF or AFD would evolve to AFO as they mature and the latter could differentiate into odontoma. However, when clinical characteristics of these lesions are analyzed, AFO is more frequent in a younger age group with mean age of 9.6 years, than AF, which affects individuals with a mean age of 14.8 years, thereby in disagreement to the continuous differentiation hypothesis. Conclusions AFOs are hamartomatous in nature, representing a stage preceding the complex odontoma.

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ABS00243 The Gasping Breath: Massive Lesion Obstructing the Airway Lipin Peter, 2nd yr PG Dept of OMFS, Azeezia College of Dental Science and Research Dr Jacob John, Professor, Dept of OMFS, Azeezia College of Dental Science and Research, Kollam, Kerala Abstract Background/Introduction Massive lesion in the oropharyngeal region can cause severe deformities and obstruction of the airway leading to fatal disorders. The diagnosis, treatment plan and its execution are both challenging and difficult. Difficulties faced by the surgeon are access to the site and getting optional airway at the time of surgical procedure. Reporting a rare massive lesion of size 10*8 cm, disfiguring the tongue and obstructing the airway in an elderly male patient which is characteristically increasing in size since past 10 years, which was successfully managed without opting for additional airway. This case is of interest in maxillofacial literature as its a rare unreported pathology of such long standing lesion of upto 9-10 years. Objectives To dissect out the lesion on the tongue without distructing the normal anatomical structures and further to recreate the distorted morphological appearance. Methods Patient prepared and intubated followed by dislocating the mandible to get access. Infiltrating the lesion with la with adrenaline. Dissecting out the lesion as a whole mass in proper anatomical plane. Results Three separate lesions were dissected out, which was sent for histopatholgical examination. The result came out as schwanoma of tongue. Conclusions Its a rare case of schwannoma of tongue, which is a benign tumor of nerve sheath origin.

EPS00251 Plexiform Ameloblastoma: A Case Report Dr Shruthi TM/Dr. Akshay Shetty/Dr Adil Shafath Sri Rajiv Gandhi College of Dental Science and Hospital Abstract Background/Introduction Robinson (1937) defined ameloblastoma as a benign tumor that is ‘usually unicentric, nonfunctional, intermittent in growth, anatomically benign and clinically persistent.’ It most commonly occur between the age of 20 - 40 years. It accounts for 1% of all tumors of the maxilla and mandible and 11% of all odontogenic tumors. 70% of ameloblastomas develop in molar-ramus region of the mandible. Radiographically it appears as unilocular or multilocular radiolucent lesion with a honeycomb or soap bubble appearance. Objectives Plexiform ameloblastoma is one of the variant of ameloblastoma, where plexiform’’ refers to the appearance of anastomosing islands of odontogenic epithelium in contrast to a follicular pattern. It is less aggressive and has a significantly lower recurrence rate.

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S194 Methods A case Report of plexiform ameloblastoma of mandible in a 23 yr old male patient who sought complete removal of the lesion but chose to undergo delayed reconstruction. It involved entire right ramus and body of mandible with lesion extending till the base of mandible Radiographically, it appeared as an expansile radiolucent, with thinned and perforated cortices. Results It was surgically resected and followed by placement of reconstruction plate. Conclusions Treatment of mandibular ameloblastoma continues to be controversial. Because of their neoplastic nature, surgical treatments differ from those of other cystic lesions. Prior to choosing a treatment the clinico radiologic variant anatomic location, clinical behavior and size of the tumor, and age of the patient should be assessed.

EPS00289 Case report on Case of Odontogenic Keratocyst Dr Karan Panchal, Guided by Dr Navin Shah K M SHAH Dental College Abstract Background/Introduction Compared to other odontogenic and non-odontogenic cysts. Odontogenic keratocyst (OKC) is most common, aggressive and likely to reoccur. Diagnosing the lesion before it involves more bone reduces the likelihood of recurrence after treatment. However the radiologic and clinical characteristics of OKC are common to many other pathologic processes making the early diagnosis difficult. OKC can be confused with ameloblastoma, giant cell granuloma, dentigerous cyst radiographically. A 50 year old female patient came with complain of swelling and discharge from lower left back tooth region. Aspiration followed by incisional biopsy was done which confirmed odontogenic keratocyst which was then operated under GA. Objectives to evaluate and treat pre- operative paraesthesia present in left portion of chin region. Methods Enucleation was performed. Results When evaluated post-operative neurosensory responses were gradually increasing. Conclusions In this case, cystic lesion though sized large it was well encapsulated. Performing enucleation also prevented secondary surgically site which would have been necessary if resection was planned with autogenic bone graft. Lower border of mandible had adequate bone as seen from CT hence enucleation was planned.

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EPS00290 Odontogenic Keratocyst or Keratocystic Odontogenic Tumor: What’s in a Name? Dr Shikhar Aich, Dr Akshay Shetty Sri Rajiv Gandhi College of Dental Science, Bangalore Abstract Background/Introduction An odontogenic keratocyst (reclassified as keratocystic odontogenic tumour (KCOT) from 2005 to 2017) is a rare and benign but locally aggressive developmental cyst. It is categorized as one of the developmental epithelial cyst which accounts for 11% of all cystic jaw lesions. It most often affects the posterior mandible and commonly presents in the third decade of life. The most peculiar clinical feature of OKC tumor is its tendency to recur frequently, the reason behind variety of treatment modalities for this cyst. Objectives To discuss the surgical management of OKC. Methods surgical approach in managing a 62 year old male patient with a large OKC of the mandible is reported. Results The treatment included surgical excision of the lesion with a wide margin of 1 cm, and Carnoy’s solution applied after excision. Reconstruction was done using Free Fibula osteocutaneous flap. An OPG was taken postoperatively. Conclusions The present case of OKC was noticed in a 62-year old male patient on the left mandible showing the clinical and radiographic presentations, diagnosis, treatment and follow up.

EPS00293 Treatment Modalities for Parotid Fistula Dr. Kunal Gajendragadkar, Dr. Kalyani Bhate At Dr. D Y Patil Dental College and Hospital Abstract Background/Introduction A parotid fistula is a rare, extremely unpleasant complication, both for the patient as well as the treating surgeon. It consists of a communication duct in between the salivary gland or between duct and the skin, through which saliva is discharged. Various treatment modalities have been used to treat this complication, viz; (1) Surgical procedures like, the use of drains graft tube, advanced dressing with AllodermTM, anastomosis of the proximal stump of the parotid duct, use of a saphenous vein graft to reconstruct the salivary duct; tympanic neurectomy, temporalis fascia pedicle flap to isolate the parotid fistula, partial or total parotidectomy, etc. (2) Conservative management like local radiation and anticholinergic antisialogogues such as scopolamine, atropine, glycopyrolate, etc. (3) Alternate treatments transdermal injections of botulinium toxin A & scopolamine, warm hypertonic saline irrigations, etc. Objectives To evaluate the different treatment modalites for parotid fistula. To classify all the modalities into surgical, medicinal and alternate methods. To present the treatment modalities in a poster format.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Methods Search engines used were Pubmed, google search, institutional library and email to authors. Keywords used were Parotid fistula, Salivary gland fistula, Onabotulinium toxin, partotidectomy. Results All the studies found were divided into surgical treatments, conservative approaches and alternative approaches. The articles were critically evaluated to conclude the best treatment outcome. Conclusions On the basis of the results obtained, newer treatment approaches were found to attain better results with fewer complications. However, more research need to be carried out to evaluate the long term efficacy of these studies.

EPS00300 Odontogenic Myxoma: An Archetypal Presentation of a Rare Entity Dr. Pankhuri Tiwari V.Y.W.S Dental College and Hospital, Amravati Abstract Background/Introduction Odontogenic Myxoma is uncommon locally aggressive benign odontogenic tumour arising from embryonic connective tissue associated with tooth formation. WHO in 2003 classified Odontogenic myxoma as benign neoplasm arising from odontogenic ectomesenchyme with or without odontogenic epithelium. However, some studies have found that cells in the matrix of odontogenic myxoma are different from ectomesenchymal tissues of developing tooth. In addition though it is rare this tumour does occur in extragnathic bones. Thus, some pathologists consider it to have osteogenic origin. At present, there is no universally accepted theory about its histogenesis. Since local infiltration accounts for its aggressive nature and high recurrence rate, it is mandatory that patients be carefully followed after surgery. Objectives Objective is to evaluate surgical management of odontogenic myxoma and report the outcome of a case managed by using surgical approach. Methods We managed a rare case of odontogenic myxoma occurring in the maxilla of a 64-year-old male patient by wide surgical excision. Radiological investigations helped us to arrive at diagnosis which was verified later by pre and post-operative histopathological examination. Results The case is successfully managed adopting a wide surgical approach. Conclusions Due to the nonspecific and rare nature of these lesions along with diagnostic and operative dilemmas related to myxomatous tumors, proper histopathological diagnosis is required for its management.

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EPS00332 Central Bone Tumors of Jaws in Children: A Clinical Experience Dr Ankit Sharma, Dr Snehal N Ingole, Dr Mohan D Deshpande, Dr Pallavi Ranadive, Dr Noaman Kazi, Dr Deepak Burungale Abstract Background/Introduction Children though less but do experience central bone tumors of jaw. These lesion can cause alteration in facial growth and development results in physical, aesthetic and psychological disturbances. The histopathological origin of these lesions are variable at times their local behaviour is aggressive and sometime not matching there benign histological behaviour hence predicting their biological behaviour as well as their treatment is a challenge. Objectives The aim is to give insight to the Clinical and Radiographical appearance of various paediatric tumors of jaws and discuss our experience in their management. Methods Patients age group from 8 to 15 reported to OPD with tumors of either of the maxilla or mandible. Their clinical presentation, imaging, pathology, treatment outcomes are reviewed. Results All the patients are diagnosed having central bone tumors of jaw by their clinical and radiographic presentation and their benign nature was confirmed with incisional biopsy. All these patient were treated surgically and are under follow up. Conclusions To eliminate pathology and achieving function and aesthetic and favourable growth of jaw effected with such central bone tumors of jaw is always a challenge in children. In order to achieve the accurate diagnosis it is important to be familiar with clinical and radiographic features as well as histopathological characteristics of such lesions.

EPS00353 Immediate Primary Reconstruction of Hemi Mandible after Resection For Aggressive Odontogenic Keratocyst (A Case Report) Dr. Panat Sushmita Sunil Institute of Dental Sciences, Bareilly Abstract Background/Introduction The Odontogenic Keratocyst is derived from the enamel organ or from the dental lamina. p53 tumor suppressor gene has been associated with it. It is also formed by degeneration of cyclic D1 and p53 protein. In 2005, the WHO established a classification in which it was termed as Keratocystic Odontogenic Tumor. In January 2017, WHO reclassified it as Odontogenic Keratocyst. It is considered to be one of the most aggressive type of cyst due to its invasion ability in the bone and also due to its high recurrence rate. Objectives The aim of this poster presentation is to discuss a case on OKC with primary reconstruction. Methods Resection of the involved bone followed by Primary Reconstruction with stainless steel Recon plate was done.

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S196 Results Patient is on 6 months followup and the result is good on the basis of no recurrence and minimal scar. Conclusions The treatment choice must take into account factors such as size and location of the tumor, as well as invasion of the surrounding tissues and previous treatments. A variety of different treatment modalities have been proposed in the literature, ranging from conservative methods such as marsupialization to more aggressive ones such as resection. However, there appears to be a consensus among most authors, according to which an association of techniques seems to be the best choice, for instance, decompression & enucleation, marsupialization & curettage, or enucleation & Carnoy’s solution.

EPS00373 Ameloblastomatous Calcifying Odontogenic Cyst Dr. Enosh Steward, III Year Jr Resident Dharmsinh Desai University Abstract Background/Introduction Since Gorlin’s first discussion of Calcifying Odontogenic Cyst (COC) in 1962, the lesion has been now included in group of odontogenic tumors wherein there is odontogenic epithelium with odontogenic ectomesenchyme with/without dental hard tissues formation. Majority of authors have categorized COC under two basic groups of cysts and tumors. The cystic variant of COC is characterized by a unicystic lesion associated with or without odontoma and are in majority. They may also show ameloblastomatous proliferative activity intraluminally or intramurally. Ameloblastomatous COC resembles unicystic ameloblastoma except for ghost cells and calcifications within the proliferative epithelium and the fact that it occurs only intraosseously. Objectives The objective of this poster is to present a case of ameloblastomatous calcifying odontogenic cyst - a rare lesion alongwith its clinical features, radiographic picture, most common site of lesion, recurrence rate and histological picture. Methods Enucleation of the lesion was done and carnoy’s solution was padded for 5 minutes and removed. Results Uneventful healing had occurred with no post operative recurrence even after 6 years of follow up. Conclusions Ameloblastomatous COC, a cystic variant of COC occurs in the mandible with a higher propensity towards the posterior region. As conservative treatment in the form of enucleation has proven to be effective, it needs to be differentiated from Ameloblastoma ex COC since it requires more aggressive form of treatment.

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EPS00384 Idiopathic Orofacial Granulomatosis: A Case Report Dr. Shripal R. Jani, 3rd year resident Faculty of Dental Science, Dharmsinh Desai University Abstract Background/Introduction Orofacial granulomatosis is an uncommon disease, usually presenting as recurrent or persistent swelling of the soft tissues, predominantly lips - termed as Cheilitis Granulomatosa. Though various aetiological factors like foreign body reactions, infections, Crohn’s disease and Sarcoidosis have been implicated in the disease process. Delayed Hypersensitivity reaction with a predominant Th1-mediated immune response provides further evidence to the etiopathogenesis in Orofacial granulomatosis. The term Idiopathic Orofacial Granulomatosis is used in cases with unknown aetiology. A 13 years old male patient presented persistent and painless swelling on upper and lower lip and swelling on gums since last 2 years. On examination, both lips were swollen, everted, soft, edematous, non-pulsatile and non-tender. Intraorally, generalized gingival enlargement covering one half of the clinical crown. Objectives The objective of this poster is to present a case of Idiopathic orofacial granulomatosis- a diagnostic and treatment challenge along with its clinical features. Methods After scrutinising all investigations, possible pathologies were ruled out and diagnosis of Idiopathic Orofacial Granulomatosis was made. The treatment was initiated with intralesional steroid injections for lip followed by gingivectomy & gingival contouring. Results Uneventful healing took place and patient is asymptomatic after 6 months follow up. Conclusions The diagnosis of Idiopathic Orofacial Granulomatosis is by exclusion supported by the histopathological evidence of chronic granulomatous inflammation. Barium meal and intestinal biopsy are not recommended to rule out Intralesional corticosteroids are beneficial and a regular follow up and review is essential.

EPS00392 Dermoid Cyst of the Floor of the Mouth Dr. Ziaur Rahman Himachal Pradesh Government Dental College and Hospital, Shimla Abstract Background/Introduction Dermoid cyst is a cyst filled with sebum like material with evidence of specialized skin derivatives. In head and neck region it accounted for 6.9% with floor of mouth comprising of 1.6%. Highest incidence in second and third decade of life with equal gender distribution. Most common site is lateral eyebrow while intraorally mostly occurs in the floor of mouth. Objectives Overview of dermoid cyst in the maxillo-facial region. Methods A case report of a female patient with submental swelling of size approx 6x5 cm.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Results Intoto excision of the cyst was done extraorally. Acceptable aesthetic results achieved. In a 2 year followup no recurrence is seen. Conclusions Dermoid cysts are infrequent in head and neck region but when it is present it is commonly located in lateral eyebrow extra-orally and floor of the mouth intra-orally. Its diagnosis is based on usg, mri and histopathological examination with clinical correlation. Definitive treatment is the complete excision of the cyst alongwith capsule. Malignant transformation is exceptional.

EPS00394 Recurrent Ameloblastoma: Reconstruction with NVBG Dr. Jaseena AK Pushpagiri College of Dental Sciences. Tiruvalla Abstract Background/Introduction Ameloblastoma is a rare odontogenic neoplasm of the mandible and maxilla with multiple histologic variants and high recurrence rates if improperly treated. The adequate therapy of ameloblastoma may require a compromise between the least destructive treatment possible of a benign tumor and sufficiently radical method to prevent recurrences. A case of recurrent ameloblastoma in a 55 year old female patient is hereby presented. Objectives Marginal resection and reconstruction of recurrent ameloblastoma with ileac crest graft. Methods The case was treated with resection and reconstruction with ileac crest graft and stabilized with reconstruction plate. Results No post operative morbidity in two months follow up. Patient is being followed up. Conclusions Recurrent meloblastoma requires more extensive method of treatment.

EPS00404 Recurrent Ameloblastoma: A Case Report Dr. Anju P.R, Post Graduate Student Government Dental College, Trivandrum Abstract Background/Introduction Ameloblastoma is benign, slow growing locally aggressive odontogenic tumor of oral cavity with local recurrence of upto 50 to 75% cases. A 21 year old female presented with complaint of swelling in lower front teeth region. Objectives Aim is to report a case of recurrent ameloblastoma in mandible which was presented as swelling in symphyseal region of mandible 8 years back. She was diagnosed with unicystic ameloblastoma and was treated by marsupialisation at that time.

S197 Methods Aspiration was done which yielded straw coloured fluid. An OPG and CBCT was taken which revealed unicystic lesion of mandible extending mesiodistally from 36 to 46 with erosion of buccal and lingual cortical wall. Surgical resection of mandible and reconstruction was done. Results Surgical resection was done from 36 to 46 and reconstruction was done with titanium reconstruction plate. No postoperative complications were noticed. Conclusions Ameloblastoma has a high rate of local recurrence if it is not adequately removed. So radical resection is the treatment of choice for ameloblastoma.

ABS00453 A Three Year Clinical Audit of Benign Masseteric Hypertrophy Dr Ashish Garg Department of Oral & Maxillofacial Surgery, PGIDS, Rohtak Abstract Background/Introduction Benign Masseteric is associated with the enlargement of masseter muscle with or without the bony overgrowth at the angle of mandible. It can occur unilaterally or bilaterally. If present bilaterally, it produces a characteristic square/quadrangular face appearance. Patient is mainly concerned for cosmetic reasons. This case series involves 8 cases who reported to the department of OMFS, PGIDS, Rohtak between the period of june 2014 to july 2017. Objectives To correct the facial asymmetry of the patients surgically by debulking of the enlarged masseter muscle and removal of the bony overgrowth at the angle of mandible, if any. Methods All the patients were treated surgically under general anaesthesia after taking informed and written consent by extra oral or intra oral approach. Extra oral approach was used in 4 patients through Risdon’s incision whereas intraoral approach was used through the vesibular incision extending to anterior border of ramus in same number of patients. In all the cases, the enlarged masseter muscle was removed and angle osteotomy was done if needed. Angle osteotomy was done with the help of surgical template made intraoperatively. Results All the patients were successfully treated surgically by both the approaches with satisfactory results when facial symmetry is concerned. All the patients were satisfied with their post operative facial appearance. Conclusions Surgical correction of benign masseteric hypertrophy by both extraoral and intraoral approach produce satisfactory results. Extraoral approach provides good accessibility to masseter muscle and the angle of mandible but it has a disadvantage of extraoral scarring and risk of damage to marginal mandibular branch of facial nerve. Intraoral approach avoids these complications but has difficult access to the operated site.

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EPS00502 Fibro-Osseous Lesions of Maxillofacial Region: An Institutional Experience Dr. Jasmine, Dr. Pallavi Ranadive, Dr. Mohan D. Deshpande, Dr. Snehal Ingole Dr. Noaman Kazi Nair Hospital Dental College, Mumbai Abstract Background/Introduction Maxillofacial fibro-osseous lesion is a generalized pathological diagnosis for lesions showing replacement of bone by a benign connective tissue matrix. Most lesions occur in younger age group around the growth spurt age. Although they do not cause any functional disability, they do cause cosmetic deformity and therefore emotional distress to the patients. Their treatment may range from only observation to active surgical intervention. Diagnosis, long-term follow up and timely intervention based upon clinical behaviour of lesion remains the mainstay of treatment. Cases seen in our institute are presented herewith. Patients reported with fibro-osseous lesions belonged to 16-60 years of age group and the mean age was 30. Two patients had a long history of presence of the lesion. Treatment for the fibro-osseous lesion at our institute ranged from just keeping the patient under observation to cosmetic contouring to surgical intervention at various intervals.

EPS00523 Treatment Modality of Central Giant Cell Granuloma Mohd. Zeeshan Career Institute of Dental Sciences and Hospital Abstract Background/Introduction The central giant cell granuloma (CGCG) is considered a benign, nonneoplastic lesion of bone found in a younger age group who are usually less than 30 years of age. The more aggressive type may cause root divergence and destruction of the surrounding bone that expand the cortical plateCentral giant cell granuloma (CGCG) is an intraosseous lesion consisting of cellular fibrous tissue that contains multiple foci of hemorrhage, aggregations of multinucleated giant cells and occasionally trabeculae of woven bone. CGCG, as described by Jaffe in 1953 is an idiopathic non-neoplastic proliferative lesion. Trauma has been considered as an important etiologic factor in the initiation of this lesion. The lesions increase by accumulation of tissue which is produced by slow, minute, continuous hemorrhages of multicentric nature due to trauma and some defect in the capillaries. Objectives Evaluation of clinical presentation of central giant cell granuloma and treatment of the lesion. Methods suggestive treatment was surgical excision of the lesion along with extraction of involved tooth. Results Patient were on the regular follow up and free of any ailment. Conclusions It occurs most commonly in the mandible than in the maxilla. The clinical behavior of CGCG is variable. It ranges from slow-growing, asymptomatic swelling to an aggressive lesion which manifests with pain. The most common presenting sign of CGCG is a painless

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 swelling with noticeable facial asymmetry. Several treatment modalities for CGCG corticosteroid therapy is also a treatment modality. In this case surgical excision of the lesion along with the extraction of involved tooth is preferred for better prognosis.

EPS00524 An atypical Presentation of Pindborg Tumor in Posterior Maxilla: A Case Report Dr. Ashish Tripathi Career Postgraduate Institute of Dental Sciences & Hospital Abstract Background/Introduction CEOT also known as Pindborg tumour- is a rare benign odontogenic neoplasm, accounts for 0.4% - 3% of all odontogenic tumours. CEOT mostly involves posterior mandible and only few cases involves maxilla. Objectives Surgical excision of lesion along with the removal of impacted tooth lying at the left infra-orbital rim region followed by placement of iodo-form dressing of the obtained surgical defect. Methods Complete surgical removal of the lesion and the impacted tooth was planned under general anaesthesia followed by placement of iodoform dressing. Results Following post-operative dressings over a period of 6 months primary closure was done. With the patient on regular follow up for 1 year, there was no clinical and radiographical evidence of re-occurence of lesion. Conclusions This case is one of the rare aspect of CEOT involving the maxillary sinus. The treatment modalities varied with the dependence of size and anatomic location of the lesion. According to Franklin and Pindborg, they advised to remove a rim of normal tissue as safe margins together with complete local resection.

EPS00527 Follicular Ameloblastoma: A Case Report Dr. Asmita Gupta Career Postgraduate Institute of Dental Sciences & Hospital Abstract Background/Introduction Ameloblastoma is a true neoplasm which is described as benign tumor of odontogenic epithelial origin which is usually unicentric, non – functional, intermittent in growth, anatomically benign and clinically persistent. It was first described by Falkson in 1879, later Churchill has given the term ameloblastoma in 1933. It is slow growing painless tumor occurs mainly in mandible most often in the molar ascending ramus area, while only 10% is seen in the mandibular anterior region. Commonly seen in second and third decade of life with no sex discrimination. Incidence of follicular ameloblastoma are most common with incidence rate of 27.7%. Radiographically it appears as radiolucent lesion usually with well circumscribed borders.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Objectives A case of anterior mandibular ameloblastoma arising from anterior mandible treated by surgical excision of the lesion along with chemical cauterization (Carnoy’s solution) and preserving the lower border from mandibular fracture by immediate reconstruction to span and support the segment. Methods Treatment of amelobalstoma included surgical saucerisation with adjuvant chemical cauterisation. Post operative surgical dressing inclusive of ribbon gauze soaked in iodoform and glycerine medicament. Results Patient is on routine follow up and is currently free of ailment. Occlusion rehabilitation has been done. Conclusions The present deserves emphasis because of its unfamiliar appearance, potential aggressive nature and deceptive radiologic appearance maximising the chance of mal-diagnosis.

EPS00528 Surgical Management of Odontogenic Myxoma Dr. Alok Kumar Career Post Graduates Institute of Dental Sciences and Hospital, Lucknow Abstract Background/Introduction Myxomas of the jaws are believed to arise from odontogenic ectomesenchyme as it bears close resemblance to the mesenchymal portion of a developing tooth. It was probably first described by Rudolf Virchow as myxofibroma in 1863. In 1992, WHO defined OM as a locally invasive neoplasm consisting of rounded and angular cells lying in an abundant mucoid stroma. These tumors are rare, benign does not show metastasis but they are locally aggressive involving the maxilla and mandible. Objectives To diagnose a case of odontogenic myxoma with clinical and radiological finding and make a treatment plan, needful treatment of patient. Methods After confirmative diagnosis through biopsy, patient was treated surgically followed by endodontically, first involve tooth preserved by endodontic treatment then lesion was surgically excised under general anesthesia. Results The patient was under follow-up and he is asymptomatic. Conclusions It is difficult to diagnose OM based on clinical and radiographic finding. Diagnosis can be made by biopsy. Differential diagnosis has great importance for all tumors involving the maxillo-facial region. Recurrence rates are high and a long follow-up period over years is essential after treatment for patients with these tumors. Due to aggressive behavior of these tumors regular follow up is absolutely necessary in the cases of odontogenic myxomas.

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EPS00538 Non Ossifying Masticatory Myositis: A Rare Case Report Dr. Anjali Sudhakaran (MDS trainee), Dr. Ravi Veeraragavan (Prof. and HOD), Dr. Shyamsunder, Dr. Jaeson Mohanan, Dr. Giri Sanker Department of Oral and Maxillofacial Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala Abstract Background/Introduction Myositis ossificans is a rare disease in which ossification develops in the muscle or soft tissue. It is divided broadly into Myositis Ossificans Progressive (MOP) and Myositis Ossificans Traumatica (MOT). In MOP multiple, heterotopic ossifications develop in the systemic muscles, fascia, tendons and ligaments. In many cases, MOP occurs in childhood, and the range of motion of the joints gradually becomes restricted, leading to ankylosis. MOT is also called traumatic myositis ossificans, is a disease in which muscles are ossified after trauma or inflammation. Objectives Treatment of MOP and MOT usually includes surgical excision of the calcification and the surrounding muscles. Patients with MO of the temporalis or masseter area often undergo a coronoidectomy and the excision of the involved calcified muscles; whereas MO of the pterygoid muscle is more debilitating and the management of these patients are more complicated than that of the patients exhibiting MO of other masticatory muscles. Methods This case report presents a rare case of Myositis of the pterygoid muscles were the patient reported with restricted mouth opening. MRI was indicative of myositis of the pterygoid muscles, temporalis and superior constrictor. After clinical and radiological examination, the patient underwent coronoidectomy with muscle biopsy. Results The patient was diagnosed with masticatory muscle myositis, which is rare in humans. Following surgical management patient was thoroughly followed up and Hyaluronidase and Triamcinolone injections were locally administered to maintain mouth opening. Conclusions MMM is rare and has not been extensively documented in humans and easily misinterpreted as a neoplasm.

ABS00539 Clinical Audit of Haemangioma of Orofacial Region Dr. Manish Garg Department of Oral and maxillofacial Surgery, PGIDS Rohtak Abstract Background/Introduction Hemangiomas are the most common benign vascular tumour in infancy and childhood, composed of an increased number of endothelial cells that line blood vessels. Hemangioma can appear anywhere on body. Approximately 60% occur in head and neck region, 25% on the trunk and 15% in arms or legs. Various treatment modalities have been advocated for haemangioma. Objectives To access the clinical features, treatment modalities and outcome of Orofacial Hemangioma.

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S200 Methods Between year 2014-2017, a total of 10 patients of orofacial hemangioma reported to the department of oral and maxillofacial surgery, PGIDS, Rohtak. Out of which 5 patients were treated by surgical excision, 2 patients by medical management using Inj. Sodium tetradecyl sulphate 60 mg (setrol) and 3 patients by cryotherapy. Results All treatment methods gave satisfactory results. Mild soft tissue necrosis was reported in cases treated with inj. Sodium tetradecyl sulphate. No complications were reported in other two groups. No recurrence was reported till latest follow up. Conclusions Treatment for orofacial haemangioma should be decided depending upon the age of patient, site and extension of lesion. Small lesions can be surgically excised. For larger lesion, medical treatment can be given followed by surgical excision, if needed. Cryotherapy is also a good option to treat orofacial haemangioma.

EPS00556 Trigeminal Neurofibroma: A Case Report Fathima Hafila M.I (IIIyr Post Graduate), Dr. Karthik MDS (Reader), Dr. Saravanan. C FDSRCS (Prof), Dr Vivek. N MDS (Prof & Dean) SRM Kattankulathur Dental College Abstract Background/Introduction A neurofibroma is a benign nerve sheath tumor in the peripheral nervous system. In 90% of cases they’re isolated tumors, while the rest are found in persons with neurofibromatosis type I (NF1), an autosomal dominant genetically inherited disease. Neurofibromas have been reported to occur with varying frequency in the head and neck region. Trigeminal nerve tumors are rare, comprising 0.2%. To our knowledge, a trigeminal nerve neurofibroma of the main trunk has been reported in trace in the oral and maxillofacial surgery literature. The histology of a neurofibroma shows a well delineated, non-encapsulated neoplasm composed of a proliferation of spindle cells within a myxoid or collagen stroma. Objectives The purpose of this poster is to report a case of a trigeminal nerve neurofibroma, its different clinical presentation. Methods A 33 year old male patient came with a complaint chronic pain in the right lower posterior teeth region. Various investigations were taken to narrow down the source of the pain. Dental factors were ruled out. CT facial bones were taken which revealed bony expansion in relation to the inferior alveolar nerve canal. Incisional biopsy in the posterior region suggested as Neurofibroma of Inferior alveolar nerve. Under GA the tumor was excised. Patient recovered uneventfully. However patient reported back with pain in the right side of the face following which MRI was taken. MRI reports revealed Neurofibroma of the Trigeminal Nerve. Conclusions The anatomic complexity of the tumor lent itself to a multidisciplinary surgical effort and appropriate planning for successful management.

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EPS00569 OSMF: A Tale of Twists and Turns—A Case Report Dr. C. Ravindran, Professor Head of Department, OMFS; Dr. J. Naveen Kumar, Professor OMFS; Dr. Vinay Sundar, Post Graduate, OMFS; Sri Ramachandra University Abstract Background/Introduction Oral sub mucous fibrosis is a chronic, complex, premalignant (1% transformation risk) lesion of the oral cavity, characterized by juxtaepithelial inflammatory reaction and progressive fibrosis of the submucosal tissues. Micro trauma produced by friction of coarse fibres of areca nut facilitates diffusion of the alkaloids into the sub epithelial connective tissue resulting in juxta-epithelial inflammatory cell infiltrate. Objectives The Objective of this e poster is to explain a case report of a patient with oral Sub mucous fibrosis. Methods The patient underwent two surgeries in a span of three months including bilateral fiberotomy, condylectomy and coronoidectomy. Results The poster will talk about the net result of the patient’s mouth opening status and further prognosis after both the surgeries. Conclusions OSMF disease is of benign pathology and needs to take a lot of factors into consideration before taking the patient to the table and also the results are not always predictable.

EPS00574 Infantile Capillary Hemangioma Dr. Sneha Singh, PG Student Govt. College of Dentistry, Indore Abstract Background/Introduction Infantile haemangioma are the most common tumors of infancy that affect 10% children. Most infantile hemangiomas involve the head and neck. As many as 30% of lesions may be evident at the time of birth, usually as relatively inconspicuous so-called precursor lesions, proliferate during the first year of life and later on involute. The hemangiomas which do not involute naturally may require surgical, non surgical treatment modalities or combination of both. Objectives To assess the treatment outcome of infantile capillary hemangioma with a combination of surgical and non surgical management. Methods Under general anaesthesia total excision of lesion present on upper lip was performed. Intra-orally Collagen sheet was placed to facilitate closure. Intralesional sclerosing agent (sodium tetra decyl sulphate) was injected on upper lid and lateral border of the nose as the lesion at these sites were irregular and diffuse in nature. Results Surgical excision resulted in functional and esthetic resolution. After 8 months of surgical excision and 3 sessions of sclerotherapy the patient has no clinical signs of recurrence or any other condition associated with tumor.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Conclusions Thus we may conclude that surgical excision along with intralesional injections of sclerosing agent provide excellent results while treating infantile capillary hemangioma.

EPS00580 Ameloblastoma and Reconstruction of Mandible Using Iliac Crest Graft: A Case Series Dr. Ajinkya Deshpande, PG Student Govt. College of Dentistry Indore Abstract Background/Introduction Ameloblastoma has been described as benign and locally invasive tumour of odontogenic origin with a strong tendency to recur. Objectives To analyse the treatment outcome with resection of tumour and immediate reconstruction with reconstruction plate and iliac crest graft. Methods Two patients with ameloblastma of mandible were treated with tumour resection and immediate reconstruction with a 2.7mm recon plate and iliac crest bone graft. Results A 6 months follow up showed satisfactory esthetic and functional results. Conclusions Complete resection of ameloblastoma and affected part of mandible permits immediate reconstruction with good post operative results.

EPS00582 Cervical Paramedian Dermoid Cyst: A Rare Case Dr. Anagha Assissi Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur Abstract Background/Introduction Intra orally dermoid cysts present as non-tender, slow growing mass in the sublingual, submental & submandibular region. The case of a 31-year-old man with a cystic lesion in the paramedian region on the left side of anterior triangle of neck is reported. The cyst was excised & was confirmed histopathologically as dermoid cyst. Clinical progress was uneventful & post-operative recovery was excellent without recurrence. Objectives To report rare case of dermoid cyst. Methods Excision of the cyst was done through incision in the crease of the neck placed 1 cm below the cystic swelling. Dissection was done through skin, subcutaneous tissue, platysma, superficial & deep fascia to identify the cystic lining. Sharp & blunt dissection was carried for enucleation of the cyst. Thorough irrigation was done followed by wound closure with subcutaneous sutures with 3-0 vicryl & skin closure with 5-0 prolene suture by subcutaneous suture for better cosmetic results.

S201 Results The microscopic description of the lesion showed granular material with occasional benign squamous cells & a few lymphocytes. There was no evidence of granuloma or malignancy in the smear. The diagnosis was cervical paramedian cyst. Conclusions Dermoid cyst are usually seen in the sublingual, submental & submandibular region. It’s occurrence in cervical paramedian region is very rare.

EPS00634 Trends in Paediatric Ameloblastoma Management: An 47 Years Institutional Experience Dr. Shibani A Nerurkar, Dr. Neelam N Andrade, Dr. Paul Mathai, Dr. Harsh Desai Nair Dental College and Hospital Abstract Background/Introduction Ameloblastoma is an aggressive, benign, odontogenic tumor comprising of 10 % of the total odontogenic tumors. It is most commonly seen in the 3rd- 4th decade of life and is considered a rarity in the younger age group. Objectives Ameloblastoma is an aggressive, benign, odontogenic tumor comprising of 10 % of the total odontogenic tumors. It is most commonly seen in the 3rd- 4th decade of life and is considered a rarity in the younger age group. Methods A retrospective study was carried out in the paediatric group of 18 years and below, diagnosed with Ameloblastoma, at our institution over the past 47 years. The relevant data was collected by reviewing patient’s case notes, radiographs, histopathology reports and treatment charts. Ameloblastomas were either enucleated with mechanical curettage or resected followed by primary reconstruction with either a reconstruction plate or free fibula flap. Results Of the total 273 paediatric tumours, Ameloblastoma was the most common (15.2%). It occurred commonly in the age group of 12-18 years with male predilection and there was no significant difference found between the occurrence of solid ameloblastoma (51.3%) and unicystic ameloblastoma (48.7%). Ten ameloblastomas which appeared as unilocular radiolucency were diagnosed as solid type. 34 were benign and one was a rare malignancy (Ameloblastic carcinosarcoma). Only two recurrences were noted over 47 years. Conclusions We conclude that ameloblastomas are not uncommon in the Indian paediatric population. Unicystic ameloblastomas in the paediatric age group can be successfully treated conservatively owing to their growth potential with emphasis on long-term follow-up. Solid, unicystic ameloblastomas must be treated radically. Pre-operative incisional biopsy from more than one area of the tumour should be emphasized.

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ABS00636 Dentigerous Cyst Involving Maxillary Sinus in Relation to Impacted Maxillary Third Molar: A Case Report Dr. Sameena Shamsudeen Kannur Dental College Abstract Background/Introduction Common developmental benign odontogenic cyst of the oral cavity which accounts for the second most common cyst of the jaws Pathogenesis involves the accumulation of fluid between the unerupted or impacted tooth crown and surrounding follicle, giving rise to the characteristic clinical and radiographic finding of a cystic lesion surrounding the neck of the tooth. Objectives enucleation of dentigerous cyst in maxillary sinus aalong with removal of impacted maxillary third molar. Methods investigations done PNS view, CT VIEW. Enucleation of cyst with surgical removal of impacted teeth under general anaesthesia planned. Vestibular incision placed in r/t 23 - 28 Mucoperiosteal flap raised. Tooth identified – bone toughing done. Cystic lesion enucleated along with tooth. Specimen sent for histopathological examination. Results Enucleation of cyst with surgical removal of impacted teeth under general anaesthesia. Conclusions Occurrence of ectopic tooth in maxillary sinus and association of a dentigerous cyst with it is a rare phenomenon. Its presence may be asymptomatic initially with clinical manifestations, later on as adjacent structures are affected. Enucleation of the cyst along with removal of the tooth is the treatment of choice.

EPS00689 Incidence and Management of Ranula Dr. Divyashree R, Dr. Ventakesh Anehosur SDM College of Dental Sciences and Hospital Abstract Background/Introduction Ranula is defined as a mucus filled cavity in relation to sublingual gland present in the floor of mouth. Ranula resembles a frog’s translucent underbelly or air sacs. Ranulas are characterized by large cystic cavities and appear as a tense fluctuant dome-shaped vesicles, Objectives The aim of this study is to evaluate the incidence, management and complications of ranula. Methods A retrospective analysis of patients reporting with salivary gland pathology in teaching hospital during the period of 2007 to 2017 was done, from which 25 cases with final diagnosis of ranula were selected. The Medical records were evaluated for principal demographic, clinical, diagnostic and therapeutic data. Percentage analysis was done on the evaluated data. Results Among the total of 25 patients diagnosed with ranula, 18 were males and 7 were females. 8, 9 and 8 patients were of 21-30 years, 31-40 years and 41-50 years age group respectively involving the left sub

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 lingual gland predominantly. The line of treatment was surgical excision of the ranula with the involved sublingual gland. The postoperative complications such as recurrence, infection and injury to Wharton’s duct was nil, but 2 (8%) patients reported back with lingual nerve paraesthesia and 2 (8%) patients with restricted tongue movements which improved with time and exercises to improve mobility. Conclusions Although marsupialization is a popular technique but it has greater than 90% recurrence rate. Careful surgical excision of ranula along with removal of sublingual gland offers excellent result with minimal or nil morbidity.

EPS00690 Marsupialization Followed by Enucleation; Conservative Approach for Management of Ameloblastoma: A Case with 8 Years Follow Up Dr. Annadi Sreevaishnavi Meghna Institute of Dental Sciences Abstract Background/Introduction Ameloblastoma is the most common odontogenic tumor of the jaws, with clinical and histological variants. Although it has been accounted as a benign neoplasm, aggressive behaviour, local invasion potential and tendency to recur make it difficult to manage. Removal of jaw cysts that reach large sizes, result in facial deformity, injuring to the neurovascular bundle or jaw fractures. Marsupialisation followed with subsequent enucleation can be considered as an alternative clinical conservative approach. Objectives To achieve normal architecture of Mandible To avoid complications with resection and reconstruction of Mandible. Methods Marsupialization & Enucleation. Results Good Prognosis with no recurrence. Conclusions Considering the age of the patient despite following aggressive methods like resection Ameloblastoma can also be managed by conservative methods with regular periodic follow up.

EPS00691 Ameloblastoma: Can It Recur? Dr, Drub T. Sharma, Dr Kiran Radder, Dr. Venkatesh Anehosur Oral and Maxillofacial Surgery S.D.M Dental College and Hospital Abstract Background/Introduction Ameloblastoma is a rare, benign, slowly-growing odontogenic tumour accounting for about 1% of all tumours of the jaws and 11% of all odontogenic tumours arising from epithelial and/or ectomesenchymal tissue. Ameloblastomas are characterized by an aggressive potential for local invasion and a high recurrence rate (ranging between 55% and 90%) requiring a precise histological diagnosis and surgical treatment. Objectives The aim of this study is to assess the recurrence rate in operated cases of ameloblastoma over a period 10 years (2006-2016) in our unit.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Methods Histopathologically proven cases of ameloblastoma between 2006 and 2016 were retrospectively assessed for recurrence post-surgery. The surgical procedure carried out involved enucleation of the pathology and chemical cauterization using carnoys solution. In the few recurred cases radical procedure of resection of the involved bone was carried out. Results Out of 52 patients operated for ameloblastoma (biopsy proven) in the period of 10 years, 34 were male and 18 were female. This signifies the male predilection of ameloblastoma. The age of patients were ranging from 30-58 years with the mean age of 38. In 82% of the patients the lesion was in posterior mandibular region. For all the patients who were diagnosed with ameloblastoma wide excision, curettage and chemical cauterization was carried out. We had a minimal recurrence of 23%. Conclusions The results of this study appear to show a higher prediction of ameloblastoma in male population, site predilection in the posterior mandibular region and middle age predilection which is in summation with the literature. Treatment of a patient with an ameloblastoma should be based on accurate clinical details, radiographs, special imaging, and a representative biopsy.

EPS00694 Maxillofacial Fibro-Osseous Lesions: Diagnostic Conundrum

S203 findings. The histopathological features suggested ossifying fibroma based on biopsy specimen taken from periphery of the lesion. Deeper tissue/excision biopsy gave the impression of aggressive cementoossifying fibroma. Since the time elapsed for the surgery was short, patient is on regular follow up and radiological monitoring. Conclusions Fibro-osseous lesions of maxillofacial region represents a diverse group of conditions in which the diagnosis is difficult to establish. Lack of standardised terminology and classification of central or intraosseous cement-osseous lesions of the jaws have long posed a dilemma for clinicians. Until 1948 it was believed that fibrous dysplasia and ossifying fibroma were the same entity. Distinguishing the fibro-osseous lesions was an irksome task. Therefore, the case presented in this review had a multi-disciplinary approach; a team of oral pathology and oral radiology apart from the maxillofacial team were involved in the proposition for the final diagnosis and treatment of the lesion. Achieving an accurate final diagnosis is of primordial concern since it will command appropriate therapeutic action. Correlation between the biologic behaviour of the lesion and clinical, radiologic and histopathologic data is essential in reaching an accurate diagnosis.

EPS00732 A Rare Case of Palatal Neurofibroma of Spindle Cell Origin A Case Report Dr C R Sobhana Dr Deepthi S Dr Vivek V Dr Ansari Fakruddin Govt Dental College Trivandrum

Dr Pallavi Priyadarshini, Guided by Dr Soumi Samuel A B Shetty Memorial Institute of Dental Sciences Abstract Background/Introduction Fibro-osseous lesions are the commonest entities reported in the head and neck region. These lesions constitute rare benign pathology with a non-odontogenic lineage that affects the craniofacial area. Benign tumours of bone such as, the ossifying fibromas cannot be accurately distinguished from several fibro-osseous lesions through any one type of investigatory method. Until 1948, lack of standardised terminologies and classification used to pose a dilemma for clinicians, to diagnose it as ossifying fibroma or fibrous dysplasia. That year, Sherman and Sternberg published a detailed description of the characteristics of ossifying fibroma, and since then most researchers coincide in considering the two lesions to be different entities. Therefore, accurate clinical, historical, histopathological and radiographical data are important in the final diagnosis of fibro-osseous lesions. Objectives To review some of the pertinent studies related to diagnosis and treatment of fibroosseous lesions. Methods The review is based on a case report that describes a case of ossifying fibroma arising in the maxilla of a 19 year old female. The relevant articles and investigation procedures by which we arrived at a diagnosis and differentiated it from other fibro-osseous lesions has been discussed. Results Studies and case reports related to diagnosis and treatment of fibroosseous lesions were analysed. Radiographic investigations like OPG, CBCT, 3D-CT face was done. The radiology report suggested an expansile lytic lesion with a lobulated outline and well defined margins. Incisional biopsy reports correlated with the radiographic

Abstract Background/Introduction Neurofibromas arise from a mixture of cell types including Schwann cells and perineural fibroblasts. They may occur as solitary lesions or in association with neurofibromatosis. Although most commonly reported in soft tissues, Neurofibromas do occur in bone. Intra-osseous lesions may produce a well demarcated or poorly defined unilocular or multilocular radiolucency. Adjacent soft tissue neurofibromas may produce cortical erosion. Solitary neurofibromas and those found in association with neurofibromatosis share the same microscopic features. The tumor is composed of spindle-shaped cells with fusiform or wavy nuclei in a delicate connective tissue matrix. It is not encapsulated and may blend with the adjacent connective tissues. The normally recommended treatment of solitary lesions following biopsy is localized excision. Objectives A 17 year old female reported to Govt dental college Trivandrum complaining of swelling inside oral cavity for 2 months. On examination a well defined solitary pink swelling of size 2x2 cm with reddish surface mucosal changes on mid palate at the junction of soft and hard palate. On palpation was firm and non tender. Uvula normal no nasal regurgitation no paresthesia or numbness was noted. No ear discharge. Methods FNAC yielded RBC’s and inflammatory cells and repeat FNAC was also inconclusive. Was posted for wide excision biopsy under GA. Results HPR - Palatal neurofibroma of spindle cell origin. Conclusions Neurofibroma of spindle cell origin in rare in oral cavity especially palate area where initial suspicion always points toward a minor salivary gland neoplasm. A wide excision is usually preferred with sufficient margin clearance. The patient is under regular followup and the healing post operatively has been satisfactory.

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EPS00773 Intramasseteric AVM Resembles As Parotid Swelling Dr Moumita Sheikh Rama Dental College & Hospital Abstract Background/Introduction Keywords: Intramasseteric, AVM, Ultrasound, CT scan, Parotid swelling. AVM of head and neck region is one of the rare vascular anomalies. AVM tend to develop in superficial areas of head and neck region such as lip, tongue, buccal mucosa and rarely in intramuscular location. The masseter muscle is the most frequent site and accounts for approximately 5% of all intramuscular AVM in the head and neck region. Objectives An intra masseteric location may be mistaken for a parotid swelling and also may pose problems in term of proximity to facial nerve. Intramuscular malformation often have a delayed presentation due to lack of obvious skin involvement or deformity. In this case report an intramuscular AVM occurring in a 20 years old male with an unusual clinical presentation is being presented. Methods The patient complained of a swelling in the preauricular region since one year. The swelling increases during chewing movement. There is no discoloration of overlying skin & no local rise in temperature. Results Ultrasound and CT scan revealed opacity into the parotid gland. Based on this clinical and radiological findings we performed superficial parotidectomy. Intraoperatively after completion of superficial parotidectomy we found a purple colour mass into the masseteric resembling AVM. Excisional biopsy of the mass was carried out with proper ligation of the feeder vessel and the final histopathology came as intramasseteric AVM. Conclusions An intra masseteric location may be mistaken for a parotid swelling. The diagnosis of intramasseteric AVM is challenging Proper surgical resection can be reliably attempted.

EPS00800 Diagnostic Dilemmas in Maxillofacial Pathology: Our Experience Dr. Ravirajsinh A. Gohil, Dr. Sajjad Abdur Rahman, Dr. Ghulam Sarwar Hashmi, Dr. Tabishur Rahman Aligarh Muslim University, Aligarh Abstract Background/Introduction In maxillofacial pathology, it is not uncommon to come across lesions which share histopathological similarities. Such diagnostically confusing lesions put the pathologists as well as surgeons in a dilemma regarding correct diagnosis and treatment. Objectives The objective of this study is to discuss various pathologies with clinically and histopathologically confusing features. Methods Five cases of maxillofacial pathologies were taken and their pretreatment as well as post-treatment histopathological reports were analyzed.

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Results One case in this series was diagnosed as OKC and later on after the management final histopathological report came out to be of unicystic ameloblastoma. In second case preoperative histopathological diagnosis of ossifying fibroma changed postoperatively to central giant cell lesion. Third case of AOT was reported on post-treatment histopathology as ameloblastoma. Fourth and fifth cases were of osteoma according to initial histopathological diagnosis and after the management one diagnosed as aggressive osteoblastoma while other as osteosarcoma. Conclusions If the diagnosis of a known confusing lesion is suspected the surgeon and the pathologist should work together evaluating all the clinical and histopathological features exhaustively and not sticking to one of the prominent feature.

EPS00829 Changing Trends in the Treatment of Osteoradionecrosis of Jaws: A Recent Review Dr. T. Bharath, 2nd yr Resident Army College of Dental Sciences Abstract Background/Introduction Osteonecrosis of jaws is painful and debilitating condition which can be caused as a complication of treatment of surgery or radiotherapy used in malignant tumours or medications used for bone modulations and anti- angiogenesis such as bisphosphonates Risk factors include total radiation dose, modality of treatment, fraction size, dose rate, oral hygiene timing of tooth extractions, as well as continued tobacco & alcohol since there is no specific treatment which acts isolated and decidedly, management of those patients requires attention, different treatment modalities employed in an appropriated manner to control and stabilize lesions, lastly a new –early management protocol is proposed based on the current clinical criteria relating to osteonecrosis together with adoption of new therapies supported by increased levels of evidence. Objectives To present current knowledge of literature on management of osteonecrosis of jaws, both radio-induced and medication related. Methods Literature review in pubmed as well as manual search for relevant publications in references of selected articles, articles in English ranging from 2010-2017, which assessed osteonecrosis of jaws as main objective, were analysed and selected. Results Current understanding of the pathophysiology of ORN based on radiation-induced fibrosis has introduced the use of drugs such as pentoxifylline, tocopherol, and clodronate. 11–13 In animal studies none of these alone could reverse reactive oxygen species, so their combined use is important. 18 In a clinical trial, Delanian et al. reported striking regression and reversal of chronic radiation changes after their combined use. 12 In a phase II trial, Delanian et al. 23 showed that mucosal and bony healing occurred over a median period of 6 months. Conclusions Current understanding of etiopathology changes the mode of treatment more towards medical and makes pentoclo therapy as an adjuvant therapy in osteoradionecrosis.

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Section: Oral Pathology—Malignant

mesothelioma’’ because it was thought to be of mesothelial origin. However, recent studies indicate that pleural SFT appears to be derived from submesothelial mesenchymal cells. Recently, SFT has been described in extrapleural sites. SFT has also been reported to occur in such sites as the sinonasal tract, nasopharynx, oral cavity, salivary gland, and thyroid. Until now very few cases of solitary fibrous has been documented in the literature. This is a case solitary fibrous tumour which arose from the soft tissue of the floor of mouth. Objectives To report a rare case of solitary fibrous tumour. Methods A 48-year-old male presented with a 3-month history of a gradually enlarging, painless mass in the right side of the floor of the mouth. On oral examination, there was a mass of elastic hardness, measuring 4x5cm, covered by normal mucosa. Contrast-enhanced CT scan revealed an enhancing mass with a low attenuation at right side of the floor of the mouth. There was no evidence of bony involvement. A differential diagnosis was made as ranula or benign sublingual gland tumor with cystic change. The tumour was surgically excised under general anesthesia. The specimen was sent for biopsy. The biopsy specimen revealed a solitary fibrous tumour with high proliferative index. Results Biposy report revealed solitary fibrous tumour with high proliferative index. Conclusions In the present case, the patient is well without recurrence and signs of metastasis 3 months after the surgery; however careful, long-term clinical follow up may be required for the determination of the biological behavior of SFT. SFT has been recognized only recently, tumors with histological features of malignancy should be regarded as potentially malignant and should be followed up closely even after a complete resection.

EPS00188 A Wolf in Sheep’s Skin Dr. Shekinah Grace Divya Philip - Post-graduate Sri Ramachandra Dental College Sri Ramachandra University, Chennai Abstract Background/Introduction Adenoid cystic carcinoma is a rare malignant tumor that affects major and minor salivary glands. It most commonly occurs in the maxilla. It is a tumor with a deceptively benign histologic appearance. Three prognostically significant histologic patterns are seen: cribriform, tubular and solid. It has relatively painless locally invasive growth and a high probability of local recurrence. Adenoid cystic carcinoma is known for its prolonged clinical course and its propensity for delayed onset of distant metastases. Some adenoid cystic carcinomas undergo dedifferentiation into high grade. Surgery is the treatment of choice of adenoid cystic carcinoma and microscopically free surgical lines of resection must be obtained. Positive lymph nodes, solid histological features, positive margins at surgery and perineural invasion of major nerves were associated with increased treatment failures and mortality. Objectives To discuss a rare case of a 27 year old female who reported to the department of Oral and Maxillofacial Surgery, Sri Ramachandra Dental Hospital with the chief complaint of right ear ache and pain on tongue movements, the further investigations done, the differential diagnosis, the unique surgical management, arrival at the final diagnosis and the post-operative treatment plan. Methods Pre - operative work up and investigations: case history, clinical examination, MRI (brain, head and neck), CT angiogram (neck and intracranial vessels), USG guided FNAB, Biopsy, Immunohistochemistry. Surgical management: Excision of tumor in relation to posterior tongue using tongue split technique under general anesthesia. Post-operative treatment plan: Radiotherapy, regular follow up. Results Post-operative final histopathology report revealed - High grade adenoid cystic carcinoma. Margins free of tumor. Conclusions Adenoid cystic carcinomas’ occurrence in the tongue is relatively rare. The combination of surgery and post-operative radiotherapy to treat adenoid cystic carcinoma has been seen to improve locoregional control of the disease. Radiation therapy has been seen to promote tumor regression and pain relief.

EPS00197 Solitary Fibrous Tumour with High Proliferative Index: A Case Report Dr. George Jacob, Dr. Gaurav Singh, Dr. Amit Gaur Sardar Patel Post Graduate Institute of Dental and Medical Science Abstract Background/Introduction Solitary fibrous tumor (SFT) is a rare spindle cell neoplasm that typically arises in the pleura. It was once referred to as a ‘‘localized

EPS00294 Rare Malignant Tumours of the Mandible Dr. Mohan Baliga Abstract Background/Introduction Cancer is a disease involving complex multiple sequential irreversible dysregulated processes showing metastasis that results in morbidity and mortality. Metastasis is a complex biological course that begins with detachment of tumor cells from the primary tumor, spreading into the distant tissues and/or organs, invading through the lymphovascular structures followed by their survival in the circulation. Metastatic tumors to the oro-facial region are uncommon and may occur in the oral soft tissues or jawbones mainly the mandible. Objectives To highlight three rare malignant tumours of the mandible to be kept in mind whenever clinicians deal with malignant tumours of the mandible. Methods From the archives of the department for a period of 20 years. Results The interdisciplinary management including surgery and chemoradiation in the prognosis and the survival rate. Conclusions The clinical presentation of metastatic tumors can be variable, which may lead to erroneous diagnosis or may create diagnostic dilemma. Therefore, they should be considered in the differential diagnosis of inflammatory and reactive lesions that are common to the oral region.

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S206 This poster highlights three rare malignant tumours such as Malignant fibrous histiocytoma, Non Hodgkins lymphoma and Adenoid Cystic carcinoma. These cases are frequently missed due to their less documentation in literature. Hence this present poster is an attempt to bring into showcase these three rare malignant tumours to aid in its proper diagnosis and diligent management.

EPS00312 Ameloblastic Carcinoma: A Case Report Dr. Debashish Borkotoky Yenepoya Dental College Abstract Background/Introduction Ameloblastic carcinoma is a rare malignant odontogenic carcinoma that has metastatic potential. Due to its rare incidence, there are few studies focusing on its radiological characteristics. When ameloblastic carcinoma demonstrates an aggressive appearance, it may be diagnosed as a malignant tumor; however, in cases showing a nonaggressive appearance, it is difficult to distinguish ameloblastic carcinoma from ameloblastoma. Clinically, ameloblastic carcinoma is more aggressive than most typical ameloblastomas with extensive local destruction, perforation of the cortical plate, extension into surrounding soft tissues, numerous recurrent lesions, and metastasis, usually to cervical lymph nodes. The radiographic appearance of ameloblastic carcinoma is consistent with that of ameloblastoma except for occasional presence of some focal radiopacities, apparently reflecting dystrophic calcification. Histologically, the tumor cells resemble cells seen in ameloblastoma but show cytologic atypia, cellular pleomorphism, nuclear hyperchromatism, mitoses, and vascular and neural invasion. We report a case of a 44-year old male patient, with a history of swelling over the right mandibular ramus region two years back for which surgical excision was performed and histopathological examination was suggestive of Ameloblastic Carcinoma. Later, the same patient reported two months back with a recurrence of the swelling over the same region, for which wide excision was performed through extraoral approach.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 which carries high mortality and morbidity. An appropriate early diagnosis and treatment can improve the prognosis and survival of patients. Conclusions Synovial sarcoma is a rare malignant tumor of which treatment is essentially surgical resection with high rates of recurrence. A head and neck surgeon should be familiar with this aggressive tumor, which carries high mortality and morbidity. An appropriate early diagnosis and treatment can improve the prognosis and survival of patients.

EPS00510 Diagnostic Markers in the Head and Neck Malignancy Dr Gopal Lahudas Nagargoje Maharashtra Institute of Dental Sciences and Research, Latur Abstract Background/Introduction Oral cancer, the largest subset of head and neck cancer, has become one of the most lethal malignancies during the last two decades. Although several diagnostic tools have been applied for the early detection of oral malignancies, it is still important to identify novel tumor markers. Early detection would significantly decrease the mortality rate of oral cancer. Advances in understanding of the molecular mechanisms underlying oral squamous cell carcinoma (OSCC) have resulted in an increasing number of biomarkers that can be used to predict the behavior of this disease. Objectives Objective of this poster is to review the role of biomarkers in predicting the outcome of Head & Neck malignancies.

EPS00541 Treatment Modalities of Keratocystic Odontogenic Tumor Dr. Shivika Choudhary

EPS00406 Synovial Sarcoma of Submandibular Region Dr. Nitesh Mishra Faculty of Dental Sciences, IMS, BHU Abstract Background/Introduction Synovial sarcoma is a malignant tumor of pluripotent mesenchymal cells. This timour commonly found in periarticular tissues, with few cases occurring in the head and neck region. Objectives To present a case of synovial sarcoma of submandibular region. Methods Case report. Results Synovial sarcoma is a rare malignant tumor of which treatment is essentially surgical resection with high rates of recurrence. A head and neck surgeon should be familiar with this aggressive tumor,

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School of Dental Sciences Sharda University Abstract Background/Introduction Management of keratocystic odontogenic tumor by conservative management and radical management. Objectives Various treatment modalities for curing odontogenic tumor. Methods By conservative management like enucleation, curettage By radical management like segmental resection, hemimandibulectomy. Results Keratocyystic odontogenic tumor can be cure by these procedures. Conclusions Its rare but it can be cured by conservative procedures as wwll as radical management.

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EPS00642 Spindle Cell Tumor of Neural Origin in Palate: A Rare Entity

EPS00688 Management of Oral Cancer with N0 Neck Cases: Our Protocol and Controversies

Ananth. C

Dr. Abhay T. Kamath, Dr. Adarsh Kudva

Govt Dental College Thiruvanthapuram

Manipal College of Dental Sciences

Abstract Background/Introduction Spindle cell carcinoma rarely occurs in the oral mucosa. In a series of 307 oral spindle neoplasms observed over a 20-year period, only two (0.7%) constituted spindle cell variant of the squamous cell carcinoma. The World Health Organization (WHO) defines this tumor as a ‘carcinoma within which there are some elements resembling a squamous cell carcinoma that are associated with a spindle cell component’. Objectives Management of spindle cell carcinoma of palate. Methods Wide excision with safety margins under GA. Results Continuos followup shows complete healing with no residual defect. Conclusions Wide excision with safety margin will be the treatment of choice for spindle cell carcinoma of palate.

Abstract Background/Introduction The treatment of patients with N0 squamous cell carcinoma (SCCA) of the head and neck remains controversial. The presence of lymph node metastases is the most important prognostic factor for survival in head and neck. Histologically proven lymph node metastasis increases the stage to 3 and may decrease survival by 50%. Objectives Watchful waiting until a patient with an N0 neck develops detectable neck disease has been shown to significantly decrease survival. Elective or prophylactic neck dissection improves regional control, and the results of salvage surgery for N0 neck, which were observed and have progressed to N? neck, are poor. Therefore, the challenge of caring for patients with an N0 neck lies in identifying which patients are at risk for developing lymph node metastases in order to treat those patients prophylactically and to decrease the risk of neck failure in the neck. Methods Thus, the protocol followed at our institution is ipsilateral supraomohyoid neck dissection for oral carcinoma with N0 neck and it has shown promising results with great patient outcome. Results Elective neck dissection resulted in higher rates of overall and disease-free survival than did therapeutic neck dissection. Conclusions This poster would give an insight into the diversity of oral cancer cases that have been treated by the above-mentioned method at our institution and their outcomes.

EPS00646 Prognostic Benefits of Use Touch Imprint Cytology of Bone Resection Margins in Patients with Oral Squamous Cell Carcinoma Dr. Monisha Fernandes AB Shetty Memorial Institute of Dental Sciences Abstract Background/Introduction A 5-mm margin of histopathologically uninvolved tissue surrounding the resected squamous cell carcinoma is widely accepted as a negative margin however use of frozen sections is limited to soft tissue assessment introperatively. Limitations in methods to assess the involvement of the bone margin at the time of surgery can negatively affect prognosis. Imprint cytology is an intra- and peri-operative tissue assessment technique that offers sensitivity and specificity that is equivalent to that of frozen sections, hence could prove to be a potent tool for obtaining tumour free margins. Objectives Intraoperative assessment of bone margins in oral squamous cell carcinomas. Methods Review of literature. Results Touch imprint cytology is an accurate, simple, rapid and cost-effective method that aids in intraoperative assessment of margins in diagnosing surgical specimens of thyroid, parathyroid, breast cancer margins, sentinel lymph nodes prostate and also oral squamous cell carcinoma. Conclusions Thus touch imprint cytology has justified the need for further study and implementation in oral squamous cell carcinoma resections.

ABS00697 Ewing’s Sarcoma of Mandible: A Rare Presentation Dr Gauri Gupta, Prof. Rinku George Saveetha Dental College and Hospital Abstract Background/Introduction ‘Ewing’s Sarcoma (ES) is a rare malignancy primarily affecting skeletal system and it is commonly diagnosed in children and young adults. It seldom occurs in head and neck region. ES has poor prognosis because of uncontrolled metastatic potential making early diagnosis and intervention critical for survival of the patient. This paper reports a rare case of ES involving mandible in an 9 year with clinical, radiological, histopathological and surgical modality. Objectives ES is an aggressive tumour showing rapid growth and metastasis. It is a part of ES family of tumours (ESFT), which also includes peripheral neuroectodermal tumour (PNET), neuroepithilioma and Askin’s tumour. This has made diagnosis even more complex. ES has the most unfavourable prognosis of all primary musculoskeletal tumours. Even with early intervention, patient with metastasis have 20% of survival rate. Here we report a case of ES involving mandible in an 9 year old girl with pertinent review of Indian literature to make the

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S208 clinicians aware of the clinical as well surgical modality of the rare tumour. Methods ‘‘We report a case of 9 year old girl with a rapidly expanding mass on the right side of her face treated by complete surgical excision followed by reconstruction with fibula graft. Results Results are satisfactory; and the patient is completely cured of disease. Conclusions Less than 70% cases of ES of mandible has been reported. It generally requires multimodal approach. It’s a radio responsive tumour and local therapy includes combination of surgery and radiotherapy; Surgery when feasible is the treatment of choice. Refinements in diagnostic imaging, along with newer techniques, ensure a long term survival rates.

ABS00702 Transmandibular Resection with or Without Lip Splitting: A Prospective Analysis of 30 Cases Shoeb Ullahtalib Ansari, Vrinda Kolte, S.R. Shenoi, Anup Garg, Kshitij Bang, Pranav Ingole, Neelima Budraja VSPM DCRC Nagpur Abstract Background/Introduction A lower lip-splitting incision is being used for transmandibular resections since the olden times for obtaining wide access to oral cancers regardless of its unfavorable aesthetic results. Here, we have described a new modification of the traditional approach for transmandibular resection without lip splitting to improve the cosmetic results. Objectives To evaluate transmandibular resection with or without lip splitting. Methods Patients of oral cancer involving mandible and retromandibular trigone who underwent transmandibular resection were reviewed from January 2016 to June 2016. Of 30 patients who underwent mandibular resection for cancer, 15 had been operated without lower lip splitting and 15 with conventional lip split approach. Each case was assessed for TNM staging, status of resection margins, perioperative and postoperative complications and aesthetic and functional results of lower lip. Results All the tumors were successfully removed in-toto by means of modified non ‘‘lip-splitting and the traditional lip split approach. The cosmetic results have been analysed in these cases. Conclusions This new modified non-lip-splitting mandibulectomy approach could certainly replace the traditional mandibulectomy approach for atleast some selected malignant lesions, with excellent cosmetic as well as functional results of the lower lip.

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Section: Oral Surgery EPS0027 Oro Antral Communication Closure by Buccal Fat Pad Saloni Bharti & Bidsh Abstract Background/Introduction It is a well documented post operative complications associated with the extraction of molars and premolars teeth. Objectives Aim of present study was evaluate the use of buccal fat for the closure of oroantral communication. Methods All defects were closed by application of buccal fat pad. Results The buccal fat pad for closure of an OAC was successfully used in patients at our department. Excluding all severe complicating cases such as tumour related defects or previously treated cases, the overall success rate for closure of OAC was nearly 98 percent. No late complications occur. Conclusions According to the recommendations and anatomiclimitatuons reported in published studies and discussed in the present report, the application of buccal fat pad is a safe and reliable procedure for closure of oroantral communication.

EPS0029 Evolution of Diclofenac Products Dr Jaismeen Kaur, PG 2nd Year Student BRS Dental College and Hospital, Panchkula Abstract Background/Introduction Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) of the phenylacetic acid class with anti-inflammatory, analgesic and antipyretic properties. Since its introduction in 1973, a number of different diclofenac containing drug products have been developed with the goal of improving efficacy, tolerability and patient convenience. Objectives This poster aims to illustrate how pharmaceutical technology has been used to modify the pharmaco-kinetic properties of diclofenac, leading to the creation of novel drug products with improved clinical utility. Methods Analysis of literature was carried out and earlier articles about edvant of diclofenac products were studied. Market survey was carried out. Results The enhanced dissolution and absorption kinetics of diclofenac potassium led to the development of several diclofenac potassiumcontaining drug products, with the ultimate goal of shortening the time to clinically meaningful analgesia. Conclusions Continuous improvements in biopharmaceutical properties of diclofenac have led to the creation of a broad array of drug products designed to treat multiple inflammatory and painful conditions.

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EPS0030 Adult Stem Cells and Tissue Engineering Strategies for Salivary Gland Regeneration Dr Aakanksha Sharma, PG 2nd Year BRS Dental College and Gen Hospital, Panchkula (Haryana) Abstract Background/Introduction Tissue engineering is the application of life sciences and materials engineering towards the development of tissue substitutes that are capable of mimicking the structure and function of their natural analogues within the body. The underlying strategy behind the development of tissue engineered organ substitutes is the combination of cells, biomaterials and biochemical cues intended to recreate the natural organ environment. Objectives This poster aims to highlight current bioengineering approaches for salivary gland tissue engineering and adult stem cell sources used for this purpose. Methods Analysis of literature was carried out and earlier articles about edvant of tissue engineering strategies for salivary gland regeneration were studied, Results It has been demonstrated that tissue engineering approaches utilizing stem cells and biomaterials have a capability to become a viable means to achieve meaningful salivary gland regeneration. Conclusions Adult stem cells and tissue engineering is a step toward the development of tissue substitutes that are capable of mimicking the structure and function of their natural analogues within body.

ABS0055 Advancements in Local Anaesthetic Devices Dr. Dharmika Jagani, B Divya Jyothi College of Dental Sciences and Research Institute Abstract Background/Introduction Pain and its successful management is one of the corner stones of dentistry worldwide since time immemorial. ‘‘DREADED INJECTION FROM DENTIST’’ can be one of the primary reasons for potential patients not seeking timely treatment for their dental problems. Objectives It is imperative to update our knowledge and skills in using newer alternatives in pain control and management and ways of administering them to increase comfort level of our patients and resolve the cliched paradigm of ‘‘PAIN AND DENTISTRY ARE INSEPERABLE’’. Methods This poster is prepared by referring to 18 articles from journals of Dental clinics of north America, National journal of maxillofacial surgery, California state journal of medicine, IOSR journals and textbooks of local anesthesia-Monheims, Stanley. F. Malamed. Results This poster overview will enlighten the practising dentists regarding newer innovations in drug delivery system and methods of rendering

S209 pain control comparing these with earlier used ones on basis of research and clinical studies available to improve patients experience at dentist and thereby provide dentist with more cooperative patient resulting in optimised dental care. Conclusions Hereby, I conclude that research showing CCLAD systems to be very promising in achieving painless injections especially with AMSA, PASA, PDL injections. Vibrotactile devices are also useful in achieving patient satisfaction during injection. Jet injectors are not very useful when compared to other devices. Intraosseous systems are very useful tools to achieve profound anesthesia, as an alternative to conventional injections. Safety syringes prevent accidental needle stick injuries and it is advisable to use them in future.

EPS0068 Comparative Study of OPG & CBCT as Pre-operative Diagnostic Tools for removal of Impacted Mandibular 3rd Molar Dr. Vimal Joseph Devadoss Rajas Dental College & Hospital,Tiunelveli Abstract Background/Introduction Extraction of the mandibular third molars is a routine procedure in maxillofacial surgery, whether for prophylactic or for orthodontic reasons. Third molars have a high incidence of impaction, associated with many conditions such as pericoronitis, caries on the distal surface of the second molar, pain, external root resorption and odontogenic cysts and tumors. Imaging examination is undoubtedly an essential tool for diagnosis and surgical management because it provides valuable information about the tooth position, the number/morphology of the roots and relationship of the tooth to adjacent structures. Objectives To evaluate the correlation of OPG findings & CBCT in the evaluation of relationship of impacted mandibular third molars to the mandibular canal. Methods 25 patients who reported to the department of OMFS, Rajas Dental College and Hospital, Tirunelveli, Tamilnadu. 25 patients with 40 impacted mandibular third molars showed 38 radiographic signs of proximity of mandibular third molar to inferior alveolar canal on digital panoramic radiographs for which CBCT was done. Results 25 patients with 40 impacted mandibular third molars showed 38 radiographic signs of proximity of mandibular third molar to inferior alveolar canal on OPG for which CBCT was done, only 28 CBCT revealed the proximity of mandibular third molar to inferior alveolar canal. Conclusions Due to the recent development of CBCT, three dimensional images are becoming more easily available. On comparison with OPG and CBCT, the golden standard is CBCT but on dosage calculation between OPG and CBCT, CBCT dosage is high but when the area of exposure is limited the radiation dosage between OPG and CBCT, is slightly more or the same. Thus using OPG and CBCT for diagnostic purpose for impacted third molar, CBCT plays a vital role in 3 dimensional view, lower radiation and cost effective.

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EPS0072 Versatility of Socket Shield Technique: A Case Study Dr. Packiyaraj MDS, Prof and HOD, Dr. Sherin A. Khalam MDS, Dr. Chandoorya. C, PG First Year Rajas Dental College & Hospital Abstract Background/Introduction Extraction of teeth is inevitably associated with distinctive changes in the surrounding hard tissue and soft tissue. Healing of extraction socket is characterized by the formation of bone within the socket and the loss of width, height of the alveolar ridge compromising the implant placement especially in the aesthetically important areas. Socket shield technique, introduced by Hurzeler in 2010, is the one which prevents the resorption and achieves the alveolar ridge preservation. Objectives To identify whether socket shield technique is a viable alternative to bone substitutes and guided bone regeneration. Methods With the socket shield technique the submucosal portion of the buccal root fragment of 1 to 2 mm is retained as a shield 1 mm coronal to the buccal alveolar plate, followed by an immediate implant placement. Results Socket shield technique reduces resorption, achieves osseointegration and minimizes buccal contour changes after tooth extraction. Conclusions It is an ideal method, which is cost effective and minimally invasive in preserving the ridge without the use of biomaterials like Guided bone regeneration and bone substitutes.

EPS0096 Application of 3D Printing in Oral and Maxillofacial Surgery Dr. Peyush Pratap Singh Maharana Pratap College of Dentistry & Research Centre, Gwalior (MP) Abstract Background/Introduction Three-dimensional printing, also known as rapid prototyping, additive manufacturing, or solid-freeform technology, is a precise computerdirected process whereby models are fabricated via successive layering of material. 3D printing refers to the production of a three dimensional object from a digital file. From aerospace technology, clothing to firearms this technology is being developed in most fields and can even be applied to Oral and Maxillofacial surgery (OMFS) Three-dimensional printed haptic models allow surgeons, students to develop a superior understanding of anatomical features, through tactile and visual spatial feedback. The ability to interact directly with a custom model of patient-specific anatomy and pathology is expected to improve preoperative planning. Objectives The aim of this poster is to describe the applications and limitations of 3-dimensional (3D) printing in advanced oral and maxillofacial surgery (OMFS) and to discuss the benefits of this modality in surgical planning, student and resident training, and client education. Methods

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 A review was done of the current methods of 3D printing, applications within oral and maxillofacial surgery and to look at their merits and pitfalls. Results The overall easy access to 3D printers makes it possible to produce sufficient hardcopy templates as tools for reconstruction of bones in Maxillofacial surgery, within few hours at a reasonable price level, which can greatly improve the quality of bone reconstruction. Conclusions This technology remains in its infancy at present however, it remains clear that 3D printing technology is here to further develop and has a successful role to play in oral and maxillofacial surgery.

EPS00108 Comparison Between the Clinical Results of Buccal Fat Pad with Collagen Sheet Over Buccal Fat Pad Alone in Reconstruction of Mucosal Defect Following Surgery for Oral Sub Mucous Fibrosis Dr. Utsav Singh Gurung Sardar Patel Post Graduate Institute of Dental and Medical Sciences (SPPGIDMS) Abstract Background/Introduction Oral submucous fibrosis (OSMF) is a potentially malignant condition characterized exclusively by the formation of vesicles along with juxta epithelial inflammatory reaction and fibroelastic changes in the lamina propria with atrophy leading to stiffness of oral mucosa. This leads to formation of fibrotic bands that ultimately results in restricted mouth opening (trismus). Burning sensation of the oral mucosa while taking hot or spicy food is the other clinical feature. It primarily affects the buccal mucosa but may involve various parts of the oral cavity and often extends to the pharynx. The disease is predominently found in Indian subcontinents, due to deleterious tobacco chewing habits present in the inhabitants. OSMF can be managed by conservative (intralesional corticosteroids plus oral supplements) or surgical means. However, the conservative management is limited only for mild cases of OSMF. Surgery is indicated for patients with marked limitation of mouth opening. Various surgical modalities include: release of fibrous bands (fibrotomy), temporalis myotomy and coronoidectomy followed by reconstruction of mucosal defect using flaps, grafts and collagen membranes. Objectives The aim of this study was to evaluate the clinical results of Buccal fat pad with Collagen sheet over Buccal fat pad alone for reconstruction of mucosal defects following surgery for oral sub mucous fibrosis. Methods A 12 months prospective study was conducted on 20 patients diagnosed with OSMF Group III or Group IV A (Khanna JN and Andrade NN classification, 1995). They were divided into two groups. Patients in group 1 were treated by Buccal fat pad alone and in Group 2 by Buccal fat pad with collagen sheet. Results The mean preoperative mouth opening was 13.55mm in group I and 13.06mm in group II. The mean postoperative mouth opening after 1 year was 35.48mm in group I and 36.51 in group II. Infection was evident in 4 patients of group I whereas none in group II. The wound dehiscence was noted in two patients after 1 week follow up in group I and none in group II. Time taken for complete epithelialization of mucosal defect in both groups was 2-3 weeks. Mean pain score was 4

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 and 2 on VAS scale after 1 week followup in group I and II respectively. Conclusions Collagen membrane can be used as an adjunct for reconstruction of mucosal defect following surgery for OSMF as pain score, physical trauma, food lodgement and consequent infection at surgical site is reduced. It further helps in maintaining structural integrity of BFP during healing phase.

EPS00112 A Novel Method of Local Drug Delivery System in Oral Surgery Dr. Beena Sivakumar People’s College of Dental Science and Research Center, Bhopal Abstract Background/Introduction Post-operative pain management is one of the important aspects after any procedures in Oral Surgery. Platelet rich fibrin (PRF) is an autologous fibrin sealant enriched with platelet concentrate, which can be produced chair side at the time of surgical procedure and can be utilized to enhance wound healing. Addition of medicaments to PRF is a novel method of local and systemic drug delivery. Objectives The objective of this study was to use Platelet rich fibrin (PRF) as a method of local drug delivery following trans-alveolar extraction of 3rd molar tooth. Methods Randomized clinical trial was conducted among patients undergoing trans-alveolar extraction of 3rd molar tooth. Patient’s blood was collected before the initiation of the procedure for the preparation of PRF. Then an opioid analgesic was incorporated into it following which the PRF was placed in the socket. Results Patient who received PRF with opioid analgesic in the extraction socket was analyzed for occurrence and intensity of post-surgical pain when compared to the control group. Time and dosage of rescue analgesia was also recorded the study group. Conclusions PRF incorporated with an analgesic drug is an effective method to enhance wound healing and in post-operative pain management. In third molar extraction.

EPS00125 Role of Plasma Rich Fibrin in Alveolar Osteitis Tushar Dubey Kothiwal Dental College Abstract Background/Introduction Dry socket or acute alveolar osteitis is a quite painful and debilitating condition for the patients who underwent extractions. It can be defined as the presence of ‘‘postoperative pain’’ in and around the site, which extraction increases in severity at any time between 1 and 3 days after the extraction, accompanied by a partially or totally

S211 disintegrated blood clot within the alveolar socket, with or without halitosis. Objectives To assess the efficacy of Platelet Rich Fibrin (PRF) on the pain and healing of the extraction socket associated with Alveolar Osteitis (Dry Socket, AO) after removal of maxillary and mandibular molars. Methods 100 adult patients with age group ranging from 18 to 40 years along with established dry socket after maxillary and mandibular molar extractions who have not received any treatment for the same were included in the study. PRF was placed in the maxillary and mandibular molar extraction sockets after adequate irrigation of the socket. All the patients evaluated for the various study variables which include pain, degree of inflammation, and healthy granulation tissue formation at 1st, 3rd, 7th, and 14th post operative day. Data were analyzed using Shapirowilk’s test, chi square test and/or studenttest, Friedman’s test, Wilcoxson’s signed rank test, and Bonferroni test, with the significance level set at P \ 0.05. Results There was significant reduction in pain associated with AO at the 3rd and 7th postoperative day along with better wound healing by the end of 2nd week. Conclusions Use of PRF in this study illustrates the promising results in terms of reduced pain and better healing in the patients with Alveolar Osteitits.

EPS00127 A Case Report of Chronic Osteomyelitis Associated with Extra-Oral Draining Sinus Dr Ramandeep Grewal (PG-3rd Year) Dr S.P.S Sodhi (H.O.D) Department of Oral & Maxillofacial Surgery, Dasmesh Institute of Research and Dental Sciences, Faridkot Abstract Background/Introduction A cutaneous draining sinus of dental origin is often a diagnostic challenge because of its common occurence and absence of dental symptoms. Proper diagnostic treatment and the elimination of the source of infection are must. Otherwise it can result in ineffective and inappropriate outcome of treatment because of wider use of antibiotics and greater awareness among the population. It is still not uncommon to find suppurative orofacial infections in day to day practice in developing countries like India. Such an inflammatory process may take one of the three courses’’‘‘ acute, subacute and chronic, depending upon factors such as virulence of the micro-organisms, resistance of the host and local conditions. We present a case of chronic suppurative osteomyelitis associated with a draining extraoral sinus, which has been successfully treated with surgical debridement and antibiotic therapy. Objectives The purpose of this study is to evaluate the efficacy of antibiotic therapy through the extra-oral drain. And also to evaluate post-operative healing of the sinus tract. Methods Under Local anesthesia sinus tract was excised and sequestrectomy and currettage was done along with the placement of the extra oral drain for instillation of local antibiotics. Healing was evaluated at regular post operative follow-ups. Results Healing of the sinus tract was satisfactory and the lesion healed completely one month post-operatively with no reocurrence.

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S212 Conclusions The present case shows that antibiotic therapy and surgical debridement is a definitive method of treating chronic suppurative osteomyelitis of mandible with favourable clinical results. Patient should be kept on regular follow ups post -operatively.

EPS00138 Use of CBCT in Oral and Maxillofacial Surgery Dr. Deepak Kumar (PG 2nd Year) Dr. Gursimrat Brar (Sr. Lecturer) Dept. of Oral and Maxillofacial Surgery, Dasmesh Institute of Research and Dental Sciences, Faridkot Abstract Background/Introduction The use of cone-beam computed tomography (CBCT) allows a 3-dimensional evaluation of the jaws; thus, surgeons can obtain more detailed and accurate information about the quality and quantity of the bone, helping them to identify anatomical features. Cone beam computed tomography (CBCT) is an alternative modality to CT or MRI that should be performed in all cases of suspected pathology of the maxillofacial region. Prior to a surgical procedure, a careful preoperative examination is necessary to avoid complications and to take the appropriate precautions. CBCT is cost-effective as compared to CT and associated with lesser radiation exposure with patient convenience. CBCT allows 3-D vision of normal anatomy and different pathologies of jaw bones and is a good tool for differential diagnosis and treatment planning. This poster gives an insight into the uses of CBCT in relation to oral and maxillofacial surgery. Objectives Role of CBCT in 3-D visualization of normal anatomy and different pathologies of jaw bones with respect to differential diagnosis and treatment planning. Methods Not applicable. It is a review articles. Results CBCT hugely expand diagnostic and treatment possibilities for the patients. Three-dimensional imaging of cysts and tumors of the maxillofacial region and can give the surgeon the vital information necessary for planning surgery with volumetric analysis, this can help anticipate the need for and volume of a potential graft for reconstruction. Conclusions CBCT is cost-effective and associated with lesser radiation exposure with patient convenience. It allows 3-D vision of normal anatomy and different pathologies of jaw bones and is a good tool for differential diagnosis and treatment planning.

EPS00142 Case Report: Herpes Zoster as a Sequelae of Traumatic Extraction Kumar Abhishek Institute of Dental Sciences Bareilly Abstract Background/Introduction Herpes-zoster or ‘shingles’ is an acute viral infection caused by reactivation of the VARICELLA-ZOSTER virus during prodromal

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 stage, the only presenting symptom may be odontalgia, which may be diagnostic challenge for the dentist. Postherpetic neuralgia, developmental anomalies, osteonecrosis of jaw bone and facial scarring are the other complication associated with it. Objectives Early diagnosis and prompt treatment of the disease in the prodromal phase by the use of antiviral agents should be the mainstay of it’s management. Methods Conservative management (Medicinal treamtent). Results After the 14 day follow up there was a significant difference in general systemic condition as well as oral lesion of HZV. Conclusions Herpes zoster infection may be infrequently encountered in general dental practice. Diagnosing these complications of herpes zoster could pose a challenge to an dental surgeon due to their varied presentation ranging from post herpetic neuralgia, external root resorption, osteonecrosis and tooth exfoliation. There is burning sensation, pain, vesiculation, ulceration along the course of the Trigeminal nerve should be treated promptly with HZV infection in mind.

EPS00157 Osteoradionecrosis Dr Priya Kumari; Dr Numair Farhan Chandra Dental College, Barabanki Abstract Background/Introduction Osteoradionecrosis (ORN) is a condition of nonvital bone in a site of radiation injury. ORN can be spontaneous, but it most commonly results from tissue injury. The absence of reserve reparative capacity is a result of the prior radiation injury. Even apparently innocuous forms of trauma such as denture-related injury, ulcers, or tooth extraction can overwhelm the reparative capacity of the radiationinjured bone. Traditionally, 3 grades of disease (I, II, III) are recognized. Grade I ORN is the most common presentation. Exposed alveolar bone is observed. Grade II designates ORN that does not respond to hyperbaric oxygen (HBO) therapy and requires sequestrectomy/saucerization. Grade III is demonstrated by fullthickness involvement and/or pathologic fracture. Therefore, patients can demonstrate grade I or grade III ORN at initial presentation. Objectives To review the current knowledge on etiology and management of osteonecrosis of the jaws, both radio-induced and medication-related, aiming to improve knowledge of professionals seeking to improve the quality of life of their patients. Methods Literature review in PubMed as well as manual search for relevant publications in reference list of selected articles. Articles in English ranging from 1983 to 2017, which assessed osteradioonecrosis of the jaws as main objective, were selected and analyzed. Results Infections, traumas and decreased vascularity have a triggering role for osteonecrosis of the jaws. Prophylactic and/or stabilizing measures can be employed in association with therapeutic modalities to properly manage osteonecrosis of the jaws patients. Conclusions Selecting an appropriate therapy for osteradioonecrosis of the jaws management based on current literature is a rational decision that can help lead to a proper treatment plan.

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EPS00192 A Case Report of of Angiofibroma Dr. Gagandeep Singh (PG 3 Year) Dasmesh Institute of Dental Science, Faridkot Abstract Background/Introduction Juvenile angiofibroma is an unusual, destructive but essentially benign tumor, mostly seen in the nasopharynx of adolescent males. Its occurrence within the maxillary sinus as a primary tumor is rare. Although histologically benign, the tumor has a tendency to be locally aggressive, and may extend into the sphenoid sinus, infratemporal fossa, orbit, cheek, or intracranial fossae. It is a relatively rare tumor with an incidence of between 1:6,000 and 1:55,000 of the population. It is important to recognize this entity in order to avoid misdiagnosis with other fibrous and vascular tumours A presentating a case report of angiofibroma. Objectives The purpose of this study to check treatment modalities. Methods Under GA. tumor was excised and healing was evaluated at regular post operative follow ups. Results Successful tumor excise and healing satisfactory no recurrence. Conclusions This present case show surgical treatment of angiofibroma with favourable clincal results. Patient should be regular follow ups.

EPS00198 Super PRFs: A Healing Aid in Future Dr. Palak Goel (2nd Year Post Graduate—Ist Author), Dr. S.P.S Sodhi (Prof and Head—Department of Oral and Maxillofacial Surgery—2nd Author) Dasmesh Institute of Research and Dental Sciences, Faridkot Abstract Background/Introduction In recent years, there has been a growing interest in the use of platelet-rich products in regenerative medicine. Platelet-rich fibrin was first developed in 2001 by Choukroun. But despite of its good clinical success certain disadvantages including possible health hazards with silica activators in glass tubes, amount of growth factors incorporated in the fibrin clot etc. led to development of newer techniques. T-PRF is a newer generation of PRF, developed by Tunali et al, where more biocompatible class IV titanium is used. Titanium tubes may be more effective at activating platelets than the glass tubes used by Choukroun in his platelet-rich fibrin (PRF) method. Another recent development is advanced PRF (A-PRF), developed by Choukroun et al, which is prepared by lowering the centrifugation speed and time, due to which leukocytes are incorporated more in the fibrin clot and hence, fasten the speed of wound healing. Also, the use of platelet concentrates in ‘‘liquid’’ form, remained an important indication in various applications leading to the development of i-PRF (injectable). Objectives Use of various variety of PRF and its derivatives in various Oral Surgical Procedures.

S213 Methods A- Prf was obtained by collecting venous blood in 10 ml red colorcoded vacutainer test tube and was centrifuged in Choukroun’s Centrifugal Machine at 1300 rpm for 7 minutes. After the process completes, it is rest for 5 minutes after which it separates into three layers. Another PRF derivative used is I- PRF which is prepared by collecting venous blood in 10ml orange color- coded test tube and is centrifuged at 700 rpm for 3 minutes. After the completion of the process, an orange color liquid is separated from the underlying RBCs layer. This liquid is collected with the syringe and can be used as such or in combination with bone graft and PRF membrane. T- PRF is a PRF derivative that is obtained by using titanium test tubes instead of glass test tubes. It is prepared by same procedure as that of standard PRF i.e. 3000 rpm for 10 minutes. Results All the PRF derivatives show promising results. It results in decreased post-operative pain and inflammation, rapid healing of the tissue and also acts as filler material. If used along with the bone graft it also helps in rapid bone healing. Conclusions PRF and its derivatives has various promising applications in Oral and Maxillofacial Surgery. It is an autologous healing biomaterial that accelerates and enhances soft tissue healing. It uses autologous blood hence, reduces the risk of cross contamination and also reduces the risk of allergic response by the patient.

ABS00202 Assessment of Position of Inferior Alveolar Canal in Relation to Impacted Mandibular Third Molars Using OPG and CBCT: A Comparative Study Dr. Rachit Lochan Srivastava, Dr. Gopinath Thilak, Dr. Vidya Ajila A.B. Shetty Memorial Institute of Dental Sciences, Mangalore 575018. Ph No. 08242204963, Email: [email protected], Mobile: 9611757720 Abstract Background/Introduction The inferior alveolar neurovascular bundle containing the inferior alveolar nerve is present in variable anatomic relationship with respect to impacted mandibular third molars. The surgical removal of mandibular third molar may result in inadvertent Inferior alveolar nerve injury because of close proximity of the root to mandibular canal. The risk can be reduced by preoperative radiographic assessment of the anatomical relationship of third molar root and mandibular canal by Panoramic radiography (OPG) and Cone beam computed tomography (CBCT). Objectives 1. To compare the accuracy of OPG and CBCT in predicting the risk of IAN injury pre-operatively. 2. To find out the distance between the anatomic locations of mandibular third molar roots in relation with mandibular canal in OPG and CBCT. Methods This was a prospective study of consecutive patients who consulted the department of Oral and Maxillofacial Surgery, A.B. Shetty Institute of dental sciences for Mandibular third molar removal. Radiographic assessment was performed to assess the relationship between the mandibular canal and impacted third molars additional CBCT imaging was performed after confirming the proximity of the canal to the tooth.

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S214 Results Statistical significant changes were present in the study in relationship to accuracy in predicting the relationship of the canal and the tooth thus helping in diagnosing and adopting better treatment option prior to the procedure. Conclusions CBCT is recommended for preoperative radiographic evaluation of complicated mandibular third molars.

EPS00207 Tooth Banking Dr. Kedarnath N.S, Dr. Madhumati Singh, Dr. Nadira Khan, Rajarajeswari Dental College and Hospital Abstract Background/Introduction Teeth are the most natural, non-invasive source of stem cells which are easy, convenient and affordable to collect, isolate and preserve with promising therapeutic approach to restore structural defects. Banking ones own tooth derived stem cells is reasonable and simple alternative to harvest stem cells with little or no trauma. Every child loses primary teeth, which creates perfect opportunity to recover and it is best time to harvest when child is young and healthy. Objectives To discuss the history, different types relevant for dentistry, their isolation approaches, collection and preservation of dental stem cells along with current status of dental and medical application. Methods The retrospective analysis of relevant articles and dental journals explaining about Dental stem cell banking, regenerative capacity of dental stem cells and stem cells from human exfoliative teeth with relevant updates. Results Dental stem cells have the potential to be utilized for medical applications like Heart therapies, regenerating brain tissue, for muscular dystrophy, bone regeneration, to regenerate cartilage, adipose tissue and bone grafting with therapeutic results. Conclusions Dental stem cells have multiple applications of restoring structural defects which can be improved with simple harvesting methods and promising therapeutic and functional regenerative capacity. The oncogenic potential is still to be determined with minimal limitations.

EPS00214 Role of Ph in Local Anesthetic Agent: An Invivo Study Dr. Indu, Dr. Karthik, Dr. Saravanan, Dr. Vivek (HOD) SRM Kattankulathur Dental College and Hospital, SRM University Abstract Background/Introduction Lignocaine is the most commonly used local anesthetic agent. Although effective anesthesia is one of the most important prerequisites for successful minor oral surgical procedures, there are incidences of failure of anesthesia. The failure rate of local anesthesia is estimated to be 5 to 15 % by American Dental Association. This failure an be attributed to various factors including infection, anatomical variations, technical mistakes and anxiety of the patient.

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Objectives To test the hypothesis and validate our invitro study that the local anesthetic solution with neutral pH is likely to improve the efficacy of local anesthetic solution in adverse local conditions as in the presence of infection. Methods Based on the result of our invitro study, the pH of multidose vials of lignocaine currently available in the market ranges from 3.3 to 3.6. The multidose vial is fortified with sterile sodium bicarbonate to bring the pH to near neutral value before administration. Results The clinical efficacy of the fortified local anesthetic agent will be evaluated and tabulated. Conclusions This study explains the role of pH and the efficacy of fortified local anesthetic agent particularly in the presence of infection.

EPS00224 Recent Methods of Dry Socket Management and Their Efficacy Presented By Dr, C Satya Kinnera (MDS Ist Year PG) Guided By Dr, G Harsha MDS, MOMSRCPS (Glasg) HOD and Prof MNR Dental College and Hospital, Sangareddy-502294 Abstract Background/Introduction Alveolar osteitis ‘‘dry socket’’, is most commonly encountered complications followed by extraction of permanent teeth. This article is a comprehensive review of efficacy of different treatment methods used in management of dry socket, various new agents in the market can accelerate the healing of socket such as plasma rich in growth factor. Objectives to asses efficacy of various methods used for dry socket management. Methods A cochrane and pub med-medline database search was conducted with search terms ‘‘dry socket’’, post extraction complications, and’’ fibrinolytic alveolitis’’, individually. Results final review includes collection of articles from cochrane database system, pubmed publications, international journal of oral and maxillofacial surgery. Conclusions all the treatments in the review have the aim to relieve patients pain and promote alveolar mucosa healing and dry socket as well as to review the efficacy of various recent treatment modalities.

EPS00229 Implant Site Preparation using Autogenous Mandibular Symphysis Graft Dr. Prateek Tripathy Kalinga Institute of Dental Sciences, Bhubaneswar Abstract Background/Introduction After tooth loss, alveolar ridge resorption is a common phenomenon which alters the size and shape of host bone available for dental implant placement. In clinical practice, though patients often demand

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 osseointegrated implants to replace their missing teeth, the deficiency of bone volume causes the biggest hinderance in such treatment option. The solution to such problem is reestablishing to ridge height and width using autogenous bone graft which is considered gold standard. Objectives To prove that mandibular symphysis is a favourable donor site for autogenous bone grafts as it has an excellent risk benefit ratio. Methods Surgical placement of autogenous mandibular symphysis bone graft in the implant site where ridge augmentation is desired. The procedure is performed in patients reporting to the Oral Surgery OPD of Kalinga Institute of Dental Sciences, Bhubaneswar. Results There are documented evidences of increased alveolar ridge volume both laterally and vertically to prepare the ridge for correct implant placement. Conclusions Hence it is concluded that implant site preparation using autogenous mandibular symphysis graft is considered gold standard.

ABS00230 Effects of Botulinum Toxin for Contralateral Hyperkinesis and Asymmetry in Facial Palsy. The Poison that Helps to Heal Dr Pritee Pandey Divya Jyoti College of Dental Sciences and Research Abstract Background/Introduction Use of botox therapy for facial sequele prompted the idea that botox might be useful in facial palsy leading to improve facial asymmetry and contralateral hyperkinesis. The application of Botox to healthy side of face in patients with facial palsy has shown to be minimally invasive technique that improves facial symmetry at rest and during facial motion. Objectives In cases in which medical or surgical treatment options are limited because of existing medical problems or advanced age, most patients with facial palsy are advised to await spontaneous recovery or are informed that no effective intervention exists. The purpose of this poster is to evaluate effect of botox treatment for facial asymmetry and contralateral hyperkinesis in facial palsy that could not be optimally treated by use of medical or surgical management because of severe medical or other problems. Methods This poster is review of collection of 27 articles. Results After administration of botox on the nonparalysed side of patients with facial palsy, marked relief was observed. Decreased facial asymmetry and strengthened facial function on paralysed side helps to increase confidence in patients. Conclusions It is concluded that such innovative therapy is of great value that decreases the relative hyperkinesis contralateral to the paralysis leading to greater symmetric function. Especially in patients with medical problems that limit the medical or surgical treatment options, in such cases Botox therapy represents a useful alternative.

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EPS00244 A Prospective Randomised Control Study to Compare the Effiacacy of Concentrated Growth Factor Following Surgical Removal of Impacted Mandibular 3rd Molar Dr. R. Muralidharan Adhiparasakthi Dental and College Abstract Background/Introduction Growth factors are protein, which regulates the complex processes of wound healing, main role on Cell migration, Cell proliferation and Angiogenesis in tissue regeneration phase. As first generation of platelet concentrate, platelet rich plasma (PRP) and Platelet rich in growth factor (PRGF) was well known. As second generation of platelet aggregation, Platelet rich fibrin (PRF) but the PRF protocol doesn’t need biochemical additives like bovine thrombin and chemical additives as Calcium Chloride to make gel condition, So PRF is free from the concern of cross-contamination. Third generation Early accelerated tissue healing using adult blood derived stem cells (CGF Compared to PRF, CGF is attained by single centrifugation using special centrifuge, results in fibrin rich blocks that are much larger, denser and richer in CGF than common PRF, So better regenerative capacity and higher versatility. In addition CGF doesn’t require any chemical or allergenic additives, such as bovine thrombin or anticoagulants, so is free from viral transmission disease. Objectives The purpose of this study is to evaluate and compare utility and efficacy of concentrated growth factor on soft tissue healing and bone healing following surgical removal of mandibular impacted 3rd molar in mandible with control group. Methods Blood Sample Centrifugation 1. The patient will be seated comfortably in the dental chair in semi supine position, In patient’s fore arm tourniquet would be applied after Dabbing with anti septic swab 2. 9 mL of blood will be drawn from the anticubital region and collected in sterilised Vacuette tubes (Greiner Bio-One, GmbH, Kremsmunster, Austria) without anticoagulant solutions. 3. This tube will be immediately centrifuged in special machine (Medifuge MF200, Silfradent, Forli, Italy) using a program with the following characteristics: 30’’ acceleration, 2’ 2,700 rpm, 4’ 2,400 rpm, 4’ 2,700 rpm, 3’ 3,000 rpm, and 36’’ deceler- ation and stop. 4. At the end of the process there would be three blood fractions: (1) the upper platelet poor plasma (PPP) layer; (2) the middle fibrin rich gel with aggregated platelets and concentrated growth factors (CGF); (3) the lower red blood cell (RBC) layer. 5. Middle fibrin rich layer along with the few mm of RBC layer would be cut and kept in the extraction socket and wound would be closed with 3-0 silk material. If required a plier would be used to create aS membrane which will be placed in the socket. Results On Clinical and Radiographic evaluation better results were observed in CGF group with respect to Pain, Edema, Wound dehiscence, Soft and Hard tissue formation. Conclusions CGF is an innovative method for producing a fibrin matrix with concentrated growth factors and its clinical applications are presently being investigated. CGF was reported to have a good regenerative capacity and a high versatility on sinus and alveolar ridge augmentation (Sohn et al., 2009). Similarly to PRF (Dohan Ehrenfest et al., 2009, 2010; Dohan et al., 2006a, b; Mosesson, 2005), CGF has a complex tridimensional architecture which makes it a real platelet, leukocyte and growth factor-rich fibrin biomaterial. In particular, the platelets and the dense fibrin network make large clusters of

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S216 coagulation in the initial millimetres of the membrane beyond the red blood cell base, as confirmed by SEM analysis. The presence of growth factors, such as TGF-b1 and VEGF, is important for stimulating cell proliferation, matrix remodeling, and angiogenesis during healing processes (Grainger et al., 2000, Intini, 2009; Rodella et al., 2010). Our data confirmed the presence of TGF-b1 and VEGF in CGF and demonstrate a similar pattern of expression also in RBC layer. In conclusion, our study demonstrates the presence of TGF-b1 and VEGF in CGF and RBC layers, suggesting that improved CGF procedure could optimize the amount of growth factors in the CGF layer or, alternatively, a possible use of RBC layer in clinical applications. Moreover, the presence of CD34 positive cells within the CGF network could lead to investigate their clinical implications.

EPS00254 A Predictable Intra-Oral Approach to Ectopically Positioned Teeth 1. Dr. Gandhali Limaye (PG Student), 2. Dr. Pranav Sathe (PG Student) Dr. D.Y. Patil Dental College & Hospital, Pimpri Pune-18 Abstract Background/Introduction Deep seated third molars always pose difficulty to the most skilled of surgeons. On rare occasions, teeth are in ectopic positions like condyle, ramus and the inferior border of mandible. An extra oral approach in such cases is not only unaesthetic, but also laden against the risk benefit ratio. Objectives The objective of this poster is to propagate an intra oral approach by use of certain optical and surgical instruments. Methods A total of 3 teeth in 2 patients were removed successfully by an intra oral approach under General Anaesthesia. The surgical aids used were a 2 mm long drill bit, illuminating spectacle mounted light (ERGOPTICS) and magnifying loupes. A pre operative assessment with CBCT helps to locate the accurate position of the tooth. Hypotensive anaesthesia maintains a clean surgical field. Results The procedures were successfully carried out intra orally without leaving a visible scar. Conclusions The author believes that if these methods are used, a predictable intra oral removal of deep seated teeth is possible with minimal surgical risk.

ABS00259 Cervical Necrotizing Fasciitis of Odontogenic Origin Presented by Dr. Sampath Kumar, Guided by Dr. G. Harsha MNR Dental College and Hospitals Abstract Background/Introduction Necrotizing fasciities of head and neck is uncommon, potentially fatal, soft tissue infection charactarized by rapidly progessive and

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 destrcutive necriosis and gas formnation in the subcutaneous tissue and fascia. Objectives The purpose of this report is to understanding of necrotizing fasciitis through a case study, that emphasizes the silent features and management of this dreaded disease as it affected the head and neck region of adult male patient through the dental infection. Methods Medical management followed by Surgical management. Results This case also outlines and appropriate sucessfull management strategy for the treatment of those patients. Conclusions Misdiagnosis and delayed treatment can results in severe systemic toxicity, carotid artery erosion, jugular vein thrombophlebitis, aspiration pneumonia, meningitis, mediastinitis and even death.

EPS00280 Ludwig’s Angina: An Emergency Dr. Nilanshu Singh Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow Abstract Background/Introduction Ludwig’s Angina is a firm, acute, toxic cellulitis of the submandibular, submental and sublingual spaces bilaterally. Many clinicians are unfamiliar with these conditions as these conditions have become less common in post antibiotic era. Its tendency to cause oedema, distortion and obstruction of airway pose a great challenge for treating physicians and anesthesiologists and can even be life threatening. Early recognition of potential cases, discussion with patient and relatives, appropriate referral, aggressive antibiotic and timely surgical intervention are very much important to reduce morbidity and mortality of Ludwig’s angina. Objectives To evaluate the treatment outcomes, associated morbidity and survivability following Ludwig’s angina. Methods Our experience with review of literature in management of patient suffering from Ludwig’s angina. Results Treatment should involve high dose of broad spectrum parentral antibiotics, immediate surgical drainage under local and general anesthesia in 75% and single patients respectively. This was in addition to extraction of offending tooth/teeth where applicable. The complications recorded were septicaemia, necrotising fascitis, laryngeal spasm and renal failure. Conclusions Ludwig’s angina is a life threatening, soft tissue infection of the submandibular, submental and sublingual fascial spaces bilaterally. If vigilant for its clinical presentation and aware of its potential for rapid compromise of the patients airway, clinicians can intervene early in order to prevent its most dire consequences. The classic manifestations of these infections, such as high fever, systemic toxicity, and local signs may be absent due to widespread use of antibiotics and/or profound immune suppression. Their tendency to cause oedema, distortion of fascial spaces and obstruction of airway pose a great challenge for treating physicians and anesthesiologists; airway control is of paramount importance, and attention to this consideration, combined with antibiotic therapy, surgical drainage, and modern

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 intensive care, have all contributed to a declining mortality. Early and liberal consultation with otolaryngology and anesthesiology services will assure the greatest hope for speedy airway control, prompt institution of intravenous antibiotic therapy, and an uncomplicated recovery from this rare and dreaded condition.

EPS00299 C-Reactive Protein: A Diagonostic Marker Dr. Harisankar. S Yenepoya Dental College and Hospital Abstract Background/Introduction C-reactive protein (CRP) was discovered by Tillet and Francis in 1930 as a substance in the serum of patients with acute inflammation that reacted with the C polysaccharide of pneumococcus. The serum levels of CRP raises with infection making it a positive acute phase reactant. This review mainly highlights the role of CRP in the field of Oral and maxillofacial surgery, It provides a knowledge based framework for interpretation and analysis of clinical observations of CRP in relation to infection, inflammation and other pathologies in orofacial region. The conventional measures to estimate infections such as evaluation of WBC count and ESR are valuable in determining state of patient at testing time. However, the predictability of these is limited. A better knowledge of the inflammatory cascade has given new insights and provided several mediators that in conjunction with the clinical manifestations can be useful as markers of infection. One such mediator is C-reactive protein (CRP) and is probably the most widely used marker. The serum levels of CRP raises with infection and also in inflammation making it a positive acute phase reactant with a very short half-life of 5–7 h. Thus, advantage of having short half lives makes serum CRP levels as sensitive indicators of oral and maxillofacial pathologies.

EPS00346 Immediate Versus Delayed Aggressive Physical Therapy Following Buccal Fat Pad Interposition in Oral Submucous Fibrosis: A Prospective Study in Central India Dr. Vijay N. Rode, MDS-III Swargiya Dadasaheb Kalmegh Smruti Dental College & Hospital, Nagpur Abstract Background/Introduction Oral submucous fibrosis is a disease of an Indian subcontinent with obscure aetiology and poorly treated with varying signs and symptom. Objectives To find out role of immediate and delayed aggressive physical therapy postoperative on oral submucous fibrosis patient. Methods In this study, 220 patients were randomly divided into two groups with mouth opening less than 16 mm and evaluated with immediate and delayed aggressive physiotherapy with buccal fat pad interposition after fibrotomy. Group A (n = 110) patients underwent aggressive

S217 mouth opening exercise from the next postoperative day while in group B (n = 110), patients underwent physiotherapy 7th day postoperatively. Pain and discomfort, mucosalization, infection, flap dehiscence and necrosis were noted. Patients were followed for 1 year on a regular interval basis. Results At the end of 1-year follow up, the postoperative mean mouth opening in group A was 38.63 mm and 34.19 mm in group B. In group A, the immediate physiotherapy results in mild to moderate pain and discomfort to the patients as compared to no apparent pain in the group B. The mean mucosalization time in group A and group B was 4.2 and 5.1 weeks, respectively. Postoperatively, all patients achieve satisfactory mouth opening. Conclusions Immediate aggressive physiotherapy yields a comparatively superior result than delayed physiotherapy with respect to mouth opening in 1 year of follow-up.

EPS00383 Cyberknife: A New Archetype in Radiotherapy Dr. Esther. P. Pathi Army College of Dental Sciences Abstract Background/Introduction It is a high precision, non invasive robot guided frameless steriotactic radiosurgery system. Objectives It is the first and only radiosurgery system designed for treatment anywhere in the body. Methods It uses continual x-ray image guidance technology and computer controlled robotic mobility to automatically track, detect and correct for patient movements. Results It is used for vascular anomalies, head and neck tumours, nasal and orbital tumours. Conclusions It improves the quality of life.

EPS00403 Preoperative Intravenous Tramadol Versus Ketorolac for Preventing Postoperative Pain After Third Molar Surgery Dr. Gaurav Verma, Reader Institute of Dental Sciences, Sehora, Jammu & Kashmir, India. Phone Number- ?919736565635 E Mail- [email protected] Abstract Background/Introduction The aim of preemptive analgesia is to prevent postoperative pain by administration of various therapeutic agents prior to surgery. Preemptive analgesia concept is based on the principle of prevention of peripheral and central sensitization of pain pathways by nociceptive impulses. Pain is a predictable outcome after surgery. Preemptive

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S218 analgesia may prove to be a valuable tool in preventing postoperative pain. Objectives The objective of this study was to evaluate & compare the preemptive analgesia efficacy of intravenous ketorolac and intravenous tramadol in prevention of postoperative pain after surgical extractions of mandibular third molars. Methods Forty patients who required surgical extraction of mandibular third molars were divided randomly into two groups. Group- I [Tramadol Group (n=20)] patients were given 50 mg tramadol intravenously preoperatively. Group- II [Ketorolac Group (n=20)] patients were given 30 mg ketorolac intravenously preoperatively. Surgical extractions were performed under local anesthesia. The parameters under evaluation were postoperative pain intensity measurement, mean time after which rescue analgesic was taken, total analgesic consumption over 5 day recovery period, and patient’s assessment of the surgical procedure. Results The result of the study revealed that, there was no statistically significant difference between the two groups in relation to the clinical parameters under investigations except patient’s assessment of the surgical procedure. Greater percentage of patients in ketorolac group rated the procedure relatively better and less painful by giving higher scores. Conclusions Although both ketorolac and tramadol were equally efficacious as preemptive analgesics on statistical backgrounds but ketorolac seems to be more efficacious on clinical grounds.

ABS00419 Oral Manifestation of Wegener’’s Granulomatosis: Two Case Report Dr Vijaykumar Pt. B.D. Sharma Uhs, Pgims, Rohtak, Haryana Abstract Background/Introduction It is a rare multisystem Autoimmune disease of unknown etiology. Its hallmark feature include Necrotizing Granulomatous inflammation & pauci immune vasculitis in small & medium size blood vessels. With classical WG there is initial involvement of respiratory tract if condition remain untreated renal involvement often develop known as generalised WG. Oral lesion as a presenting feature are only in 2% of these cases. So recognition of this feature importance for timely diagnosis & management of this potentially fatal disease. Objectives To share our experience of a rare WG in the aspect of oral manifestation, Histologic behaviour, differential diagnosis with prognosis & Treatment modalities. Methods here 2 case report, both were female with oral lesion in different in location that demonstrate the disease spectrum and current status of WG with respect to diagnosis, laboratory findings and treatment. Results After 3 month of follow up both patient was quiet normal and relieved of all symptoms. No any mortaltity. Patient is on regular follow up. Conclusions Clinician should be aware with the broad spectrum of oral and systemic component of WG as well as disease recognition and provide oral health to these patients.

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EPS00425 Feasibility of Using I-PRF and Assessment of Clinical Healing After Its Use in Extraction Sockets: A Pilot Study Dr Samarth Vajpayee Rishiraj College Dental College, Bhopal Abstract Background/Introduction The monocytes play an essential role on bone growth, vascularization and production of vascular endothelial growth factor (VEGF) which leads to more and earlier vascularization, faster soft tissue growth, release of BMPs and more cytokines. IPRF is a concept to get the whole amount of cells from the blood, white cells, platelets, along with circulating stem cells and endothelial cells essentially terming A-PRF & I-PRF as ‘‘blood concentrates’’. Objectives To assess the feasibility of using IPRF and to compare the hemostasis, soft tissue healing and incidence of dry Socket of mandibular extraction wounds with and without the use of autologous IPRF. Methods Group A consisted of 30 patients where IPRF was placed in the extraction socket of mandibular teeth. Group B consisted of 30 patients as the control group where the extraction sockets were evaluated without any intra socket medicaments. Postoperative hemostasis, healing and incidence of dry socket were evaluated using predetermined criteria immediately after extraction and on the first, third, seventh and fourteenth post-operative days and statistical analysis was done. Results The result shows rapid hemostasis in the extraction socket treated with IPRF when compared with the socket without IPRF. Soft tissue healing was better in study site as compared to control site. Incidence of dry socket also appeared to be less than that of control group. Conclusions Autologous IPRF is biocompatible and has significantly improved hemostasis, soft tissue healing, and decreased incidence of dry socket. Time to prepare IPRF is lesser, easy and economical. It proves to be a promising next generation PRF derivative in this short pilot study.

EPS00426 Treatment Modalities for Oro-Antral Fistula Closure Dr Shubham Dubey, Guided by Dr. Ananth Kumar G. B. K M Shah Dental College and Hospital, Vadodara Abstract Background/Introduction Communication or fistula tract between oral cavity and maxillary antrum mainly shows nasal regurgitation, loss of resonance, foul smelling pus discharge, post nasal drip etc. This might be the result of iatrogenic complications or from dental infections, osteomyelitis, radiation therapy or trauma. The management of fistula or oro-antral communication depends on the duration, size of the defects, location and associated sinus infection and inflammation. Various treatment modalities have been suggested based on the above mentioned criteria.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Objectives The main objective of the surgery is to close the defect, prevent nasal regurgitation and sinus inflammation. Methods In this poster we would like to share our experience of managing oroantral fistula using buccal advancement flap, buccal fat pad with buccal advancement flap and Facial Artery Musculomucosal Flap. Results All the technique shows good results and there is no gapping of closure seen. Conclusions Buccal advancement flap is the most commonly use technique for closure of oro-antral fistula with small defects. Disadvantages, is the risk of reduction of the buccal sulcus depth. Buccal fat pad flap has been widely used to reconstruct OAF with moderate defects because of its physical and biological properties like anatomical location closest to the recipient bed, vascularization, etc. The facial artery musculomucosal flap, technically a combination of the nasolabial flap and the buccal mucosal flap which use in closure of large defects of oro-antral fistula.

EPS00436 Evaluation of Technique of Coronectomy of Mandibular 3rd Molars Situated in Close Proximity to the IAN Dr. Kamil Rajpari (3rd PG), Dr. Neelam. N. Andrade (Professor & HOD), Dr. Tejas Mhatre

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EPS00442 A Demon Hiding in Plain Sight: Parotid Fistula—A Case Report Dr Afshan Qureshi Abstract Background/Introduction Trauma is the most common etiology for a parotid fistula. Other causes include post parotidectomy, infections and malignancy. We report two cases of a chronic parotid fistula. Diagnosis was confirmed by fistulography and ultrasonography of the local part. One patient underwent superficial parotidectomy and the other patient showed favourable outcomes with warm saline injections and pressure dressing of the fistulous tract and closure of the cutaneous opening of fistula. No recurrence of the fistula has been reported in these two pateints over a period of 6 months. Objectives Early diagnosis and judicious treatment planning in patients with trauma in the pre-auricular region. Methods 1. Warm saline injections intralesionally followed by pressure dressing. 2. Superficial parotidectomy. Results Both the procedures gave favourable results, with no sign of reoccurrence with a follow up of 6 months on both the patients. Conclusions Treatment modalities differ from patient to patient, early diagnosis & judicious treatment planning does happen to give favourable outcomes.

Nair Hospital & Dental College Abstract Background/Introduction The mandibular third molar remains the tooth most prone to impaction. Problems which may arise due to tooth impaction include pericoronitis, cheek biting, pressure on adjacent teeth resulting in pain, food impaction, association with pathological lesions such as cysts and tumours. Thus, the surgical removal of impacted wisdom teeth remains a common procedure in dental practice. Paraesthesia, anaesthesia of the inferior alveolar nerve are unwanted complications of third molar surgery that are frequently disturbing to both the patient and the practitioner. Objectives 1. To evaluate the benefits of coronectomy of mandibular 3rd molar situated in close proximity to the neurovascular bundle. 2. To evaluate change in position of the remaining root stumps in association with the neurovascular bundle. Methods A total of 50 cases were included in the study. Co-relation of the anatomic relationship between the tooth apices and the nerve as per the criteria given by JP Rood [1992] were followed as the basis for performing coronectomy. Teeth that had an active peri-apical infection and mobile teeth were excluded. The parameters included in the study were neurological evaluation, post-operative trismus, bone formation, soft tissue healing and change in the position in the roots. Results Results showed that the technique of coronectomy in third molars does not lead to excessive complications and has a far lower incidence of complications than would be predicted in cases where the radiographic signs indicate a high risk of nerve damage. Conclusions Coronectomy can be suggested for teeth that are very close to inferior alveolar nerve with the risk of a secondary operation.

EPS00459 Recent Imaging Modalities in Oral & Maxillofacial Surgery Giriraj Sandeep Raja Rajeswari Dental College & Hospital, Bangalore Abstract Background/Introduction Radiographic Imaging is one of the greatest investigative tools used in medical sciences since ages. In the early ages, there were no imaging tools that are required to assess the disease severity later on the invention of radiographs brought little use in the clinical assessment of a disease and its severity. Various advancements like Ultrasound (US), Computerized Tomography (CT), Magnetic Resonance Imaging (MRI), Positron Emission Tomography (PET), Single Photon Emission Computed Tomography (SPECT) came into existence to overcome the disadvantages of each. Objectives To review current advances in imaging technology and their uses in different disciplines of oral and maxillofacial surgery. Methods A retrospective analysis describing the history of advancements in imaging of maxillofacial injuries, joint pathologies and evaluation of neoplasms and infections. Results Imaging plays a key role in dental implantation, management of maxillofacial trauma, facial reconstruction, TMJ pathology, and evaluation and treatment of neoplasms and infections. In addition to

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S220 traditional conventional radiography, recent advances in CT, MRI, and PET/CT fusion technology have made radiology an even more vital Combined PET and CT (PET/CT). Conclusions Advances in head and neck imaging can be divided into three broad categories: biologic imaging, high (spatial or contrast) resolution imaging and new Magnetic Resonance findings, associated with pervasive clinical diagnosis. The significance of the information obtained through these applications is a matter of active research.

EPS00474 Endoscopy: A Boon in Maxillofacail Surgery Dr. T. Vignesh Prabhu A.E.C.S Maaruti College of Dental Sciences and Research Centre, Bangalore-76 Abstract Background/Introduction The advanced surgical trend is to enhance the variety of minimally invasive approaches and, in particular, the possible applications of endoscopy in head and neck surgery. Many procedures of maxillofacial surgery like TMJ disorders, jaw pathologies, trauma and facial aesthetic surgeries can be diagnosed and treated with lesser rate of complications using endoscopic techniques. Recent technological advances in field of endoscopy resulted in substantial improvement in techniques of endoscope- controlled oral and maxillofacial procedures. Objectives Importance of endoscopy in maxillofacial surgery. Methods Described In Detail In E-Poster. Results It Is An Overview Of Endoscopy Applications In Maxillofacial Surgery And Should Be Considered For Further Research And Development In Maxillofacial Surgery. Conclusions This Poster Presents Endoscopy Is A Minimally Invasive Procedures. The Oral And Maxillofacial Surgeons Are Applying Endoscopy In Various Procedures With Different Functions, Increased Success, Decreased Complications, Enhances Afficiency.

EPS00475 Can a Single Buccal Infiltration of 4% Articaine Provide Equivalent Local Anesthesia as Compared to Buccal and Palatal Infiltration of 2% Lignocaine in Maxillary Tooth Extraction? Dr. Suchismita Tripathi and Dr. Indrajeet Singh Abstract Background/Introduction The aim of the study is to demostrate whether articaine administered alone as a single buccal infiltration in a maxillary tooth removal provided favorable palatal anaesthesia as compared to buccal and palatal injection, for a surgical procedure.

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Objectives To ascertain whether during the extraction of permanent maxillary teeth a single buccal injection results in a more painful experience than the routine use of bilateral injections, and to compare the pain resulting from 2 types of injection. Methods 100 patients to be studied will be selected from patients visiting the opd department of oral and maxillofacial surgery, school of dental sciences, sharda university, who needs maxillary tooth extraction. Results According to the VAS scores, the pain of injection between buccal infiltration without a separate palatal injection and routine administration with additional palatal injection was statistically significant. All patients described both extractions as ‘‘acceptable’’ and no patient requested an additional palatal injection to ensure comfortable extraction. Conclusions The routine use of a palatal injection for the removal of permanent maxillary teeth may not be required when articaine/HCl is used as the local anesthetic.

EPS00481 Efficacy of Low Level Laser Therapy Following Surgical Removal of Impacted Lower Third Molars Dr. Manodh, Dr Sailesh Kumar, Dr Arjun Raj Meenakshi Ammal Dental College and Hospital, Chennai Abstract Background/Introduction To evaluate the effectiveness of Low-Level Laser Therapy (LLLT) in the control of postoperative pain, swelling, and trismus associated with the surgical removal of impacted mandibular third molars. Objectives This prospective study was done to control postoperative pain, swelling and trismus using Low Level Laser therapy and to compare the efficacy of Low Level Laser therapy over analgesics and antibiotics given after surgical removal of impacted third molars. Methods 2 groups with a sample size of each 25 patients who had undergone prophylactic surgical removal of impacted lower third molars under LA, following which one group received LLLT and other was prescribed analgesics and antibiotics. A diode laser device with a continuous wavelength of 940 nm was used in LLLT. The assessment was carried out with the help of Visual Analog Scale for pain and measurement done for the size of swelling and mouth opening. All patients included in the study were followed up on the 1st, 3rd and 7th postoperative day. Results Intensity of pain, swelling and extent of mouth opening was lower in the laser group than in the control group using analgesic and antibiotic medications in all evaluations. Conclusions Patients treated with LLLT experienced larger clinical reductions in the intensities of pain, swelling, and trismus postoperatively. This avoids use of medications and discomfort after third molar surgery and complications of the same.

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EPS00492 Recent Advances in Wound Healing

EPS00493 Plasma Cell Lesion a Rare Case

Dr. Aashi Gupta, Post-Graduate Student, Dr. Amit Bali, Professor

Dr. Amit Patange/Dr. Ramdas Balakrishna/Dr. Suhas Prabhakar

Dept. of Oral and Maxillofacial Surgery, MMCDSR, Maharishi Markandeshwar University, Mullana

KLE Societys Institute of Dental Sciences, Bangalore

Abstract Background/Introduction Successful wound care involves local and systemic factors of a patient in an ideal wound healing environment. The importance of wound care cannot be underestimated, as poorly managed acute wound can result in a chronic wound, which in many cases have eventually resulted in the failure of treatment. In the past, wound healing was related to dry environment as it supported the fact that dry environment would prevent bacterial growth. However, as supported by recent evidences, current practices emphasise on moist wound closure to prevent cell dehydration; stimulate cell migration, collagen synthesis and angiogenesis. Objectives This presentation aims to discuss recent updates in wound closure techniques and products. Methods Study of PeriAcryl90 Oral Tissue Adhesive (GluStitch), OpSite (Smith &Nephew, London, England), Derma Gel (Medline Industries Inc, Mundelein, IL), DuoDERM (Convatec, Skillman, NJ), Tegaderm alginate silver (3M, St Paul, MN), Lyofoam (Molnlycke Health care, USA, LLC, Norcoss, GA) and Biobrane (Smith &Nephew, London, England) on wound healing. Results Closure methodologies for surgical or traumatic wounds include suture, staples, adhesives and glues. Sutures have been the popular aid in wound closure from the past. Tissue adhesives are a new entry to limit the use of sutures as they cause less trauma to the investing tissues, fall in the rate of needle stick injuries, less technique sensitive and no more follow-up appointments for suture removal. Update in wound dressing methods promote the moist environment required for wound healing. It’s observed that films give an effective barrier to external contamination and are transparent. However, hydrogels are comfortable wound dressing containing desloughing agents. In many cases, wound dressing should have been waterproof. Hydrocolloids are waterproof, with a mixture of pectins, gelatins, sodium carboxymethylcellulose and elastomers. They showed promotion of granulation tissue and were found cost-effective. In few cases haemostatic properties of alginates came to use. They have proved exceptional utility in sinuses. Foam dressings conform to body contours. However, superficial wound closure was best done by laminates in most subjects. Conclusions Many clinicians stick to the old school methods for wound care while new products and technologies have been launched in wound care armamentarium. The field of wound care is expanding with ever advancing technology and concepts. It is required that clinicians practice and adapt to the products in order to deliver better and speedy healing of wounds.

Abstract Background/Introduction A Rare case of plasma cell tumor was referred to our institution with a complaint of nasal discharge and pain over cheek and perialar region. Objectives A Case report. Methods Patient name Akash 21 yr old male went to ENT surgeon with a complaint of nasal discharge since 1 month and pain on left cheek and perialar region since 15days. PNS view revealed hazyness in the left maxillary sinus. The patient was then referred to our institution for the further management. CT scan revealed a cystic lesion in the left maxillary sinus with erosion of anterior wall of maxillary sinus and with expansion of anterior and posterior aspect of the hard palate. Aspiration of the lesion revealed a mucous exudate. Biopsy shows non specific inflammatory lesion. Enucleation of the cystic lesion was done under General Anaesthesia. Results Histopathology revealed that the connective tissue stroma was found to be rich in plasma cells arranged in sheets and nodules along with Russell bodies suggestive of a plasma rich lesion. IHC studies for Kappa and Lamda were advised to obtain a definitive diagnosis. Conclusions Role of Immunohistochemistry, diagnosis and management will be discussed.

EPS00495 Parotidectomy (Retrograde Facial Nerve Dissection) Dr Hemanth Cr College of Dental Sciences, Davangere Abstract Background/Introduction Tumors of salivary gland are relatively uncommon and represent 2% of all head and neck neoplasms. Parotid gland comprises to 85% of salivary gland tumors of which 80% are benign with pleomorphic adenoma parotidectomy is a common surgical procedure for the treatment of benign and malignant lesions of parotid gland. Objectives Analysing the efficacy of retrograde facial nerve disection compared to antegrade facial nerve dissection in treating the parotid gland tumors. Methods Review of literature. Results Retrograde facial nerve dissection is an easy technique with low complication and without compromising surgical outcome when compared to antegrade facial nerve dissection. Conclusions Superficial parotidectomy is the most preferred in treating lesions of the parotid gland tumors. Retrograde facial nerve dissection is an easy technique with low complication and without compromising surgical outcome.

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EPS00503 Efficacy of Hydroxyapatite and Platelet Rich Plasma in Bilateral Mandibular Impaction Dr. Ravi Ganeshwar Sree Balaji Dental College Abstract Background/Introduction Healing of bone is a complex process which involves participation of many cell types and growth factors. The healing of fracture or wound is accomplished by the interaction of osteoblasts and extracellular matrix under the influence of various growth factors of which some are secreted by platelets. These factors can activate the proliferation and differentiation of the local osteoprogenitor cells into bone forming cells leading to the formation of new bone matrix and mineralization. Objectives After surgically removed identical mesioangular mandibular impaction and placing bone graft. By combining with calcium chloride, PRP releases these growth factors. Soft tissue healing is also substantially improved through the application of PRP, by increasing collagen content, promoting angiogenesis and increasing early wound strength. Methods The extraction socket of the study group was packed with PRP and hydroxyapatite granules and that of control group was sutured without PRP and hydroxyapatite. The bone density of both extraction sockets were evaluated radiographically using gray level histogram and compared periodically on immediate postoperative day, 1st and 3rd month postoperatively and postoperative sequelae of both the control group and study group in terms of oedema & pain or any other adverse reactions were also assessed. Results Data suggested evidence of early bone formation and maturation radiographically in study group as compared to control group. The percentage of facial swelling was numerically greater on the control side as compared to the study side, Conclusions This study clearly indicated a definitive improvement in the wound healing, increase in bone density, which signifies and highlights the use of PRP and hydroxyapatite granules, certainly as a valid method in inducing and accelerating bone regeneration.

ABS00519 A Comparative Study on Effects of Dexamethasone Sodium Phosphate Given Submucosally and Intramuscularly on Postoperative Complications after Removal of Impacted Lower Third Molars Dr. Sonal, Dr. Amit Kumar ITS Dental College & Hospital, Greater Noida, UP Abstract Background/Introduction The removal of lower 3rd molars is the most common surgical procedure and is often associated with swelling, pain, and trismus as a result of the postoperative inflammatory response. To reduce

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 postoperative complications, the use of corticosteroids has gained wide acceptance. Objectives This study was conducted at the Department of Oral and Maxillofacial Surgery, ITS Dental College, Greater Noida and included 60 patients in 30 each group of whom required removal of a single impacted mandibular third molar under local anesthesia. Measurements of facial swelling, trismus and pain were made preoperatively and on the first, third, and seventh postoperative days. Methods The study includes 60 patients 30 in group A and 30 in group B each of whom required removal of a single impacted mandibular third molar under local anaesthesia, were randomly allocated to one of 2 groups of 30 each. The 2 groups were given dexamethasone 4 mg submucosally and intramuscularly. Results Both dexamethasone groups A & B were associated with a significant reduction in the amounts of swelling and pain, but group A submucosal dexamethasone had a significant effect on swelling and trismus. The comparable results obtained shows that submucosal dexamethasone is an effective alternative to dexamethasone given systemically. Conclusions Submucosal dexamethasone, is quite simple, less invasive, painless, convenient for the surgeon and the patient, and offers a low-cost solution for the typical discomfort associated with the extraction of impacted lower third molars.

EPS00529 Uses of Autologous Fat in Maxillofacial Surgery Ashish Shukla Raja Rajeswari Dental College & Hospital, Bengalore Abstract Background/Introduction Autologous fat filling can be considered as valid alternative in various procedures for both functional and aesthetic purposes. The use of adipose tissue transfer for the correction of maxillo-facial defects was first reported at the end of the 19th century by Neuber and has since been subject of numerous research projects and studies. Objectives To review the uses of autologous fat in the field of maxillofacial surgery and its outcomes. Methods Clinical applications include soft tissue augmentation to improve contour irregularities, interpositional material in TMJ surgery, malar augmentation and treatment of post parotidectomy defects. Buccal fat pad- derived stem cells in combination with autogenous illiac bone graft is used in the treatment of maxillofacial atrophy. Results This poster reviews the basic principles underlying fat injection and overview of their use in maxillofacial regions. Conclusions This autologous fat is completely biocompatible, in most patients available in sufficient quantities naturally integrated into the host tissue, removable if necessary, cost effective and potentially permanent.

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ABS00530 A Novel Therapeutic Regenaration in Periapical Surgery: Case Series Keerthi R Sri Sai Collage of Dental Surgery, Vikarabad, Telangana Abstract Background/Introduction Apical surgery is considered a standard oral surgical procedure. It is often a last resort to surgically maintain a tooth with a periapical lesion that cannot be managed with conventional endodontic (re)treatment. Objectives To assess the potential benefits of a combination of bone graft, platelet-rich fibrin (PRF) and amnion membrane in terms of reduced post-operative discomfort, Radiographic evidence of accelerated periapical bone healing and present a novel therapeutic option in the management of large periapical lesions. Methods Two cases of radicular cysts were treated through a combined regenerative approach of Bio-Gen mix, PRF and amnion membrane. The patients were assessed for discomfort immediate post-operatively and after a week. The patients were recalled every month for the next 6 months for radiographic assessment of the periapical healing. Results Amnion membrane combined with bone graft and PRF have enhanced the radiographic healing outcome and reduced the post-operative discomfort. Conclusions The results of this case series substantiates the credibility of using a combination of amnion membrane with a bone graft and PRF to enhance radiographic healing outcome with decreased post-operative discomfort and present a viable regenerative treatment modality in periapical surgery.

EPS00542 Morphological Factors in Determining the Difficulty Index in Impacted Mandibular Third Molar Surgery Kalangi Raja Harsha Abstract Background/Introduction Surgical removal of mandibular impacted third molars is one of the most common surgical procedures carried out in oral and maxillofacial surgery. Our study mainly focuses on predicting the local factors based on clinical and radiological information is essential in the safeguard of the surgeon, the preparation of the patient for the procedure, minimizing operative time and also to minimizing the risk of postoperative complications. Objectives The objective of this study was to investigate morphological factors and radiological factors associated in the removal of impacted mandibular third molars and also to correlate with the total surgical intervention time. Methods A total of 50 patients who were diagnosed with 50 impacted mandibular third molars, were involved in the study. All the radiological and clinical data were taken preoperatively. Surgical

S223 extraction was performed under local anesthesia by different operators and surgical difficulty was assessed by the total intervention time. Results ANOVA test was performed and increased surgical difficulty was associated with gender and tongue encroachment. It was also associated with the occlusal level of impaction, retromolar space, bone content, and angulation of the impaction (P\ 0.05). Conclusions Both clinical and radiological factors are essential in predicting surgical difficulty in impacted mandibular third molar removal and in order minimize postoperative complications.

EPS00545 A Comparative Study to Evaluate Efficacy of 0.5% Centbucridine to 2% Lignocaine (with Adrenaline) as Local Anesthetics in Dental Extractions Dr. Dipak B, Dr. Dhanshree J, Dr. Snehal I, Dr. Deepshree M, Dr. Aanand N, Dr. Ankit S Nair Hospital Dental College, Mumbai 40008 Abstract Background/Introduction 2% Lignocaine is the most commonly used local anesthetic (LA) agent has a vasodilative effect and needs to be combined with adrenaline. O.5% Centbucridine is a non-ester, non-amide group Of LA with an inherent vasoconstructive property. Because of encouraging results of earlier trials, we decided to undertake a study between 0.5% Centbucridine & 2% lignocaine with epinephrine in dental procedure, which is considered as reference standard. Objectives 1. To study Onset of action, Depth, Duration of anesthesia & Vasoconstriction ability 2. To study and compare the systemic changes. 3. To observe any signs of toxicity & allergic reaction after administration. Methods The study group comprised of fifty patients, male and female, of consenting age which required extraction of bilateral mandibular non impacted molars, by Pterygomandibular block. Results 1. 2%Lignocaine with epinephrine shows longer duration and greater depth of anesthesia. 2. 0.5% Centbucridine shows better cardiovascular stability & onset of aneasthesia. Conclusions A total 50 patient were included & there were no significant differences with LA’S. Centbucridine can be used for dental procedure in patients who cannot tolerate lignocaine or where adrenaline is contraindicated.

EPS00546 Malignant Otitis Externa Associated with Osteomyelitis of Condyle CH. Mohan Vamsikrishna Guided by Dr. P. Srinivas Chakravarthy Abstract Background/Introduction Malignant otitis externa refers to invasive infection in external auditory canal and skull base caused by pseudomonas aeruginosa,

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S224 staphylococcus aureus, klebsiella, proteus and some fungus such as aspergillus, fumigatus. Objectives Objective of this presentation elucidates the specific features of clinical course of malignant otitis externa and its treatment by combination of pharmacological and surgical treatment. Methods Patient underwent antimicrobial regimen with no improvement with in 10days then patient underwent antifungal therapy and finally underwent surgical procedure by pre auricular appraoch condylectomy and post auricular approach mastoidectomy and debridement of inflammatory changes in auditory canal. Results By this ccombination of pharmacological and surgical approach Infection is cleared without any postoperative complications and also no recurrence is observed. Conclusions Several therapies are described for MOE and osteomyelitis treatment. They range from simple antibiotic treatment up to wide resections, and combination of both. We hereby conclude that timely treatment of this disease is paramount and this must be based upon specific diagnosis and pharmacological and surgical treatment so as to guarantee total removal of the lesion.

ABS00561 Comparison of Physics Forceps V/S Conventional Forceps in Extraction of Grossly Decayed and RCT Failed Mandibular Molar Tooth: A Triple Blinded Randomized Control Trial Dr. Vandana Singh, Prof Dr. Uma Maheswari, Prof. Dr. Muthusekar Saveetha Dental College, Chennai Abstract Background/Introduction The Physics forceps were developed by Golden Dental Solutions, Michigan which is based on the biomechanical principles of a firstclass lever, creep and stress distribution without the squeezing, grasping, twisting and pulling forces to perform atrumatic extraction. Conventional forceps work by forces placed equally on the facial and lingual portion of the tooth and elevating it out of the socket by movement of the operator’s arm and wrist. This pulling force technique invites unnecessary complications including fracture of roots, bone and loss of tissue. Objectives 1. To reduce postoperative pain and swelling. 2. To reduce Gingival Laceration. 3. To avoid fracture of cortical plate for future prosthetic placement. Methods 62 patients took part in this Triple blinded Randomized control trial. To compare the outcomes of two groups. Patients where randomized and equally divided in two groups, Results Pysics forceps had statistically significant reduction in operating time, significant lesser fracture of buccal bone and there was not much difference in postoperative pain. Conclusions According to the study, physics forceps was more effficient in extraction of grossly decayed and RCT Failed tooth compare to conventional forceps.

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EPS00562 A Comparitive Study to Evaluate the Benefits of Dexmedetomidine Injected in Combination with Lignocaine Verses Only Lignocaine During Surgical Extraction of Impacted Mandibular Third Molar Dr. Parijat Singh Kothiwal Dental College and Research Centre Moradabad Abstract Background/Introduction Dexmedetomidine, a selective a-2 adrenoceptor agonist, is intravenously administered to patients as a sedative. However, attention has recently been paid to dexmedetomidine as a possible additive for local anesthesia. Acomparative study was conducted to evaluate the benefits of adding dexmedetomidine to local anesthesia during mandibular third molar impaction surgery with mandibular third molar impaction surgery when local anesthesia is used alone. Objectives To assess the overall comfort during the surgery o To assess the perioperative pain control o To assess the sedative effect on the patient o To evaluate the cardio-vascular status of the patient. Methods 30 healthy patients of mandibular impacted third molar were taken. The patients were randomly selected for choice of local anesthetic solution viz. local anesthetic ? dexmedetomidine (12.5 microgram) or local anesthesia alone with vasoconstrictor. Group 1: consists of 15 patients who will be undergoing surgical extraction of mandibular third molar under 2 ml of lignocaine without vasoconstrictor plus 0.125 ml dexmedetomedine (12.5 microgram) Group 2: consists of 15 patients who will be undergoing surgical extraction of mandibular third molar under 2 ml of lignocaine with vasoconstrictor. Results In the group 1 the onset of action of local anesthesia was reduced and the duration of action was increased. Sedative score 2 was seen in the group 1. Conclusions Addition of dexmedetomidine to lidocaine enhances the potency of lidocaine without any major influences on the cardiovascular system when locally injected.

EPS00589 A Common Tumor in an Uncommon Location 1. Dr Rahul Kumar Sanklecha, 2. Dr. Abdulla Kirash Sri Hasanamba Dental College and Hospital Abstract Background/Introduction Keratocystic Odontogenic Tumor (KCOT) is an aggressive tumor of odontogenic epithelium. It comprises 3% to 11% of all oral tumors It is uncommon in the maxilla, with 20 % of cases occurring in the posterior maxillary region and only 13 % in the anterior region. Hence, finding a KCOT in the maxilla is rare and more so in the anterior region. Objectives To evaluate swellings in the anterior maxilla.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Methods We hereby present you a 39 year old male patient who presented to our unit with the chief complaint of swelling in the upper front teeth region since 6 months. He gave history of trauma to the teeth 2 years ago. He was a chronic smoker and alcoholic. The swelling was intermittently increasing and decreasing in size and it was also associated with pain. The treatment was done by surgical excision and chemical cauterization of the tumour. Results There was no recurrence of tumour noted after the patient was followed up for 1.5 years. Conclusions The swellings occurring in the jaw bones are not always common cysts. So keeping in mind all the possible diagnosis we have to make all the required investigations and plan the treatment accordingly.

EPS00592 Acinic Cell Carcinoma: An Incidental Finding (A Case Report)

S225 and project through restoration of known horizontal, vertical and sagittal buttresses. Objectives The aim is to aid in assessing the intra-operative position, projection and symmetry of repositioned or deformed skeletal anatong, visualization of deep skeletal contours involving the orbit, mandibular condyle and skull base, variation in head position and craniofacial development. Methods CAD/CAM software enables the clinician to import 2-D CT data in DICOM format and generate an accurate 3-D representation of skeletal and soft tissue anatomy. Results There are several factors that contribute to poor outcomes, including surgeons. Reliance on 2-D imaging for treatment planning on a 3-D problem have been overcome by the application of the above mentioned system in oral and maxillofacial surgeries. Conclusions Computer aided navigation surgeries has shown great potential for clinical application particularly when precise location of any instrument or bony anatomic landmark is required.

Amruta Vokkaligara Sangha Dental College Abstract Background/Introduction Acinic cell carcinoma is a malignant tumour representing 2% of all salivary tumours. It arises more frequently in parotid gland. Previously malignant nature of this carcinoma was disputed and it was termed as acinic cell tumour or benign adenoma considering its potential to recur and metastatize. Objectives The objective of this study was to report a case of 35 year old female patient who presented with the history of swelling in the right side of cheek since 3 years. Methods Through Intraoral approach the lesion was surgically excised under local anesthesia. Results The excised lesion was then confirmed histopathologically as Acinic cell Carcinoma of parotid gland. Conclusions Therefore we conclude that acinic cell carcinoma can be successfully treated with superficial or total parotidectomy with sparing of facial nerve.

EPS00594 Computer Aided Navigation Surgeries Diganth Vokkaligara Sangha Dental College Abstract Background/Introduction Requiring functional and esthetic considerations, surgery in the oral and maxillofacial region remains intellectually and technically challenging for even the most experienced surgeons. Complex congenital, developmental and acquired deformities of craniomaxilofacial skeleton are currently managed by re-establishing facial symmetry

ABS00614 ‘‘Scalpel Versus Diathermy’’: The Better Wand? Dr. Abdul Wahab, Dr. Madhulaxmi, Dr. Abhinav Prabhu, Dr. Manay Roshini Saveetha Dental College, Chennai Abstract Background/Introduction Literature has innumerable studies to support or contradict the use of scalpel and diathermy in skin incisions and neck dissections. However, there has not been any study to validate the best means in the oral mucosa. Therefore, with our original research work, we hoped to solve the dilemma between the use of scalpel and diathermy among oral and maxillofacial surgeons. Objectives The purpose of the study was to compare the wound healing of mucosal incisions made by scalpel and diathermy. Methods A prospective, split mouth study was designed on patients undergoing anterior maxillary osteotomy, Le fort 1 osteotomy or both, during the time period from January 2015 to April 2017. In group A, the incision was made by scalpel and in group B, the incision was made by diathermy. Southampton scoring system was used to assess the wound healing on the first, third, seventh and tenth postoperative days. Student’s t-test was used to compare continuous variables, and the ¨Ià2 test was used to compare proportions among groups. P \ 0.05 was considered significant. Results A total of 113 participants were enrolled in the study. 77 patients in group A and 87 patients in group B had postoperative complications of wound healing. The difference in wound healing between the two groups was statistically significant (p). Conclusions We observed that wound healing was better in the scalpel incisions when compared to the incisions made with diathermy.

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EPS00615 A Prospective Study to Compare and Evaluate the Synergistic Effect of Platelet Rich Fibrin (PRF) and Alendronate in Post Extraction Sockets Dr. Yama N. Patel Karnavati School of Dentistry, Uvarsad, Gandhinagar, Gujarat Abstract Background/Introduction Maintenance of alveolar bone width and height following tooth loss is essential with regard to the restoration of missing teeth with endosseous dental implants or prosthodontic approach. A various amount of alveolar ridge resorption is likely to occur after tooth extraction at buccal and lingual alveolar bone plates. Alendronate is well known for its potent inhibition of osteoclast-mediated bone resorption. Platelet rich fibrin (PRF) could serve as a resorbable membrane for guided bone regeneration (GBR), that allows the migration of osteogenic and angiogenic cells and permits the underlying blood clot to mineralize. Objectives objective of this study is to compare and evaluate the synergistic effect of alendronate and PRF in to extraction socket. Methods Twenty patients with age between 25 and 65 years were selected from the out patient department of Oral and maxillofacial department, Karnavati school of dentistry. The patients were divided into two groups: 10 patients in each group. In 1 group after the extraction of teeth from molars to midline the sockets were irrigated with saline and sutured on right side, on left side PRF was placed and sutured. In the other group the right side was treated the same way after extraction as in first group where as in the left side sockets PRF soaked in 20mg/ml alendronate was placed and sutured. Patients were evaluated: clinically for any local irritation, socket closure, swelling and pain; Radiologically with orthopantomograph or IOPA X-rays were taken immediately after the extraction, 1 month after extraction and 3 months after extraction to determine the amount of bone loss prevented. Results Clinical study is under progress. Conclusions Clinical study is under progress.

EPS00617 Short Term Evaluation of Gustatory Changes After Surgical Removal of Mandibular Third Molar: A Prospective Randomized Control Trial First Author: Dr. Rahul Anand (Former Postgraduate Student), Second Author: Dr. D. Prabhu Shankar Reader, Presenter: Dr. Melita Juliet J (Postgraduate) Meenakshi Ammal Dental College and Hospital Abstract Background/Introduction Nothing would be more tiresome than eating and drinking if God had not made taste as pleasure and food as necessity. Voltaire Peripheral nerve damage associated with third molar extraction is almost exclusively reported as a somatosensory change (primarily involving

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 touch), but studies on chemogustatory changes are minimal or less documented. Objectives 1. To evaluate changes in gustatory sensations with Claussen’s 5-Komponent-Chemo-Gustometry. 2. To establish a statistical corelation between type of impaction, Pederson’s difficulty index score and incidence of suprathreshold taste change. Methods A total of 60 subjects were included in the study. Chemogustatory evaluation was perfomed pre and postoperatively by dividing the subjects into group 1 (difficulty index score 3-4), group 2 (difficulty index score 5-6) and group 3 (difficulty index score 7-8). The contralateral side of the included patient was considered as control. Five variant chemical stimuli with three differential concentrations were used: - Sweet- glucose in solution - Salty-sodium chloride solutions Sour-citric acid - Bitter- quinine solution - Bitter-phenylthiourea. Results Group 3 subjects showed higher incidence of increase in taste threshold with statistical significant P value of 0.001. - Salty and sour taste have more predilection for increased taste threshold. Conclusions Suprathreshold taste changes occur after surgical removal of an impacted mandibular third molar with high difficulty index score. These deficits maybe the result of nerve compression, laceration or stretch, but get resolved within three months. Increased awareness of these complications will allow the practitioner to effectively communicate with patients prior to the surgical procedure.

EPS00620 Management of Complications of Lateral Window Approach Sinus Lift Procedure Dr. Sandeep Thadani, Dr. Swapna Nayan, Dr. Gokul Venkateshwar D.Y Patil University School of Dentistry Abstract Background/Introduction Sinus lift procedure using lateral window approach is a commonly performed oral surgical procedure in oral and maxillofacial surgical practice. Lateral window approach has its associated possible complications of post-operative bleeding, swelling, perforation of schneiderian membrane, displacement of implant, paresthesia and sinusitis which have a direct impact on the patient’s quality of life after the surgery. Objectives To study the postoperative seqeulae after lateral window sinus lift and methods of their management. Methods In a series of 5 patients, various complications such as bleeding, perforation of schneiderian membrane, implant displaced into the sinus, paresthesia, acute sinusitis and graft infection and exposure were encountered and managed successfully. Results Maxillary sinus elevation procedure using lateral window approach may have various complications which if managed can make this procedure worthwhile to both the surgeon and the patient. Conclusions Maxillary sinus elevation procedure using lateral window approach may have various complications which if managed can make this procedure worthwhile to both the surgeon and the patient.

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EPS00626 Efficacy of 7.5% Buffered Lignocaine Hydrochloride During Surgical Removal of Impacted Mandibular Third Molars: A Prospective Double Blinded Randomized Control Trial Dr R S Neelakandan, Dr Prabhu Shankar, Dr Faiza M Meenakshi Ammal Dental College Abstract Background/Introduction Injection of local anaesthesia is often the only painful part of a dental procedure. Many factors influence the pain on injection, including pH of the solution. Alkalinizing local anaesthetics has been attempted over the years to alleviate pain leading to the concept of buffering local anaesthetics. Objectives To determine the effect of 7.5% Sodium bicarbonate as a buffering agent to local anaesthetic on Pain, Onset & Duration. Methods Split-mouth study involving 50 patients. Control: 2% Lignocaine Hydrochloride with 1:80,000 conc. Adrenaline Study: 7.5% Buffered Lignocaine hydrochloride with 1:80,000 conc. Adrenaline. Parameters assessed: Pain using VAS Time of onset Duration of anaesthesia. Results All patients had no pain with Buffered solution whereas majority had moderate to severe pain with Conventional Lignocaine Onset time with Buffered Lignocaine was 0–30 secs and greater than 60 secs with conventional lignocaine. The anaesthetic effect stayed for over 5 hours with Buffered lignocaine and was less than 3 hours with conventional lignocaine. Conclusions 2% lignocaine with 7.5% sodium bicarbonate significantly decreases pain, provide rapid onset and prolongs duration of anaesthesia when compared to Unbuffered 2% lignocaine during administration of IANB.

EPS00629 Assessment of Grafted Third Molar Extraction Socket: A Comparative Study Between Autologous Platelet Rich Fibrin and Platelet Rich Plasma Grafts Dr. Neelakandan, Dr. K. Siva Kumar, Dr. Karthik Meenakshi Ammal Dental College and Hospital, Chennai Abstract Background/Introduction Dental extractions are the most frequently performed procedure in oral and maxillofacial surgery. Attempts to improve and hasten bone healing in sockets have been made with autografts and allografts. Disadvantages like donor site morbidity have urged clinicians to look for autologous materials like platelet rich plasma and platelet rich fibrin. In this study we are comparing the efficacy of PRF and PRP in third molar socket regarding the healing aspect.

S227 Objectives To radiographically assess the lamina dura, bone density and trabecular pattern at the extraction site. To compare the radiological parameters in GroupA (PRF) with GroupB (PRP). Methods 30 adult patients with age of 19-35 years undergoing bilateral 3rd molar extraction were selected. Out of 30 patients 15 were included in groupA (PRF) and groupB (PRP). PRF and PRP preparation was done and placed in the sockets after extraction in respective groups and bone healing was assessed using RVG at 4th and 8th week. Results No statistical difference present between GroupA and GroupB at 4th week post-op. Statistical difference present between GroupA and GroupB at 8th week post-op. Conclusions We concluded that PRF is a viable option to improve postoperative healing in extraction sockets.

EPS00647 Aggressive Osteoblastoma: A Diagnostic Challenge? Dr K Raghunandan, Guided by Dr. Joyce P. Sequeira Yenepoya Dental College and Hospital Abstract Background/Introduction Benign osteoblastoma is a rare primary bone tumor that constitutes approximately 1% of all primary bone tumors. Its occurrence in the craniomaxillofacial region is also rare and represents only 15% of all osteoblastomas. The tumor shows a predilection for the male gender and constitutes less than 1% of all tumors of the maxillofacial region. In the maxillofacial region, the mandible is affected more frequently than the maxilla. Few cases of osteoblastomas involving maxillofacial region have been reported in the literature. Objectives This case report is regarding a 47-year-old female patient with a solitary swelling on the left palate involving alveolar ridge and buccal vestibule measuring 3*2cm and excision biopsy of the same was done under LA and extraction of 25 root stump was done. Biopsy report suggested CHRONIC NONSPECIFIC OSTEOMYELITIS Later patient reported to Dept with a recurrence in the same region which was surgically excised under LA on 5/1/16 and the biopsy was suggestive of AGGRESSIVE OSSIFYING FIBROMA Again patient has reported with the recurrence of the lesion in the same region and burning sensation since 4months on 28/5/16. The biopsy was suggestive of BENIGN OSTEOBLASTOMA. Again the patient had reported 1year later with the recurrence of the lesion over the same region with associated pain and burning sensation involving 11 21 22 region for which surgical resection (partial maxillectomy) was done and histopathological examination was done and suggestive of AGGRESSIVE OSTEOBLASTOMA. Methods Not applicable. Results Not applicable. Conclusions Not applicable.

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EPS00648 Surgical Treatment Modalities of Obstructive Sleep Apnea Dr. Naveen Lalchandani Abstract Background/Introduction Obstructive sleep apnoea (OSA) is a common chronic disorder affecting about 2–4% of the adult population, with the highest prevalence reported among middle-aged men. The condition is characterized by repetitive episodes of complete or partial collapse of the upper airway (mainly the oropharyngeal tract) during sleep, with a consequent cessation/reduction of the airflow. The obstructive events (apnoeas or hypopnoeas) cause a progressive asphyxia that increasingly stimulates breathing efforts against the collapsed airway, typically until the person is awakened. Objectives The role of surgery in management of OSA has been widely explored in an attempt to find a treatment option that could be definitive. However, its role remains extremely controversial. The aim of the surgery is to remove the cause of upper airway obstruction and to widen the airway, after a precise detection of the site where the obstruction occurs. The most common sites of obstruction are the oropharyngeal tract (collapse of the retropalatal and retrolingual regions due to macroglossia, low-lying soft palate or enlarged tonsils) and the nose (congestion, polyposis, chronic rhinitis. Methods Adenoidectomy, tonsillectomy, uvulo palatopharyngoplasty, nasal surgery, lateral pharyngoplasty, uvulopalatoplasty, linguoplasty, lingual, mandibular advancement, genioglissus advancement, hyoid myotomy, maxillomandibular advancement. Results In adult patient maxillomandibular advancement and tracheostomy procedure shows more success rates. Conclusions The role of surgery remains controversial. Tonsillectomy and adenoidectomy are useful in children and in adults with enlarged tonsils. Uvulopalatopharyngoplasty is a well established procedure to be considered as a second-line option when PAP has failed. Maxillar mandibular surgery is extremely effective and can be suggested to patients with craniofacial malformations.

EPS00663 Oro Antral Communication: Incidence and Treatment Options Dr. Sayali Desai, Dr. Venkatesh Anehosur SDM College of Dental Sciences, Dharwad Abstract Background/Introduction Oro antral communication is a common complication following removal of maxillary premolars and molars because of anatomic proximity of root apices of these teeth to the maxillary antrum. Various methods have been described in the literature for closure of these communications which vary from simple local methods like buccal advancement, buccal fat pad to complex regionals like temporalis flap.

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Objectives The aim of the study is to find the incidence of oro antral communication and its treatment options. Methods A retrospective study was conducted of patients who reported to the Department of Oral and Maxillofacial Surgery from 2012 to 2017. The study was conducted to evaluate aetiology and the treatment modalities adopted at our Department. Results Out of the 105000 extractions performed in the department, 10 cases of oro antral communication were reported. The incidence was most common following extraction of first molar followed by second molar and third molar. Most of the cases were closed by buccal fat pad with buccal advancement flap after retrieval of the displaced root from the antrum through the socket. Conclusions Primary closure might be considered as a quick method for oro antral communication. However, in case primary closure of the flap does not provide adequate closure of the communication, buccal advancement flap or buccal fat pad with buccal advancement flap is the treatment of choice.

EPS00664 Incidence of Odontogenic Infection and Management Protocol Dr Priti Kumari, Dr Venkatesh Anehosur Department of Oral and Maxillofacial Surgery SDM CDS Dharwad Abstract Background/Introduction A retrospective study was conducted of patient who reported in SDM CDS CFU with odontogenic infection from August 2012 to August 2017. A total 103 of patient were included in the study. Objectives The aim of the study was to find the incidence of odontogenic infection and management protocol reported to SDM CDS last 5 year. Methods All patient in this study underwent surgical incision and drainage, received IV antibiotics, and had culture and sensitivity performed. Patient demographics reviewed were gender, age, involved facial spaces, microorganism identified and antibiotics resistance from culture and sensitivity testing.: The successful management of single and multi space orofacial odontogenic infections involves identification of the source of the infection, then anatomical space encountered, the predominant microorganism that are found during the various stage of odontogenic facial space infection. Patient should be hospitalized, and administration of parenteral antibiotics and fluids, utilization of interpretation of laboratory and diagnostic imaging studies and control of possible surgical complication. Results there were 56 male (54%) and 47 (46%) female patient ranging in age from 17 to 70 years, with a mean age of 24 years (SD=14.5). Forty patient (38.8%) presented with a single facial space abcess. The submandibular space was the most frequent location for a single space abcess (30%), followed by the buccal space (27.5%) and the lateral pharyngeal space (12.5%). Sixty three (61.2%) patients presented with multiple space involvement, totalling 142 space involved. The submandibular space (28.2%) was again the most frequent location, followed by the submental space (14.8%) and the lateral pharyngeal space (14.0%), ludwigs angina (2%).

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Conclusions Patient who underwent surgical incision and drainage in the operating room had a tendency for involvement of multiple space abcess with submandibular space, submental and lateral pharyngeal space effected most frequently. Gram positive cocci and gram negative rods had the greatest growth percentage in cultures.

EPS00667 Piezosurgery: A Promising Technical Modality for Osteotomy

S229 cross bite, previous failure of other devices. Distalisation of molars and also distraction osteogenesis. In conclusion surgical assistance provides better and faster results than only orthodontic treatment in correction of skeletal deformities.

EPS00677 Minimally Invasive Treatment of Oral Ranuala with a ‘‘Mucosal Tunnel Technique ‘‘ Dr. M Suresh, Kumar (HOD), Dr. Meraj Sultana

Dr. Mangal Anil More

Meghna Institute of Dental Sciences

Y M T Dental College and Hospital, Kharghar, Navi Mumbai

Abstract Background/Introduction A Ranula is a pseudocyst that is caused by extravasation of mucous from sublingual gland. The term ranula is derived from latin word ‘‘rana’’meaning frog, as these masses appear as a blue-hued swelling in the floor of mouth, reminiscent of a frogs underbelly.’’RANUwas first reported by Hippocrates Celsius. Oral ranulas are located above the mylohyoid and encompass the floor of mouth, whereas cer. Vical ranulas extend into the fascial spaces of the neck either through or around the mylohyoid muscle. Objectives The mucosal tunnel technique is a safe, effective, simple and minimally invasive treatment of oral ranula. Methods Marsupilization, more often Excision of entire sublingual gland, Mucosal tunnel technique. Results Because of the squamous mucosa embeded under the bottom of the sub lingual gland, mucosal tunnel did not heal postoperatively, and the natural channels allowed sufficient drainage of cystic fluid for the ranula to disappear. Conclusions Regardless of the treatment that is used to treat ranulas, the best approach is to preserve the sublingual gland, which ensures that physiological functions are maintained. It is therefore important to find an eff, ective, easy, and minimally-invasive procedure that would allow a short course of treatment, reduce postoperative complication and prevent recurrences.

Abstract Background/Introduction Piezosurgery is a promising meticulous and soft tissue sparing system for bone cutting based on ultrasonic vibrations. It has therapeutic features that include micrometric cut (precise and secure action), a selective cut (affecting mineralised tissues, but not surrounding soft tissues) and clear surgical field (the result of cavitation effect created by an irrigation or cooling solution and oscillating tip) The major advantage of piezosurgery are decreased blood loss, less vibration and noise, reduction in the impact on soft tissues (vessels and nerves) and increased comfort for the patient. Compaired to traditional methods, it enables optimal healing because it reduces post surgery swelling and discomfort. The indications of piezosurgery in oral and maxillofacial surgery are sinus lift, bone graft harvesting, osteogenic distraction, ridge expansion, endodontic surgery, periodontal surgery, inferior nerve decompression, cyst removal, impacted tooth removal. In conclusion, piezosurgery represents an innovative technical modality for different aspects of bone surgery with a rapidly increasing number of indications in the filled of oral and maxillofacial surgery.

EPS00668 Surgically Assisted Orthodontic Treatment Dr. Priyanka C. Kokane YMT Dental College and Hospital, Kharghar, Navi Mumbai Abstract Background/Introduction Orthodontic treatments are one of the most time consuming treatment. In order to overcome the inconvenience caused to the patient due to the prolonged treatment span, surgically assisted orthodontic treatments are the most promising adjuvant to the conventional treatment. It helps in faster tooth movement, safer expansion of constricted arches, enhanced post-orthodontic treatment stability, retraction of canine, increase traction of impacted tooth and many more. These uses have lead to the wider acceptance of the procedure. Taking aesthetic into consideration young adults, & children prefer it as the most convenient line of treatment. Various procedures which could be carried out using the surgical method include: Corticotomy (linear cutting technique in the cortical plates surrounding the teeth to produce mobilization of the teeth.) Surgically assisted rapid palatal expansion (SARPE) Commonly done in adults whose palatal sutures have fused & cannot be expanded via other techniques. It can also be carried out in patients of maxillary hypoplasia, bilateral posterior

EPS00682 Primary Tuberculous Granuloma in Maxilla: A Rare Case Report Mohammed Faisal Meghana Institute of Dental Sciences, Nizamabad Abstract Background/Introduction Tuberculosis is a chronic granulomatous disease caused by Mycobacterium tuberculosis. There are two forms namely primary and secondary tuberculosis. Pulmonary tuberculosis is the most common form of primary tuberculosis. Primary tuberculosis in extrapulmonary site though very uncommon can occur in any site, such as skin, brain, bone, eye, genitourinary tract and oral cavity. Objectives: Surgical management of the excision of lesion which is diagnosed as primary tuberculous granuloma involving maxilla.

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S230 Methods A 43 year old male patient reported with chief complaint of swelling in right maxillary region since 1 month associated with pain which is intermittent, non continuous and relieved on medication. Intraorally diffuse swelling in buccal mucosa with mild tenderness without any secondary changes, histopathological report revealed langerhan’s cells suggestive of tuberculous granuloma. Results Surgical excision of the lesion followed by post operative treatment with anti tubercular drug therapy. Conclusions This case report emphasizes the fact that primary oral tuberculosis should be considered in the diagnosis of soft tissue swellings, as the communicable nature of the disease demands early diagnosis and treatment.

EPS00684 Glandular Odontogenic Cyst: A Case Report Dr. Bibhu Prasad Mishra, Dr Meghali Diwaker ITS Dental College Abstract Background/Introduction Glandular odontogenic cyst is a rare developmental cyst of the jaws. The histological features of GOC strongly suggest an origin from the remains of dental lamina. Radiographically GOC presents as well defined radiolucencies with uni or multilocular appearance. A case of GOC in a 35 year old female is presented here. Objectives the cyst was present in the mandibular parasymphyseal region of the patient. The objective was to carry out decompression of the cyst. Methods Clinical, histologic and imaging features were evaluated. Due to the high tendency of recurrence and the aggressive potential of GOC, Careful clinical and radiological evaluation must be carried out. Results No recurrence till 3 months of follow up. Conclusions This poster demonstrates the clinical presentation and radiological appearance at 1st, 2nd and 3rd month along with etiology and histological appearance of this rare entity.

EPS00708 Twin Mix Formulation as a Superior Adjunctive for Pain and Inflammatory Control in Minor Oral Surgery

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 dexamethasonized solution of local anesthesia a freshly prepared mixture of 1.8ml of 2% Lignocaine with adrenaline (1:200000) and 1 ml (4mg) dexamethasone making 2.8 ml solution. The solution is deposited in pterygomandibular space. The advantage of such an administration includes ease of administration, single prick for dual drug delivery, lesser sting of local anaesthetic injection, prolonged duration of the soft tissue anaesthesia and improved quality of life in the postoperative period after the surgical procedure. Objectives 1. Evaluation of the latency and duration of Twin-mix vs LAand its impact on postoperative sequelae 2. Anti-inflammatory effects of Twin mix- Local vs various routes of Dexamethasone administration. 3. Assessing stability of active ingredients in the twin-mix solution. Methods A prospective, randomized, double blind trial was designed to validate the efficacy of Twin-mix and LA in the surgical removal of impacted mandibular third molars. Clinical parameters of anaesthetic latency, anaesthetic duration and post-operative patient discomfort were assessed. VAS was used to assess the overall pain and specific facial measurements recorded to assess postoperative swelling. The stability of active ingredients were also assessed using a double beam UV-visible spectrophotometery. Plasma dexamethasone determination was done in venous using high performance liquid chromatography. Results Addition of dexamethasone to lignocaine, and its administration as an intra-space injection significantly shortens the latency and prolongs the duration of the soft tissue anesthesia, with improved quality of life in the post-operative period after surgical extraction of mandibular third molars. This phenomenon kept local dexamethasone concentrations high in the tissues surrounding the surgical wound initially and higher plasma concentration at the late stages. The anaesthetic efficacy of the twin-mix admixture and the stability of the local anesthetic solution was found physically compatible with the solution of 2 %lignocaine with 1:200,000 epinephrine. The mixing of the two solutions did not show any significant variations in the individual solution when subjected to double beam UV visible spectrophotometery. Conclusions Dexamethasone, which is 20–30 times more potent than cortisol, exerts a strong anti-inflammatory action by inducing the synthesis of endogenous proteins that block the enzymatic activation. Dexamethasone has a half-life of 36–54h, which makes it a suitable drug for a single-shot preoperative therapy controlling surgically induced inflammation in the maxillofacial region. The preoperative administration of 4mg dexamethasone in the pterygomandibular space along with local anesthetic solution demonstrated obvious clinical advantages when used for surgical removal of impacted mandibular third molars. This Poster highlights our experience with Twin mix which included a better clinical outcome with improved quality of life postoperatively when compared to use of plain 2%Lignocaine.

Dr. Darpan Bhargava, Dr. R.S. Neelakandan, Dr. Shreya Panwar (PG Trainee)

EPS00716 Versatality of Pedicled Buccal Fat Pad in Closure of Oral Defects

People’s College of Dental Sciences, Bhopal; Meenakshi Ammal Dental College, Chennai

Dr. Saurabh Chalke, Dr. Yogesh Kini, Dr. Gokul

Abstract Background/Introduction Glucocorticoids are potential suppressor agents of multiple signaling pathways leading to decreased levels of inflammatory mediators at the site of surgery. This study highlights the use of Twin mix -

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Abstract Background/Introduction The use of buccal fat pad as a grafting source in the closure of intraoral defects has gained popularity in the last quarter of this

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 century. Because of the ease of access and rich blood supply, its use in oral defects is an attractive concept. Objectives To find out versatality of pedicled buccal fat pad in closure of oral defects. Methods The study comprised of 3 patients with oral submucous fibrosis, 1 patient with oroantral fistula, 1 patient with TMJ ankylosis. The acquired oral defects following resection of pathology in the oral cavity, were reconstructed with pedicled buccal fat pad. The Post operative follow up at the intervals of 1st, 7th and 15th day, followed by 1st month, 2nd month and 3rd month was done. Results The procedure was successful in all the patients. Healing was satisfactory with no breakdown or liquefaction necrosis post operatively. All the patients had definitive colour change at the end of 1st post operative month owing to the epithelialisation with uneventful healing. Conclusions The results of this study support the view that the use of buccal fat pad is a simple, convenient and reliable method for the reconstruction of small to medium sized intra oral defects.

ABS00744 Odontogenic Keratocyst: Our Experience with Diagnostic and Treatment Challenges Dr. Samridhi Maheshwari, Ist Year Post Graduate, Dr. Pravesh Mehra, HOD & Prof LHMC, New Delhi Abstract Background/Introduction Odontogenic keratocyst (OKC) is a unique cyst because of its locally aggressive behaviour, high recurrence rate and characteristic histological appearance. It accounts for approximately 12% to14% of all odontogenic cysts of the jaws. It has a predilection for the posterior part of the mandible, with a peak incidence in patients between 10 and 30 years of age and a slight male predominance. Radiographically, the lesion is most often unilocular or multilocular radiolucency, surrounded by smooth or scalloped margins with sclerotic borders. OKC has presumably arisen from cell rests of the dental lamina or from offshoots of the basal cell layer of the oral epithelium. Objectives To ascertain the challenges met en route while diagnosing each patient efiiciently, thus paving the way for a customised treatment approach. Methods This paper attempts to present a case series of three such cases with varied clinical presentations. Results Varied clinical presentations of a similar pathology proved nothing short of a diagnostic challenge for us clinicians. However, a systemic approach to clinical reasoning using every step of the diagnostic ladder judiciously becomes an imperative tool in achieving the correct diagnosis. Also, tailoring the treatment modality in each case based on extent of the pathology also added to the complexity. Conclusions In management of a disease, diagnostic reasoning remains critical.A timely diagnosis enables the patient to have the best opportunity for a positive health outcome because clinical decision making will be tailored to a correct understanding of the afflicting pathology, thus

S231 reducing patient morbidity and mortality. Maxillofacial pathologies are often found masquerading as other conditions thus posing a diagnostic hurdle in patient management. Rare presentation of common pathologies adds to the ambiguity. The purpose of this paper is to present case series of different clinical patterns of odontogenic keratocyst and their management.

ABS00746 Antimicrobial Efficacy of Alveogyl vs Zonc Oxide Eugenol in Alveolar Ostitis Nivethitha Mohan, Uma Maheshwari Saveetha Dental College Abstract Background/Introduction This study was done in vitro to compare the antiomicrobial efficacy of alveogyl vs zinc oxide eugenol in microbial load of alveolar ostitis. Objectives To compare the antiomicrobial efficacy of alveogyl vs zinc oxide eugenol in microbial load of alveolar ostitis. Methods Fresh strains of enterococcus, staphylococcus albus, pesudomonas aeruginosa were used. 5 round cavities were prepared on the muller’s agar plates. Each batcteria were spread on two agar plates and divided into two groups- group A alveogyl and group B zinc oxide eugenol. Agar well diffusion method was performed in which in which the zone of inhibition was measured to compare the efficacy of alveogyl vs zinc oxide eugenol. Results Results Were Represented Diagramatically And Schematically. Conclusions Sion Oxide Eugenol Has Better Anti Mibrobial Property As Compared To Alveogyl In Alveolar Osteitis.

EPS00750 Lingual Based Flap Incision for Mandibular Third Molar Disimpaction Dr. Axadevsinh Pargara, Dr. Anil managutti, Dr. Akash Prajapati Narsinhbhai Patel Dental College and Hospital, Visnagar, Gujarat Abstract Background/Introduction Third molar can present themselves completely and or partially retained and may be mucosal, submucosal, or completely retained within the jaw. The surgical techniques include an incision type, playing a key role in wound healing, presenting a series of incisions described over time, by different researchers and authors, each of these has been given to ensure adequate access and decease the side effect of the procedures such as pain, trismus, swelling, dry socket and infection. Objectives Comparison of post operative complications Pain, Trismus, swelling and wound dehiscence of conventional flap with lingually based triangular flap for impacted mandibular third molar surgery.

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S232 Methods A lingually based triangular flap was used to remove the impacted mandibular third molar on the contralateral side of the patient. An incision was made adjacent to the distal surface of the mandibular second molar, and extended along the sulcus to the distobuccal corner of the mandibular second molar. An oblique vestibular incision was made and extended into the vestibular fornix of the mandible, aligned with the mesiobuccal cusp of the second molar. It was continued postero superiorly towards the anterior border of mandibular ramus. Results Post operative complicatios like Pain, Trismus, swelling and wound dehiscence score is less with lingually based flap incision compared with other routinlely used triangular flap. Conclusions To conclude that this new flap design is preferable to the routinely used flap for impacted third molar surgery.

EPS00758 Recent Advances of Intermaxillary Fixation Dr Mohit Rathore BRS Dental College and General Hospital Abstract Background/Introduction Intermaxillary fixation (IMF) is commonly used in oral & maxillofacial surgery. Most commonly used in maxillofacial trauma, to achieve stable occlusion for ease of function. Objectives To study the recent advances of IMF such as screws, Thermoforming plates, modification of arch bars & using of adhesive cast splint etc. Methods Review of literature will be done for various new methods of IMF. Inference will be drawn on advantages and disadvantages of each technique acc. To literature, same will be presented in pictorial form. Results According to the literature different techniques are invented and reviewed, all have merits and demerits. Conclusions We belive that newer techniques of IMF are valuable tools in the hands of maxillofacial surgeons.

EPS00763 Radiofrequency Ablation: A Treatment Modality of Trigeminal Neuralgia Kiran Shubha, Dr. Ravi Narula Abstract Background/Introduction TN is a nueropathic pain condition… Affecting the face… Likely etiology is vascular compression of trigeminal nerve leading to focal demylination and abberant nureal discharge. Carbamazepine remain the drug of choice in the first line treatment of TN. Minimally invasion interventional pain. Therapies and surgeries are possible option when drug therapy fails. Younger patients may benifit from microvascular decompression, elderly patients with poor surgical risk may be more suitable for percutanous trigeminal nerve rhizolysis. KEY WORDS: interventional treatment, minimally invasive, pain management, radiofrequency rhizolysis, trigeminal nueralgia.

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EPS00778 Clinico Radiological Assessment of Alveolar Socket Preservation Using Autogenous and Alloplastic Bone Graft Dr Deepak Tanwar, Dr. Amit Kumar ITS Dental College and Hospital, Greater Noida Abstract Background/Introduction To preserve bone at the future implant site we used socket preservation technique. Which involved the placement of autogenous and alloplastic bone graft material in future implant site. Objectives To compare effect of autogenous and alloplast graft in 1. Healing Time 2. Bony architecture. Methods The present study was approved by the Institutional Ethical Committee. A randomized, controlled, prospective, Clinical study was designed to investigate the efficacy of Autogenous graft in alveolar ridge preservation as compared to nova bone putty. Patients having at least two teeth indicated for extraction were selected. The two extraction sockets were allocated to one of the following groups using random number table: Socket grafted with Autogenous graft Socket grafted with nova bone putty. Results Of the 30 selected sites in 15 patients, 30 sites were grafted with ridge preservation technique (15 grafted with Autogenous and 15 grafted with nova bone dental putty) Among 30 grafted sites, 18 were in the maxilla (10-Autogenous and nova bone putty) and 12 were in mandible (5-Autogenous and 7-nova bone putty). On the 7th day follow-up visit, uneventful healing was observed in all the patients at all the sites. One patient reported with sign of infection graft rejection. At the end of 6 months, a satisfactory clinical healing was observed in all the patients. Visually, Autogenous sites showed minimum alveolar ridge width shrinkage compared to sites grafted with nova bone putty. Conclusions The clinical outcome of alveolar ridge preservation procedure is satisfactory with no reported complications. The study is able to validate the need of alveolar ridge preservation technique in maintaining height and width of residual alveolar ridge after extraction. Autogenous graft has shown more promising results as compared to nova bone dental putty in achieving minimum volumetric alveolar bone loss when it is grafted immediately in postextraction socket. Histologically, it has shown to facilitate new bone formation.

EPS00821 A Comparative Study of Effectiveness of Three Different Wound Closure Techniques ‘‘A Randomized Clinical Study’’ Dr. Jasmin Tamboli, Dr. Vrinda Kolte, Dr. Nilima Agrawal (Principal Investigator) (Co-Investigator) (Co-Investigator) (P.G. Student) (Prof And Guide) (Senior Lecturer) Abstract Background/Introduction Different problems that have been come across with the use of sutures encouraged the development of sutureless skin closures such as wound glues or more commonly surgical adhesive strips. Here we are

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 discussing the benefits and limits of 3 different wound closure techniques. Objectives To evaluate & compare duration needed for the placement of suture with cyanoacrylate and steri strips. - To evaluate and compare wound dehiscence after placement of suture with cyanoacrylate and steri strips. - To evaluate and compare postoperative scar formation after placement of suture with cyanoacrylate and steri strips. - To evaluate and compare postoperative patient satisfaction after placement of suture with cyanoacrylate and steri strips. Methods To evaluate & compare duration needed for the placement of suture with cyanoacrylate and steri strips. - To evaluate and compare wound dehiscence after placement of suture with cyanoacrylate and steri strips. - To evaluate and compare postoperative scar formation after placement of suture with cyanoacrylate and steri strips. To evaluate and compare postoperative patient satisfaction after placement of suture with cyanoacrylate and steri strips. Results Awaited. Conclusions Awaited.

EPS00827 Sinus Lift Dr Mohit B Shankar, 1st Year PG Rajarajeshwari Dental College & Hospital Abstract Background/Introduction The paired maxillary sinuses are air-filled spaces lying within bilateral maxillae, lateral to the nasal cavity, superior to the maxillary teeth, inferior to the orbital floors, and anterior to infratemporal fossa. These are the largest of the paranasal sinuses, measuring an average of 12.5 mL in vol. The maxillary sinuses are lined with thin bilaminar mucoperiosteal Schneiderian membrane. The primary indication for sinus graft surgery is planned implant reconstruction of edentulous posterior maxilla afflicted with postextraction alveolar bone loss and sinus pneumatization, resulting in bone too atrophic for implant placement. Objectives To discuss the advantages - disadvantages & indications - contraindications of these different techniques. Methods There are currently two techniques widely used for maxillary sinus augmentation, the lateral window technique & sinus intrusion osteotomy. These techniques use several types of bone graft material: autogenous bone, allograft, xenograft & alloplastic. Results Newer advanced techniques are better as they are minimally invasive, cause less post-operative trauma, less time consuming and give reliable results for successful implant placement. Conclusions The goal of the sinus lift is to graft extra bone into the maxillary sinus, so more bone is available to support a dental implant. But the wish of patients and dentists for minimalivasive methods lead to the development of new innovative techniques, comprehensive treatment planning& reliable implant positioning.

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EPS00828 Piezosurgery -Boon to Cranio Maxillofacial Surgery Dr. Rohit N Rathod [FIRST YR PG OMFS] Rajarajeswari Dental College & Hospital, Bangalore, India Abstract Background/Introduction Piezoelectric device or piezo surgery device was originally developed for the a traumatic cutting of bone by way of ultrasonic vibrations and as an alternative to the mechanical and electrical instruments that are used in conventional oral surgery, recent research have also shown the benefits of their use in craniofacial surgery, plastic and reconstructive surgery, head and neck surgery, neurosurgery, traumatology. Objectives 1. To discuss the advantages & disadvantages of piezosurgery. 2. To review the current concepts and application of piezosurgery in craniomaxillofacial surgery. Methods We have studied piezosurgery over conventional bur method in many cases- 1. Impaction 2. Intraoral bone grafting like parasympsis, ramus, etc 3. Maxillary & mandibular osteotomies 4. Ridge expansion 5. Maxillary Sinus lift 6. Distraction osteogenesis,8 Implants. Results Key features of piezosurgery include the selective cutting of bone without damaging the adjacent soft tissue (e.g. vessels, nerves or mucosa), providing a clear visibility in the operating field, and cutting with micron sensitivity without the generation of heat. Conclusions Piezoelectric device allows better results compared to a traditional surgical saw, intraoperative blood loss, postoperative swelling and nerve impairment.

EPS00836 Determination of Efficacy of Lidocaine 2% with Adrenaline 1:200,000 and 0.5% Ropivacaine Without Adrenaline in Infra Orbital Nerve Block Dr. Shruti Jain, Dr. S.R. Shenoi, Dr. Nilima Agrawal, Dr. Vrinda Kolte Dr. Anup Garg VSPM’S Dental College Nagpur Abstract Background/Introduction Peripheral nerve block is a common regional anesthetic technique and is used for broad spectrum of surgical, interventional or diagnostic procedures. Various adjuvant to increase the duration of block are describe in literature. The aim of prolonging the duration of block to treat post operative pain is a key issue in regional anesthesia. Objectives To evaluate and compare the effect of 1.8ml ropivacaine 0.5% and 1.8ml lidocaine 2% with adrenaline 1:200,000 in infra orbital nerve block on – 1. Onset of action 2. Duration of action. Methods • 50 patients will be divided in 2 groups wherein, Group A –Lidocaine group Group B- Ropivacaine group • Both the groups will be evaluated for pain based on VAS and VRS. • Onset- will be calculated from the point of retrieval of needle till the first sensation of numbness • Duration of action- From complete loss of sensation till response to prick of probe.

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Results Awaited. Conclusions Awaited.

Section: Miscellaneous

EPS00838 Use of Endoscopy in Oral and Maxillofacial Surgery

Dr. Reethu. M.S

EPS0044 Dermal Fillers

Rajarajeswari Dental College and Hospital Dr. Monisha Uday H Rajarajeshwari Dental College and Hospital, Bangalore Abstract Background/Introduction The Endoscope has been described as an extra set of eyes and is the basis for innovation across multiple surgical disciplines and the fabrication of a new class of instruments and surgical techniques. The versatility of the endoscope enables the surgeon to deliver a better and improved quality of treatment as a result of efficient evaluation of internal structures. Some surgical procedures may also be completed with less morbidity and, perhaps, with a greater margin of safety (i.e. avoiding technical error) with the use of and endoscope. Increasingly, more endoscopic procedures are being described in the craniomaxillofacial region. Decreased complication rates, comparable success rates, diverse functionality, and efficiency make the endoscope a helpful instrument in a surgeon’s armamentarium. The aim of the poster is to discuss the use of endoscopic techniques for the treatment of craniomaxillofacial trauma, craniofacial deformities, obstructive salivary gland disease, maxillary sinus disorders trigeminal nerve injury and temporomandibular joint (TMJ) disorders. Objectives To discuss the benefits, advantages and disadvantages of Endoscopy techniques. Methods Review of Articles of the past 20years on Endoscopy in Oral and Maxillofacial Surgery. Results The use of this unique tool has been described in a wide range of surgical treatments, including fractures and orbital, frontal sinus, and other maxillofacial injuries. It is also used in orthognathic procedures. The adjunctive include sialoendoscopy for obstructive salivary gland diseases, arthroscopy, TMJ surgery and removal of foreign bodies. Conclusions The oral and maxillofacial surgeons are finding advantages and new applications for endoscopically assisted maxillofacial surgical procedures. Decreased complication rates, comparable success rates, diverse functionality, and efficiency make the endoscope a helpful instrument in a surgeon’s armamentarium.

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Abstract Background/Introduction Dermal fillers plays important role in macro esthetic profile of patient that focuses on overall facial appearance of patient. Filling agents for soft tissue augmentation procedures are now widely available based on the long standing successful track records it has wide applications in facial deformities, lip enhancement, depressed scars, facial folds, it is injected into the skin to help fill in facial wrinkles, restoring a smoother appearance and play an important role in soft tissue augmentation. Objectives The ultimate goal of dermal fillers is to smooth out wrinkles and folds, even out scars, volumize furrows and sunken valleys, contour unevenness and laxity, and sculpt skin into a rejuvenated look. Methods Dermal filler is an injectable cosmetic filler. Types of dermal fillers include tissue derived and synthetic derived. These materials have included injectable Bovine collagen, autologous collagen, autologous fat, hyaluronic acid derivatives, allogenic and synthetic Products, recombinant human collagen. Results Selection of dermal fillers include immunological safety long term benefits efficiency, cost practicality, fillers persists for long duration, painless, non toxic, non carcinogenic. Conclusions It has given the widespread popularity of soft tissue augmentation and the ever present need to develop safer fillers that last longer than the current products.

EPS0049 Transoral Robotic Surgery in Head and Neck Cancer Dr. Swati Sahu New Horizon Dental Collage & Research Institute; Bilaspur (CG) Abstract Background/Introduction The evolution of surgical oncologic technology has moved toward reducing patient morbidity without compromising oncologic resection. In head and neck surgery, organ-preserving techniques have paved the way for the development of transoral techniques that remove tumors of the upper aerodigestive tract without external incisions and potentially spare the patient adjuvant treatment. Objectives To review the published clinical data in Telerobotic Head and Neck surgery, evaluate the benefit of existing clinical applications and identify areas for potential development. Methods A qualitative review was performed of publications in PubMed, Medline identified from the following keyword searches: Telerobotic/ Robotic ENT, Otorhinolaryngology, Head and Neck surgery.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Results Clinical benefits include avoidance or dose reduction of adjuvant chemoradiotherapy and improved swallow function. The primary clinical advantage of robotic-assisted neck surgery is the avoidance of a neck scar. Conclusions The primary outcomes of robotic surgery in the head and neck region demonstrate good disease control, quick postoperative functional recovery and low surgical morbidity. However, definitive recommendations for the application of robotic surgical systems will require more well-designed studies and technical modifications in current surgical robots and in the future.

EPS0071 Obstructive Sleep Apnea–Assessment & Management Dr. Soumendu Karak K.D. Dental College, Mathura Abstract Background/Introduction Obstructive sleep apnoea (OSA) is caused by a complete or partial obstruction of airway during sleep resulting in sleep disturbance & day time somnolence. Untreated OSA may excerbate diseases & has been associated with diabetes, cardiovascular morbidity & mortality. Objectives Knowledge of facial growth & development will provide successful treatment for patients with OSA. Once properly diagnose, several treatment modalities are available that leads to successful improvement in both patient subjective & objective assessment. Methods Depend upon situation continuous positive airway pressure (CPAP); tongue stabilizing appliance; geroge gauze appliance; uvulopharyngoplasty (UVPP); genial advancement with or without hyoid suspension;maxillomandibular advancement (MMA) are choice of treatment according to American Association of Sleep Apnoea. Results Though polysomnographic result is satisfactory, both the conservative and surgical methods having some limitation & potential side effect like dental changes, skeletal changes, temporary and permanent neurosensory changes etc. Conclusions Successful control of OSA by multidisciplinary clinical team not only improve patient life style but also it reduce subsequent risk factor for diabetes, hypertension, heart attack, stroke, arrhythmia and premature death.

EPS00109 Odontogenic Infections Dr Dhwani Govindbhai Ranveria, Guided By-Dr Nimisha Desai Karnavati School of Dentistry, Uvarsad, Gandhinagar Abstract Background/Introduction An odontogenic infection is caused by dental caries, deep fillings or failed root canal treatment, pericoronitis and periodontal disease. The course of infection depends on the virulence of the bacteria, host resistance factors, and the regional anatomy. The periapical infection

S235 is the most common form and is caused by invasion of the root canal system by microorganisms. Pericoronitis is another common cause. Objectives The discoveries of antibiotics are encouraging trends towards conquest of the microbial infection. Methods This study emphasizes the detection of pathogenic microorganisms by microbiological examination and culture of specimens representative of the infection, importance of early and correct diagnosis of infections, prompt treatment and supportive care. Results The age group most commonly involved was in the third and fourth decades of life. Extraction followed by incision and drainage was done. The most commonly involved space was submandibular followed by buccal space. Conclusions Amoxicillin and Clavulanic acid combination performed better, as 100 % strains were sensitive to it. The results of this study saw a changing trend in terms of predominance of anaerobic bacteria over aerobic ones. Dental infections can be treated by elimination of the primary source of infection with antibiotics as adjunctive therapy.

EPS00114 Access Osteotomy in Maxillofacial Skeleton Maj S Jayanth Perumal Army Dental Centre (R&R) Abstract Background/Introduction Surgical management of malignancies and pathologies requires resection of the primary lesion with a safe margins and adequate access poses a challenge to the operating team. Access to even the most inaccessible sites of craniomaxillofacial region can be achieved by using techniques and combination of osteotomies. Objectives To review the surgical accesses that aid in removal of inaccessible tumors and treatment of various pathologies of head and neck region with a series of 09 cases operated in the Department of Oral and Maxillofacial Surgery, Army Dental Centre (R&R) from Jun 2014Jun 2017. Methods Three cases of juvenile nasoangiofibroma were operated through transfacial approach with maxillary swing and one case was operated through a transoral approach using a Le Fort I osteotomy. One case of orbital floor tumor was approached through transfacial approach with an osteotomy on the infraorbital rim only. One case of SCC of the base of the tongue, two cases of odontoidectomy and one case of SOL of posterior pharynx were approached with a lip-split mandibular osteotomy and mandibular swing. Results Six out of nine cases developed paraesthesia along the distribution of sensory nerve. No occlusal discrepancy, neuromotor deficit or any other significant long term complications encountered. Conclusions Surgical access is the primary difficulty in resection of inaccessible tumors and pathologies of craniofacial region. Multiple techniques and combination of osteotomies have been employed to facilitate the access but the appropriate surgical approach must be selected considering the size, location of the tumor and extension into adjacent structures.

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EPS00115 Evaluation of Placement Accuracy and Angulation of Dental Implant Using Indegenious Stent.: An In Vivo and Vitro Study G. Karthik Rajan Sri Ramakrishna Dental College and Hospital Abstract Background/Introduction Implant dentistry has evolved into the main stream of restorative practices all over the world. When performing an implant surgery it is crucial to place implants in optimal position as on prosthetic rehabilitation plan. A surgical stent is essential for correct placement of implant during surgery, even with surgical stent the implant placement is not always as intended as there are iatrogenic errors. To eliminate such discrepancies, an extra component with the surgical stent has been designed at the same time, an attempt is made to access the bone width using a Intraoral radiographic horizontal and vertical positioner. Objectives To evaluate the guide drill accuracy on planned angulation (coronally and sagittally). Methods Alloplastic maxilla and mandible are going to be used to assess radiographic positioner and surgical stent for determination of bone width and final implant position. The results are going to be compared in patients with implant prosthetic rehabilitation. Results The results acheived on the alloplastic models was the determined angulations, the results were clinical carried out on patients and the finial outcome was acheived for the determined angulation. Conclusions Thus this study proves that not a much complicated stent is required for the placement of implant in the determined angulation. The placement of abutment can be a straight one.

ABS00132 Autologus Blood Injection in Chronic TMJ Subluxation Dr. Sonal Anchlia, Dr Vikash, Dr Hardi, Dr Philip Abstract Background/Introduction Temporomandibular joint (TMJ) Subluxation is excessive forward movement of the condyle beyond the articular eminence with complete separation of the articular surfaces. Objectives This study was conducted to assess the role of Arthrocentesis followed by Autologous blood injection to the TMJ in the treatment of chronic recurrent TMJ subluxation. Methods Sixteen patients with bilateral/Unilateral Chronic recurrent Condylar Subluxation were included in the study. Arthrocentesis using a single puncture was performed on each patient, followed by injection of 2 ml autologous blood into the superior joint compartment and 1 ml into the joint capsule. Patients with MRI findings suggestive of articular disc degenerative changes were excluded. All patients were assessed in terms of total mouth opening, deviation while mouth opening, pain according to VAS scale, clicking and grinding sound while mouth

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 opening, range of lateral excursion, duration of subluxation episodes, previous treatment taken, deleterious habits, psychological issues, OPG and MRI findings. Results All 16 patients had a successful outcome with reduction in average mouth opening of 14.4 mm and no further episodes of dislocation, reduction in pain of mean VAS 4, reduction in deviation in mandible of average 3 mm and absence of clicking sound, thus requiring no further treatment at their 1-year follow-up. Post treatment OPG showed that condylar head was within normal relation to the glenoid fossa in its new position. Conclusions Autologous blood injection along with Arthrocentesis is a safe, simple, and effective treatment for patients with chronic recurrent TMJ Subluxation.

EPS00137 Mesenchymal Stem Cells: The Regenerative Medicine in Oral and Maxillofacial Surgery Dr Vishnuraj R, Dr A.K. Adhyapok, Dr Subhas Ch. Debnath Regional Dental College Assam Abstract Background/Introduction Regenerative medicine is an emerging field of biotechnology that combine various aspects of medicine, cell and molecular biology, material science and bioengineering in order to regenerate, repair and replace tissue. The oral and maxillofacial surgery have a role in the treatment of traumatic and degenerative diseases that leads to tissue loss. To rehabilitate these minuses, techniques have been improved over time. Since 1990 growth factors, platelet concentrates, biomaterials, scaffolds and autologous tissues serve these purposes in oral and maxillofacial surgery. The frontier of regenerative medicine is represented by the mesenchymal stem cells (MSCs). With increasingly sophisticated technology to support MSCs manipulation, they are undoubtedly the future of regenerative medicine and they are showing perceptives unimaginable just a few years ago. Oral cavity turned out to be an important source of MSCs with the advantage to be easily accessible to the surgeon thus avoiding to increase the morbidity of the patient. Objectives To investigate the role of MSCs in clinical practice for bone regeneration, documenting the state of art and indentifying future research directions. Methods A search of the literature was performed using the key words ‘‘MSC and bone regeneration’’ and data was collected based on the recent articles. Results MSCs represent an exciting and promising stem cell population for regeneration of bone in skeletal diseases, especially when tissue engineering or biomaterials are applied. Conclusions The future is the regeneration of whole organs or biological systems consisting of many different tissues, starting from an initial stems cell line, perhaps using innovative scaffolds together with the nanoengineering of biological tissues.

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EPS00141 Awareness of Organ Donation Among Dental and Medical Students and Practitioners in and Around Melmaruvathur Dr. S. Duraimurugan Adhiparasakthi Dental College & Hospital Abstract Background/Introduction Transplantation is defined as the transfer (engraftment) of human cells, tissues or organs from a donor to recipient with an aim of restoring function(s) in the body. On December 23rd, 1954, the first organ transplantation was carried out in the history of surgery and it is one of the most important findings in the field of transplantation. A kidney was transplanted between two identical twin brothers Richard & Ronald Herrick by Dr. Joseph Hume at Brighton, Birmingham for which the operating surgeon received the noble prize. Since then we have come a long way to reach our present state. But in almost every country the number of willing organ donors falls short of the number of people on the waiting list by many thousands. Asian countries in particular have significant disparity between the number of waiting organ recipients and willing organ donors. The main reason for this disparity is the non-willingness of individuals for organ donation. Many factors must be taken into account when studying the knowledge and attitudes of people towards organ donation. A variety of factors influence these attitudes towards organ donation and these factors vary greatly with geographic location, education level and other factors. As health care personnel we remain one of the most reliable sources for general population to get information about a relatively safe procedure. But, before we impart knowledge, we ourselves must be thoroughly informed about organ donation. Basic information on procedures, pros and cons and the ethical issues involving organ donation should be included in the dental and medical undergraduate curriculum, so that future doctors can become informed advocates. Objectives This study aims to determine the knowledge, attitude and practices towards organ donation amongst the Students & Staff members of Adhiparasakthi Dental College & Hospital, Melmaruvathur & Melmaruvathur Adhiparasakthi Institute of Medical Sciences & Research, Melmaruvathur and the variation amongst the study population and determination of the factors that cause the variation. Methods A cross sectional questionnaire based study was conducted amongst the students and staff members of Adhiparasakthi Dental College & Hospital, Melmaruvathur & Melmaruvathur Adhiparasakthi Institute of Medical Sciences, Melmaruvathur. The study sample comprised of undergraduate & postgraduate dental students and the staff members from the dental college. From the medical college, samples were collected from the undergraduate students and the staff members. Anonymity and confidentiality of respondents were maintained and participation was voluntary. A 39 item self-administered questionnaire was developed based on previous studies (2, 5, 7–10). The questionnaire comprised of four sections. The first section of the questionnaire gathered the demographic details from the students, which included age, gender, year of study, religion and parents education level. The remaining three sections consisted of questions to judge the knowledge, attitude and practices of the individuals towards organ donation. Some questions were based on the dichotomous scale whereas other questions were based on a four point likert scale. After obtaining permission from the higher authorities the questionnaires were distributed to the students during lecture classes. The

S237 participants were instructed not to discuss with one another to avoid the possibility of a bias or a confounding factor. Only questionnaires which were fully completed were included in the study. Once the questionnaires were completed the data was compiled into a Microsoft Excel spreadsheet and the Statistical Analysis was carried out using IBM SPSS for Microsoft Windows version 23. Correlation between knowledge, attitude and practice scores was calculated by Pearson’s correlation coefficient. A p value. Results A total of 750 questionnaires were handed out to the undergraduate students, postgraduate students and the staff members of Adhiparasakthi Dental College & Hospital and Melmaruvathur Adhiparasakthi Institute of Medical Sciences. 619 questionnaires were collected back after completion. The response rate was 82.53 %. The remaining questionnaires were either incomplete or the individuals were not willing to participate in the study due to varied reasons. Out of the 619 participants 68. 49 % belonged to Adhiparasakthi Dental College & Hospital (n = 424) and 31. 51 % belonged to Melmaruvathur Adhiparasakthi Institute of Medical Sciences (n = 195). In Adhiparasakthi Dental College & Hospital 86 participants belonged to the first year, 94 belonged to the second year, 84 belonged to the third year, 99 belonged to the fourth year and 61 were from the Compulsory Rotary Internship. In Melmaruvathur Adhiparasakthi Dental College & Hospital, 133 belonged to the first year, 55 belonged to the final year and 7 were from the Compulsory Rotary Internship. The study population comprised of 31. 3 % of males (n = 194) and 68.7 % of females (n = 425). The mean age was 19.3 years with a standard deviation of ±2.1 years. Out of the 619 individuals, 18. 9 % were 17 years of age (n = 117), 29. 4 % were 18 years of age (n = 182), 9 % were 19 years of age (9.0 %), 12. 6 % were 20 years of age (n = 78), 16. 3 % were 21 years of age (n = 101), 9. 9 % were 22 years of age (n = 61), 2. 6 % were 23 years of age (n = 16) and 1. 4 % were 24 years of age and above (n = 8). Conclusions The knowledge, attitudes and practices of the medical and dental students towards organ donation can be greatly improved by increasing the knowledge amongst the students. Education about organ donation is the first step whereas the other steps which must be taken are education about various government and private organizations for organ donation. If these steps are implemented the disparity between the donors and the recipients may be curbed.

EPS00147 Obstructive Sleep Apnea Prof. Dr. A. Thangavelu, Mds, Dnb, Dr. R. Amirthaa Varshini Rajah Muthiah Dental College and Hospital Abstract Background/Introduction Obese Patients Complaining Of Snoring And Disturbed Sleep. Objectives Reduction In Snoring And Apenic Episodes Affecting Sleep. Methods Anterior Mandible Box Osteotomy With Debulking Of Tongue. Results Improvement Clinically And With Regards To Ahi Index. Conclusions Long Term Follow Up Under Progress At Present Patients Are Symptom Free.

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EPS00164 Platelet Rich Plasma a Treatment Modality for Androgenic Alopecia

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 remnant roots, and concomitant regenerative therapy showed preliminary favorable outcomes. However, wider application of this technique for longer following up periods is required for further conclusive recommendations.

G. Satya Vani Government Dental College, Vjayawada Abstract Background/Introduction Alopecia is a medical terminology which Is used for various types of hair loss like androgenic alopecia areata. Cicatrical alopecia, trichotillomania, traction alopecia. PRP become a newer modality for treatment of androgenic alopecia. The pivotal discovery of PDGF in promoting wound healing, angiogenesis and tissue remodelling threw light on this novel autologous therapeutic modality. PRP is a concentration of multiple Growth promoting factors by virtue platelet alone and plasma protein, fibrin and fibronectin. This PRP works in a multipronged manner serving as an elixir for hair growth and improving overall environment. PRP is a promising therapeutic modality. Objectives To provide an overview of platelet-rich plasma (PRP) injected into the scalp for the management of androgenic alopecia. Methods A literature review was performed to evaluate the benefits of PRP in androgenic alopecia. Results In general, PRP showed a benefit on patients with androgenic alopecia, including increased hair density and quality. Conclusions PRP injection is a simple, cost effective and feasible treatment option for androgenic alopecia, with high overall patient satisfaction.

EPS00166 Immediate Dental Implants DR Deepak Sharma MPCD&RC Abstract Background/Introduction Immediate implant insertion in extraction sockets raises a series of challenges for clinicians. Objectives This preliminary study demonstrates the use of a modified insertion technique of implant placement at the time of extraction. Methods a sulcular buccal incision with releasing periosteal incisions were made around the site to be replaced, and implant insertion into the interseptal/interradicular bone was performed. The remnants of roots were atraumatically extracted, and the bony defects around the implant were grafted with synthetic resorbable bone substitute ˆI2Tricalcium phosphate, and the flap was sutured. Results The modified insertion technique followed showed an implant survival rate of 100 %. Conclusions The combination of immediate implant placement with engagement of the interseptal/interradicular bone, atraumatic extraction of

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EPS00167 Piezoelectric Surgery in Oral and Maxillofacial Surgery Bhart Vashishat, Gaurav Singh, Amit Gaur Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow Abstract Background/Introduction Piezoelectric bone surgery is a minimally invasive technique, its physical and mechanical properties have several clinical advantages: precise cutting with micron sensitivity without the generation of heat, and it also lessens the risk of damage to surrounding soft tissues and important structures such as nerves, vessels and mucosa by selective cutting of bone and better visualisation of the surgical field. This technique also reduces the damage to osteocytes and permits good survival of bony cells during harvesting of bone and it seems to be more efficient in the first phases of bony healing, it induces an earlier increase in bone morphogenetic proteins, controls the inflammatory process better, and stimulates remodelling of bone with greater pace. Objectives To describe various applications of piezoelectric surgical device in the field of oral and maxillofacial surgery. Methods Over the past two decades, an increasing amount of literature has shown that piezoelectric devices are innovative tools and that there is extensive indication of their use in oral and maxillofacial surgery. Specific oral surgery indications include - bone graft harvesting, corticotomy, bone biopsy, implant site preparation, sinus augmentation surgery, distraction osteogenesis, ridge expansion, endodontic surgery, inferior alveolar nerve transposition, cyst removal and dental extraction-mainly impacted teeth, orthognathic and reconstructive surgery, surgically assisted rapid maxillary expansion, removal of osteosynthetic materials. Results Piezosurgery produces micro-vibrations and reduced noise, in contrast to the conventional surgical saw or rotary bur. Micro-vibration and reduced noise minimise a patientTMs psychological stress and fear during osteotomy under local anaesthesia. Conclusions Piezoelectric surgery is an innovative ultrasonic technique for safe and effective osteotomy or osteoplasty compared with traditional methods that use rotating or mechanical instruments. It provides extreme precision on micrometric cutting, safety as well as great control on the surgical site. Moreover, the device causes minimal bleeding during and after the operative procedure and the healing process is shorter. Limitations are- slightly longer operating time for osteotomies than with traditional saws and large initial costs.

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EPS00168 Salivary Pacemakers: Neuroelectrical Stimulation of Salivary Gland in Xerostomia Patients Dr. Mercy Kamatam Government Dental College and Hospital, Vijayawada Abstract Background/Introduction Xerostomia is a symptom of oral dryness that occurs when salivary flow is not sufficient to compensate the fluid loss from the oral cavity. Objectives The objective of this review is to present the advances of neuroelectrical stimulation for the treatment of xerostomia based on the accumulated knowledge of neurological control of salivary secretion. Methods Neuro-electrical stimulator or salivary pacemakers are miniature intra oral device that increase the salivation by means of stimulating the salivary reflex arch. There are three generations of salivary pacemakers. Results Frst generation led to an immediate (direct) response (increase of salivation as a result of the stimulation) and a cumulative long-term (indirect) response (sustained increase of basal salivary flow rate) as well as subjective improvement in symptomatic xerostomia. Second generation was effective during application and up to 10 min after its removal and third generation results are the most convenient and safe means to treat xerostomia. Conclusions Neuro electrical stimulation offers a new non pharmacological method of treatment which overtakes the relevant role in therapeutic stimulation salivation for the patients requiring long term therapy.

EPS00172 Comparison of Clinical Profile of Odontogenic Space Infection Between Diabetic and Non Diabetic Patients Sreejith S

S239 involvement. To assess the difference in outcomes of odontogenic space infections. To assess the differences in disease progression of odontogenic space infections between non-diabetic, controlled diabetic and uncontrolled diabetic patients. Methods Cross sectional study conducted over a period of 20 months, from January 2013 to August 2014. Inclusion criteria includes patients with maxillofacial space infections of odontogenic origin, patients with age group 14 years or above. Exclusion criteria includes maxillofacial space infections of non odontogenic origin. Eg; salivary gland infections, malignancy, upper respiratory tract infection etc. Odontogenic infections without maxillofacial space involvement. Eg; apical periodontitis, periapical abscess etc. Patients with any other cause of immunosuppresion. Eg; HIV, steroid medication etc. Results Out of 175 patients 113 (64%)-non-diabetic 62 (46%)-diabetic. 26 (15%)-controlled diabetes 36 (21%)-uncontrolled diabetes Primary space involvement. Out of 175 patients, 26 patients (14.9%) had no primary space involvement Secondary spaces 83 patients (47.4%) had secondary space involvement. Culture-sensitivity and gram staining 89 cultures showed sterile or no growth 86 positive cultures- 65 cultures were gram positive and 21 cultures were gram negative 59 patients had streptococci infection 21 had klebsiella infection. 5 patients were infected by other gram positive bacteria staphylococci and enterococci 1 patient showed candidial growth in the culture. Conclusions Within the limits of the study, the following conclusions are drawn from the study: The patients with odontogenic space infections belonging to diabetic groups (both controlled and uncontrolled) more frequently have multiple teeth involvement, multiple primary space involvement, multiple secondary space involvement as compared to non-diabetic patients which can be attributed to old age and poor periodontal status in diabetic patients. Streptococci remain to be the most commonly associated microorganism with odontogenic space infection, both overall and in non-diabetic patients. But diabetic patients are more frequently have infection predominated by gram negative bacteria especially, Klebsiella sp.

EPS00180 Ridge Augmentation with Symphysial Graft: A Case Report

Government Dental College Kottayam Abstract Background/Introduction Odontogenic infections are one of the most common diseases in the oral and maxillofacial region The infections generally spread via path of least resistance through connective tissue and along fascial plane. There are different types of spaces in and around oral and maxillofacial region classified based on anatomical landmarks and boundaries. Primary spaces and Secondary spaces. Patients with systemic diseases like diabetes are more susceptible to infectionsowing to compromised neutrophil adherence, chemotaxis, phagocytosis, bactericidal activity and cell-mediated immunity. So this study was formulated to—Understand the differences in pattern of disease progression in diabetic and non-diabetic patients and to assess if a more aggressive treatment approach is needed to treat diabetic patients with odontogenic space infections. Objectives To compare the disease progression, space involvement, complications and outcome of odontogenic space infections between nondiabetic, controlled diabetic and uncontrolled diabetic patients. To evaluate difference in pattern of the primary and secondary space

Dr. Sanjana Sethi Bharati Vidyapeeth Dental College and Hosptal, Pune Abstract Background/Introduction Alveolar ridge resorption after the tooth loss due to trauma in anterior region is a common phenomenon which alters the size and shape of the ridge. The demand of osseointegrated implants to replace missing teeth which is mostly avoided due to the deficiency of bone, despite of many recent advances the use of autogenous bone graft is the solution for the best outcome. The mandibular symphysis (chin graft) is a favourable donor site as it has an excellent risk benefit ratio. This prepares the alveolar bone volume both vertically and laterally for the implant to be placed. Bone harvested from the mandibular symphysis is mainly cortical in nature, allowing application of rigid fixation in situ and thus providing good primary stability. These grafts can be easily carved to intimately fill in defects and provide good alveolar contour. In our case we have used chin graft in the region of 11, 12 and the result has been very good.

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S240 Objectives To evaluate the bone changes after the rigde transformation post grafting. Methods Osteotomies were performed in a monocortical fashion, 5 mm anterior to the mental foramen, cephalad to the inferior border of the mandible, caudal to the expected position of the apices of the anterior teeth, and at the midline. The size of the corticocancellous block was then measured. Results Healed uneventfully without wound dehiscence, paresthesia, or lip droop. Sufficient bone was obtained for ridge augmentation with eventual implant placement. Conclusions The thick cortical layer of the transplant prevents or reduces resorption and the cancellous part help to fasten the regeneration. It does not produce immune reactions and are incorporated by osteoclastic resorption with a shorter healing period compared with other methods of osseous repair.

EPS00183 Human Dentin as Novel Biomaterial for Bone Regeneration Ritu K Patel KSD Abstract Background/Introduction Although autogenous bone is considered the gold standard among graft materials, donor site morbidity may be an associated problem. Structure and composition of dentin is similar to the bone. Dentin is thought to have a high osteoconductivity and osteoinductivity. In some patients, tooth extraction is required before dental implant treatment. It would be beneficial if extracted teeth could be utilized as autogenous grafting material. Objectives The aim of this study is to examine the efficacy and safety of Autogenous partially demineralized dentin matrix (APDDM) prepared onsite, for clinical application in bone regeneration procedures in oral and maxillofacial surgery. Methods APDDM is transplanted in bone regeneration procedures related to implant dentistry including socket preservation, alveolar ridge augmentation, and maxillary sinus floor augmentation. Results There are no systemic or local complications in any of the cases, and oral rehabilitation using dental implants is successful in all cases for at least 2 years after attachment of the suprastructure. Conclusions APDDM, is an efficient, safe, and reasonable bone substitute. Consequently, this material has the potential to become one of the options as a bone substitute in implant dentistry.

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EPS00189 Treatment Options in Trigeminal Neuralgia Naveen Kumar Jain Government Dental College, Trivandrum Abstract Background/Introduction Trigeminal neuralgia (TN) is defined by the International Headache Society (IHS) as ‘‘unilateral disorder characterized by brief electric shock-like pains, abrupt in onset and termination, and limited to the distribution of one or more divisions of the trigeminal nerve’’ [International Headache Society, 2004]. The IHS suggests a classification of TN as either classic (essential or idiopathic) TN (CTN) or symptomatic TN (STN; pain indistinguishable from that of CTN, but caused by a demonstrable structural lesion other than vascular compression). The diagnosis of CTN requires the absence of a clinically evident neurological deficit. CTN starts in the second or third divisions, affecting the cheek or the chin [International Headache Society, 2004]. The ophthalmic division alone is involved in less than 5% of cases [De Simone et al. 2005]. The single attack generally lasts from less than a seconds, patient may clutch the hand over face and experience severe lancinating pain associated with spasmodic contraction of facial muscles during attacks. Objectives Review of Treatment options for management of Trigeminal neuralgia. Methods Review Of Literature. Results Medical Management Superior To Surgical Management. Conclusions It is advisable to treat first with medical management and if patient not respond to it then only surgical options is opted.

EPS00200 Stem Cell Therapy ‘‘A New Revolt in Maxillofacial Practice’’ Naveen Nandagopal Govt Dental College Kottayam Abstract Background/Introduction Stem cells are unique type of cells having specialized capacity for self-renewal and potency, can give rise to one and sometimes many different cell types. Stemcell therapy involves manipulation of the cells in vitro and using for therapeutic purposes. The possible applications of stem cells are replacement and repair of tissues and organs. Replacement of oromaxillofacialstructure is difficult, because functions suchas facialexpression, articulation, chewing, and swallowing are delicate and made of a complex anatomical structure with soft and hard tissues. Stem cells, biomimetic materials, and growth factors are essential toform these three-dimensional structures. Regeneration of

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 oral and maxillofacial structures can be carried out using stem celltherapy that has gained momentum in future. Objectives The poster shortly review the available literatures on stem cell regarding their properties, types and its advantages and also aims to discuss the possibilities of stem cell therapy in oral and maxillofacial region and its recentadvances till today. Methods Here we used relevant articles written in English from the basics of stem cells till its recent advances. Results Stem cells can be useful in the regeneration of bone, PDL, soft tissues of oral and maxillofacial region and to correct large craniofacial defects due to cyst enucleation, tumor resection, and trauma. Stem cells in maxillofacial region can replace the common technique of transfer of tissue by not having its disadvantages. Conclusions The future dentistry will be more of regenerative based, where patients can use his own cells to treat diseases. Stem cell therapy has got a paramount role as a future treatment modality in maxillofacial region. Stem cells should be differentiated to the appropriate cell types before they can be used clinically, otherwise lead to deleterious effects, so it should be very carefully analyzed. Longer patient followup is needed to study the life time of regenerated tissue.

EPS00203 Knowledge, Attitude, and Practice of Needle Stick and Sharps Injuries Among Dental Professionals Of Pimpri- Chinchwad Dr. Sanyukta Sanjay Raut

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EPS00204 Transoral Robotic Surgery (TORS) Dr. Shivani Savarkar/Dr. Ramdas Balakrishna K.L.E. Society’s Institute of Dental Sciences, Bangalore Abstract Background/Introduction TORS is a recent biomedical engineering advancement that features use of a surgical robot. Currently, the ‘‘da Vinci system’’ is being used that allows precise removal of tumors of oral cavity, pharynx, parapharynx and larynx. Objectives Literature review of Transoral Robotic Surgery (TORS). Methods Literature search and review including online published articles (Pubmed search). Results A minimally invasive technique can be employed, since a magnified image of the surgical site with improved surgical access are feasible. Complete eradication of primary tumor and involved lymph nodes is facilitated, along with postoperative preservation of airway and swallowing. Reduction in pain and infection along with rapid recovery can be expected. Few drawbacks include expensive equipment, lack of sensory tactile sensation, and longer operating times. Conclusions Better functional, cosmetic and oncological outcomes with lesser morbidity can be expected with TORS. This may obviate the need for radical procedures like mandibulotomy, suprahyoid or lateral pharyngotomy, chemoradiation etc., for otherwise inaccessible tumors. But, more prospective trials and long-term follow-ups are needed to justify this paradigm shift towards minimally invasive surgery.

Dr. D.Y. Patil Dental College and Hospital, Pimpri, Pune Abstract Background/Introduction Healthcare workers (HCWs) including dental professionals are at an occupational risk of exposure to blood-borne pathogens following needle stick injuries (NSIs) and sharps injuries (SIs). A thorough understanding of the safe practices while handling sharps is crucial for HCWs. Objectives The purpose of this study was to determine the prevalence of NSIs among the clinical dental practitioners. Methods A cross-sectional survey was conducted in May 2014 using a structured questionnaire that was administered to 540 dental professionals at Pimpri-Chinchwad to assess the knowledge, attitude, practices, and self-report information of NSIs. Results In the present study, 80% of dental professionals had knowledge about Universal Precaution Guidelines B. A total of 28.3% participants had an NSI during the previous 12 months. About 33.7% of NSIs occurred during device recapping. Most common reason for failure to report the incidents of NSIs, as declared by 21.1% of the participants, included the fear of being blamed or getting into trouble for having an NSI. Conclusions The knowledge of dental professionals on NSIs and their preventive measures are inadequate. Authors recommend thorough training on Universal Precaution Guidelines, protocols regarding post-exposure prophylaxis, and safety devices to prevent such injuries.

EPS00208 PRP from Socket to Scalp: Our Experience Dr Sanidhya Sreenivasa KLE Institue of Dental Sciences Abstract Background/Introduction Platelet Rich Plasma (PRP) is a concentrate of platelets, with small amounts of blood and plasma. PRP is an autogenous source of fresh platelets and clotting factors; therefore, it contains multiple growth and tissue modulation factors produced by platelets or present in plasma. Objectives To evaluate the uses of PRP in various procedures in oral and maxillofacial surgery. Methods PRP is derived from the centrifugation of the patient’s own blood and it contains growth factors that influence wound healing, thereby playing an important role in tissue repairing mechanisms. We discuss the cases treated with platelet-rich plasma at our unit since 2015 in various cases like male androgenic alopecia, derma abrasion, socket preservation, wound healing etc.

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S242 Results The use of PRP in surgical practice could have beneficial outcomes, reducing bleeding and enhancing soft tissue healing and bone regeneration. Conclusions PRP is a new approach to tissue regeneration and it is becoming a valuable adjunct to promote healing in many procedures in dental and oral maxillofacial surgery.

EPS00228 Awareness of Forensic Dentistry Among Dental Students and Practitioners in and Around Kanchipuram District Dr. Veeramuthu Adhiparasakthi Dental College and Hospital Abstract Background/Introduction Forensic dentistry is a challenging and fascinating branch of forensic science that involves the application of dental sciences in the identification of decreased individuals through the comparison of antemortem and post-mortem records. Today we consider forensic odontology to be a specialized &reliable method of identification in multiple fatality individuals. The aim of this poster it to analyze the awareness, knowledge and attitude of forensic odontology among Dental students and practitioners. The important applicationof forensic odontology include identification of humans through dental records and assisting at the scene of crime. It is used in the determination of age, gender of the living or deceased and to testify as an expert witness in the court to present forensic evidence. Objectives The aim of the study is to evaluate the knowledge, attitude and practice of forensic dentistry among dental students practitioners in and around kanchipuram district. Methods A cross-sectional study was conducted in a sample of 903 dental students and practitioners in and around kanchipuram district and data was collected by means of a questionnaire. Results Our study shows 68% of knowledge is from internet and 41.4% is from book, 87.4% of people reported that it is important to know about forensic dentistry, 83.7 % report that forensic is useful in identifying criminals, 80.6% reported that it is important to maintain the clinical record of the patient, 81.5% reported that we can identify the age from forensic odontology, 78.6% people reported that DNA, finger prints and teeth can be used to identify the individuals, 50.2% reported that fragmented bodies decently, the evidences and materials for toxicological analysis, dental records are used to identify the age and gender of the person during the mass disaster, 25.4% reported comparing post and antimortam dental data for identification of individual, 50.8% reported that lip prints are study of chelioscopy, 17% of people underwent formal training, evaluating and presenting dental evidence,60% reported lip prints are unique as finger prints. Conclusions the study revealed in adequate knowledge, poor attitude and lack of practice of forensic odontology prevailing among the dental students and practitioners in and around kanchipuram district.

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EPS00234 Suprazygomatic Maxillary Nerve Block for Isolated Zygomatic Arch Fracture Reduction Dr Abin Ann Abraham Government Dental College, Kottayam Abstract Background/Introduction Pain control is an integral part of minor oral surgery and maxillary/mandibular nerve blocks have proved promising in achieving the same. Numerous methods are illustrated in the literature to produce profound regional anaesthesia and selection of the specific technique is determined, in large part, by the nature of the treatment to be provided. Complete maxillary nerve block is not commonly required because they are believed to be difficult and may be associated with complications. Literature review suggests that an extra oral technique to anesthetise the maxillary nerve via the suprazygomatic approach is more safe and efficacious. The aim of this study was to determine the effectiveness of extra oral maxillary nerve block through suprazygomatic approach from frontozygomatic angle in patients undergoing isolated zygomatic arch fracture reduction. Objectives 1. To assess the pain during zygomatic arch fracture reduction by VAS scale. 2. To assess the time required for the onset of anesthesia (subjective symptoms). 3. To assess the time needed for the onset of peak effect of anesthesia (objective symptoms). 4. To assess the inter incisal opening before and after the procedure. 5. To record the complications namely hematoma, visual disturbance or deviation of the lower jaw immediately following the injections. 6. To record the positive aspiration of blood during the injection. Methods Extra oral suprazygomatic maxillary nerve block was administered in 50 patients for reduction of isolated zygomatic arch fracture. Lidocaine 2% with 1:80000 adrenaline anesthetic solutions was used to anesthetize maxillary nerve through a 21 gauge 45 mm long needle. The following parameters were evaluated: onset of anesthesia, peak effect of anesthesia, outcome of treatment, complications and pain during arch elevation. Results The blocks were effective with majority of the patients (80 %) who reported only mild pain during the elevation of zygomatic arch fracture thus favouring the efficacy of the frontozygomatic angle approach. The subjective symptoms were reported in 9.08 minutes (mean value) and objective symptoms were reported in 13.08 minutes (mean value). Out of 50 patients, 18% had positive aspiration during injection procedure, 10% developed hematoma, 2% had temporary visual disturbance which resolved within 6 hours time and 4% developed transient facial nerve paralysis which resolved within 24 hours without any intervention. Conclusions The present study has favoured the frontozygomatic angle approach for the maxillary nerve block as a simple, safe, efficacious method associated with minimum complications.

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EPS00263 Mangement of Hemangiomas and Vascular Malformations with Percutaneous Injections of Sodium Tetradecyl Sulfate Dr. Neelakamal Hallur, Dr. Aaisha Siddiqua, Dr. Syed Zakaullah, Dr. Ashwin Shah, Dr. Chaitanya K, Dr. Shereen Fatima Al-Badar Dental College and Hospital Gulbarga Abstract Background/Introduction Hemangiomas are rarely occurring vascular tumours. These are most common tumours of infancy (10%) with F:M ratio of 3:1, 60% of these occur in head and neck. They can cause aesthetic and functional impairment, depending on location. The most common site is the upper lip but can occur on tongue, buccal mucosa and palate. Objectives To Evaluate Use Of Percutaneous Injections Of Sodium Tetradecyl Sulfate In Management Of Hemangiomas And Vascular Malformations. Methods MRI, USG, CT Angiography techniques are used as diagnostic aids. The conservative modalities for hemangioma as well as vascular malformations, Sclerotherapy is an effective method which produces endothelial damage that results in permanent endofibrosis and clinical obliteration of the vessel. Various sclerosing agents used are osmotic agents, hypertonic saline solution, detergent solutions like sodium morrhuate, ethanolamine oleate, sodium tetradecyl sulphate, polidocanol & sclerosant foam. These agents induce sclerosis on venous endothelium via interference with cell membrane lipids until either diluted or inactivated by serum surfactants. Results cases of Haemangioma’s and vascular malformations in aesthetic zone of maxillofacial region were successfully managed with sclerotherapy with sodium tetradecyl sulphate injections. Conclusions Percutaneous injection of sodium tetradecyl sulphate can be use successfully in management of Haemangioma’s and vascular malformations.

EPS00265 Management of Trigeminal Neuralgia with Cryotherapy Dr. Rifaquat Ali Career Post Graduate Institute of Dental Science and Hospital, Lucknow Abstract Background/Introduction trigeminal neuralgia is also called as tic doulourex was first explained by ARATEUS. Trigeminal is the most common orofacial painful under neuralgia and is among the most painful conditions in orofacial pain. Females are more commonly affected than male. Lloyed et al.(1976) introduced cryotherapy of trigeminal neuralgia. Cryotherapy when performed leads to necrosis of the affected nerve branch.

S243 Objectives to describe and evaluation of clinical presentation of trigeminal neuralgia and treatment planning, and patient needful treatment. Methods the case with diagnosis of trigeminal neuralgia was selected and treated by cryotherapy with ablation nerve branch, and patient was followed on regular interval. Results the patient was followed for long period and was asymptomatic. Conclusions cryotherapy is an important asset in treatment of trigeminal neuralgia. It is a very simple, reversible, reliable and repeatable procedure with no mortality and with a negligible and transient morbidity.

EPS00309 Tooth Derived Bone Graft for Alveolar Ridge Preservation: A Case Series Dr Nirav Patel Narsinhbhai Patel Dental Collage and Hospital, Visnagar, Gujarat Abstract Background/Introduction Alveolar ridge resorption is inevitable in all post extraction cases. Retaining its shape & size is needed for prosthetic rehabilitation in aesthetic and functional position. It can be achieved by ridge preservation through modified extraction technique and use of autogenic or allogenic graft materials. Autogenous bone graft is still considered the gold standard, in spite of the need for harvesting bone and possible surgical morbidity. Objectives It is well-know that jawbones, alveolar bone, and teeth develop from cells of the neural crest and many proteins are common in formation of bone, dentin, and cementum. Dentin and bone having same biochemical similarities led to the idea of using it as a bone regeneration material. In this graft dentin, which comprises more than 85% of hydroxyapatite, can serve as native bone grafting material. Recently, several studies have reported that extracted teeth, which undergo a process of cleaning, grinding, demineralization, and sterilization, can be a very effective bone graft to fill alveolar bone defects. Methods A total of 4 graft sites in 2 patients were included in this study. A alveolar bone augmentation immediately after dental extraction. Vertical dimension of bone was measured after extraction after grafting and one week and one month follow-up. Results Infection of graft material or graft bed was not observed and graft sites healed without any notable complications. The vertical dimensions of alveolar bone increased by 5.38 mm. Conclusions Autogenous demineralized dentin matrix from extracted tooth grafted to extraction sockets for the augmentation of vertical dimension is effective method.

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EPS00314 Cardiopulmonary Cerebral Resuscitation (CPCR) Shardul Malkani Rajarajeshwari Dental College and Hospital Bangalore Abstract Background/Introduction Cessation of blood flow and ventilation constitutes cardiopulmonary arrest (CPA) that leads to inadequate oxygen and nutrient delivery to tissue, shock and ultimately death. Cardiopulmonary arrest is typically associated with loss of consciousness, collapse, lack of a palpable pulse, pale or cyanotic mucous membranes, lack of effective respirations, and lack of measurable blood pressure. Cardiopulmonary-cerebral resuscitation refers to re-establishing blood flow to the cerebral and coronary systems in the event of CPA by performing manual cardiac and thoracic compressions and manual ventilation until spontaneous circulation and ventilation occurs. The decision to begin CPCR has to be based on clinical signs, consideration on potential outcome and underlying disease process. Objectives To review the current concepts and to evaluate the efficacy of Cardiopulmonary cerebral Resuscitation. Methods There three phases of CPCR: 1) Basic Life Support (BLS) 2) Advanced life support (ALS) 3) Post- resuscitation care. Results The alternative CPCR demonstrated an improvement in the incidence of good recovery. Conclusions The ultimate goal of cardiopulmonary cerebral resuscitation (CPCR) is to improve long-term outcome in patients who have suffered cardiac arrest. Therefore a new protocol of CPCR has been described.

EPS00318 Platelet Rich Plasma and its Application in Oral Surgery Dr. Bhagyashree Jagtap, Dr. Kalyani Bhate

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Results The effect of platelet-derived products is considered to be effective because of the high number of platelets which contain a wide range of growth factors. It has also been observed that PRP provides a safe and effective means of speeding alveolar bone repair. Conclusions PRP is prepared from the patient’s own blood and contains growth factors that influences wound healing.

EPS00328 Bilateral Variation in Anatomic Structures of the Inferior Alveolar Neurovascular Bundle: A Cadaveric Study 1) Dr Pratik Agrawal, 2) Dr Navin Shah, 3) Dr Neel Shah K.M. Shah Dental College & Hospital, Vadodara Abstract Background/Introduction Knowledge of the variations of the mandibular nerve, its branches and communications are clinically important especially for dental surgeons to understand the effectiveness of the nerve block and complications following regional anesthesia. This study would give us a brief idea of the pattern and position of the neurovascular bundle and its implications in implantology, dentoalveolar surgeries, pre prosthetic surgeries, orthognathic surgery etc. Objectives To check variation in arrangement pattern of anatomic structures of the inferior alveolar neurovascular bundle bilaterally. Methods The study is being conducted in 10 hemi mandibles of 5 cadavers. Cadaveric dissection is carried out to carefully expose the mandibular canal and inferior alveolar neurovascular bundle bilaterally, histopathological evaluation is done and interpretation is carried out. Results As it is an ongoing study results are being awaited. Conclusions No Definitive conclusion can be made at present as it is an ongoing study, but the study will surely help in knowing the anatomical variation of Inferior alveolar neurovascular bundle.

Dr. D. Y. Patil Dental College and Hospital, Pimpri Abstract Background/Introduction Platelet-rich plasma (PRP) is a new approach in tissue regeneration and a developing area for clinicians and researchers. It is used in various surgical fields, including oral and maxillofacial surgery. It contains growth factors that influence wound healing. Of these growth factors, platelet-derived growth factor, transforming growth factor, insulin-like growth factor, and epidermal growth factor play a pivotal role in tissue repair mechanisms. Objectives To describe the different bioactive substances included in PRP and their participation in the healing process. To elucidate the different techniques and available technology for PRP preparation in human studies, to clarify risks, and to provide guidance for future research. Methods Search engines PubMed, Google Search and Institutional Library were used. Keywords used were Platelet rich Plasma, Third molar extraction, Secondary alveolar bone graft, Sinus lift procedure, Cysts in oral cavity.

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EPS00330 Difficult Airway Intubation Techniques in Oral and Maxillofacial Surgery Apurva Vivek Vaidya Terna Dental College and Hospital Navi Mumbai Abstract Background/Introduction One of the most important issues and concerns of head and neck surgery is the airway problem. The anesthesiology practice management guidelines define a difficult airway as a clinical situation in which a trained anesthesiologist experiences difficulty with face mask ventilation of the upper airway, difficulty with tracheal intubation, or both. Myriad modalities of intubation techniques exists for management of difficult airway. Each of these techniques have their own indications. Since oral and maxillofacial surgeons often face such

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situations of difficult airway, thorough knowledge of appropriate airway is extremely essential. This poster depicts difficult airway intubation techniques in oral and maxillofacial surgery.

EPS00348 Computerised Planning and Intraoperative Navigation: An in Vogue in Cranio-Maxillofacial Surgery

EPS00343 Epistaxis: The Dilemma and It’s Management

Dr. Usha

Dr Trishala B. Fernandes, Dr. Francis Akkara and Dr. Vikas Dhupar

Abstract Background/Introduction The refinements in preoperative planning for craniomaxillofacial surgery procedures have lead to major improvements in clinical outcomes. Introduction of computer aided surgery (CAS) into craniomaxillofacial surgery provides the surgeon with a highly reliable, reconstructive tool. This technique not only provides safety in surgical interventions, but also opens a broadened spectrum of possible surgical approaches. Objectives To enlighten about newer and technologically advanced computer aided surgery (CAS) which includes presurgical planning with stereolithographic models and intraoperative navigation in planning and implementation of complex cranio-maxillofacial surgeries. Methods Computer aided presurgical planning with stereolithographic models, intraoperative navigation and intraoperative CT/MRI imaging are engineered to assist in planning and implementation of complex cranio-maxillofacial surgeries such as complex orbital reconstruction, maxillo-mandibular reconstruction, cranial reconstruction, head and neck tumor resection, skull base surgery, craniofacial/orthognathic surgery, TMJ surgery, dental & craniofacial implantology. Results The additional precision provided by computer aided surgery (CAS) makes it a useful tool and brought it to forefront of surgical techniques and offers new opportunities in the field of craniomaxillofacial surgeries. Conclusions Preoperative computer aided design and stereolithographic modeling combined with intraoperative navigation provides a useful guide for and possibly more accurate reconstruction of a variety of complex cranio-maxillofacial deformities. Although probably not necessary for routine use, computer aided surgery is indicated for complex posttraumatic or postablative reconstruction of orbits, cranium, maxilla and mandible; total TMJ replacement; orthognathic surgery; and complex dental/craniofacial implantology.

Goa Dental College and Hospital Abstract Background/Introduction Epistaxis is one of the commonest emergencies presenting to the casualty department, initially seen by both ENT physicians and Oral Maxillofacial surgeons. Treatment strategies have been broadly similar for decades. However recently, with the evolution of endoscopic technology, new ways of actively managing epistaxis are now available. Objectives The objective of this poster is to review the different currently available treatment modalities for the management of epistaxis and to propose a comprehensive yet simple and modern algorithm of its treatment. Treatment options will be divided into medical, non-surgical interventional, and interventional options and will be described along with their advantages, disadvantages, complications and success/failure rates, Methods The traditional management of acute epistaxis includes identification of the bleeding point by using a head mirror or other light source. If a bleeding point is localised then chemical or electrocautery is performed. If unsuccessful further management takes a stepwise approach; initially anterior packing with medicated gauze or sponge and if unsuccessful, more advanced techniques such as compressive balloons or posterior nasal packing may be used. Finally, endoscopic arterial ligation or embolisation can be used to stem intractable bleeds. Results The management of epistaxis includes a wide range of strategies and treatment options. However, it is important to appreciate when to correctly employ the different individual interventions. It is also important to involve an experienced endoscopist who can intervene with endoscopic control in he ER or ESPAL in the OR. Recent literature advocates an earlier surgical intervention with ESPAL for these cases due to its simplicity, high success rate, low risks and cost effectiveness in comparison to other treatment modalities. Conclusions Over the past decade, there has been a significant increase in the options available for the management of epistaxis. Traditional strategies like nasal packing have been supplemented by modern technology using the latest optic and electrical devices. Treatment should ideally use a systematic protocol, starting with simple procedures that can be undertaken in the clinic environment and proceeding to endoscopic techniques for more difficult cases.

New Horizon Dental College & Research Institute, Bilaspur (C.G.)

EPS00352 Role of Botox-A in Temporomandibular Disorders Dr. Abhishek Sharma Subharti Dental College, Meerut Abstract Background/Introduction Temporomandibular disorders (TMD), musculoskeletal disorders of the masticatory system, are common clinical labels for pain in the orofacial area. Since myofascial pains and mouth opening limitation are the most frequent symptoms in masticatory muscle disorders, directing treatments at the muscular components of TMD could yield therapeutic gains.

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S246 Objectives The present study was conducted to evaluate the efficacy of Botulinium toxin type-A (BTX-A) therapy in patients with temporomandibular joint disorders refractory to the conservative management. To achieve this aim, the following objectives were followed in the study: 1. To clinically assess the pain in temporomandibular disorders with the help of Visual Analog Scale (VAS). 2. To clinically assess the range of mandibular motion, tenderness of the masticatory muscles, oro-facial function and facial harmony with photographic evaluation (Pre-op & Post-op). Methods This short sample study included total of 5 patients with TMD’s reported to the Department Of Oral & Maxillofacial Surgery, Subharti Dental College, Meerut. RDC/TMD (Research Diagnostic Criteria) Axis-I was used to diagnose the TMD’s. Patients who failed in noninvasive conservative therapies such as soft diet, NSAID’s, physiotherapy, oral appliances, muscle relaxants and anti-depressants were included in the study. In this procedure, patients were asked to clench their jaws to make the injection sites more prominent. Botox-A injections were given on the affected side with 25 units each to masseter and temporalis muscle region divided evenly over 5 sites in each region. Patients were followed-up for 6 months. Results Out of 5 patients in the study, 4 were benefitted from the study. The study showed a reduction in pain on Visual Analog Scale and the mouth opening was increased post Botox-A therapy. Conclusions With the positive outcomes shown from the study, clinical injections of BTX-A in masticatory musculatures of TMD patients could be considered as useful supportive treatment options for controlling complex TMDs. Although long term study with large sample size will be required to establish the role of Botox-A in TMD’s.

EPS00371 Social Media: Friend or Foe??? Dr. Vishnu. J, Junior Resident

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Conclusions This poster discusses the risks and benefits of social media and suggests that a better understanding of social media and its role in the development and practice of newly qualified maxillofacial surgeons could benefit both trainees and patients.

EPS00372 Digital Planning: Unleashing the Anatomic Truth—’A Guide to Aid’ Dr. Nambinayaki E.M., Prof. Dr. Veerabahu M. Abstract Background/Introduction The best part of dentistry at this level is transforming lives!! We live in a digital era, the struggle of which is to display the ‘ANATOMIC TRUTH’, to show the 3D anatomy both static and in function as it exists in nature. Objectives The AIM is to prove the accuracy of treating patients digitally overcoming the flaws of conventional surgical planning. Methods Standardized CBCT scanning protocol All data were stored and transferred in DICOM format Materialize software. Results The potential benefits and actual limits of an integrated 3D virtual approach for the treatment of the patient with a maxillofacial deformity are discussed comprehensively from our experience using 3D virtual treatment planning clinically. Conclusions This purpose of 3D craniofacial imaging and reconstruction is to decipher the 3D anatomic truth and treat patients with more accuracy avoiding errors due to conventional model surgery.

EPS00378 To Heal or Not to Heal: Incision Techniques

Govt. Dental College, Kozhikode Dr. Deepa R Abstract Background/Introduction Social media are part of the fabric of today’s world, from which health care is not excluded. The use of social media has greatly expanded in the last decade, with widespread use of smartphones, the internet, and other multimedia to enhance learning. There is evidence to suggest that social media has a place in healthcare education and dentistry. This poster explores the various ways social media can help, as well as hinder, the practice of dental professionalism especially in oral and maxillofacial surgery. Objectives - Explores social media and its uses in oral and maxillofacial surgery Discusses the advantages and disadvantages of social media, and how it could be used to improve learning in oral and maxillofacial surgery. - Encourages safe use of social media for all maxillofacial surgeons and dental care professional. Methods Literature review, article search and web media. Results This poster discusses the risks and benefits of social media and suggests that a better understanding of social media and its role in the development and practice of newly qualified maxillofacial surgeons could benefit both trainees and patients.

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Government Dental College, Kozhikode Abstract Background/Introduction Various devices have been introduced in recent years to achieve hemostasis with minimal tissue injury during surgery; these tools include the laser, electrosurgical devices (needle, scissor, or knife), radiofrequency needle ablation device. All of these devices use heat energy to denature protein, leading to vascular tamponade and eventual hemostasis. Objectives To find the least traumatic incision method. Methods Pub med and clinical key search. Results The disadvantage of using heat energy during surgery is lateral heating of the surgical field, leading to damaged vital structures, delayed wound healing as a result of compromised blood circulation, and increased postoperative pain caused by sensory nerve injury. The ultrasonic scalpel denatures protein by mechanically breaking the hydrogen bonds in protein molecules.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Conclusions Although all lasers cut tissue by the same process, lasers of different wavelengths have different penetration, absorption, scatter, and tissue effect based on the energy absorption by different elements within tissue. The CO2 laser, with a wavelength in the infrared region (10,600 nm), has the advantage of precisely cutting tissue with limited injury to the surrounding tissue. The limitations of laser include slow dissection, inadequate hemostasis, and uncontrolled lateral dispersion of heat resulting in tissue damage. To obviate these problems, ultrasonic energy has also been used in tissue dissection. Unlike the heatproducing devices, the ultrasonic scalpel generates much less heat from tissue friction.

EPS00386 Salivary Biosensors Nikhil Kaushal, Post Graduate Trainee Army College of Dental Sciences Abstract Background/Introduction Saliva sampling is relatively simple and the presence of various disease-signalling biomarkers in saliva has meant that it can accurately reflect normal and disease states in humans. Biosensors are small, self-contained analytical devices used for the detection and measurement of a particular substance. The most common salivary biomarkers and their biosensing mechanisms are discussed. Objectives The significance of salivary biomarkers for clinical diagnosis and therapeutic applications has been reported with additional focus on technologies and biosensing platforms for screening these biomarkers. The poster aims to increase awareness about the same. Methods Salivary Glucose, Lactate, Phosphate, Hormones, Antibodies, Enzymes are discussed briefly in the poster. Results Salivary biosensors have reported excellent sensitivity, detection limit, and response time. Conclusions Hand held salivary detectors allows portability, which in turn provides rapid point-of-care diagnosis and reduces costs which is highly beneficial characteristic especially for applications in developing countries.

EPS00387 Quantum Dots (QD): A Boon in Early Diagnosis of Oral Squamous Cell Carcinoma and Surgical Treatment Dr. Suhasis Mondal S.C.B Medical College & Hospital, Cuttack Abstract Background/Introduction Quantum dots (QDs) were developed on the interdisciplinary advancement of nanotechnology, chemistry, and optics. The unique optical properties of QDs have shown promising prospects in the personalized surgical treatment for cancer patients. QDs are nanocrystals (with a diameter of 2–10 nm) composed of elements

S247 belonging to group II–IV or group III–V. Compared with traditional fluorescence markers, QDs have narrow emission spectrum, wide excitation spectrum, high intensity of fluorescence, and good photochemical stability due to the quantum size and dielectric confinement effects. In addition, any emission spectrum from ultraviolet to nearinfrared (or from blue to red) under the same excitation wavelength of light can be obtained by changing the particle size of QDs. These optical characteristics of QDs are not possessed by any of the current fluorescent probes, including a variety of organic fluorescent dyes and fluorescent proteins. Particularly, the fluorescence of recently developed QDs with an emission of near-infrared wavelength from 700 nm to 900 nm has strong penetration in human tissues, which is extremely suitable for visible in-vivo medical imaging. Oral squamous cell carcinoma is one of the most common oral cancers. Because most oral cancers are diagnosed and treated at an advanced stage, the overall 5-year survival rate is only 50–60% presently. It has been reported that the 5-year survival rate for patients of oral cancers that are diagnosed and treated at an early stage is over 80%. Thus, early diagnosis is vital to improve patient quality of life and survival rate. Recent research has demonstrated that surface-modified QDs conjugated with membrane-penetrating polypeptides can be used in labelling various types of cells, not only rapidly and efficiently but also with no damage to the live cells. Fluorescent probes have been developed by conjugating QDs with target molecules (eg. antibodies and peptides) and have been used for in-vivo visualization of cancer cells and tumour angiogenesis, sentinel lymph node detection, and imaging of drug targeting studies. These studies have demonstrated that excellent optical properties of QDs have promising prospects in visualization of cancer development and personalized therapies. Objectives To explore the competence of near-infrared luminescent quantum dots for visual in vivo imaging on oral squamous carcinoma cells with review of literatures. Methods Yang K, Cao YA, Shi C, et al. Quantum dot-based visual in vivo imaging for oral squamous cell carcinoma in mice: The use of conjugate membrane-penetrating polypeptide-conjugated near-infrared quantum dots to label oral squamous carcinoma BcaCD885 cells through endocytosis (Qtracker QD800, Invitrogen, CA, USA). The maximum emission wavelength of the QDs is 800 nm, and a custom peptide is used to deliver QDs into the cytoplasm of live cells with no cell-type specificity. Qtracker QD800-labelled BcaCD885 cells (BcaCD885/QD800) were implanted into nude mice for in vivo imaging and the sensitivity and dynamic imaging conditions of Qtracker QD800 were investigated as a visual in vivo detection modality for BcaCD885 cells. Yang K, Li Z, Cao Y, Yu X, Mei J, et al. Effect of peptide-conjugated near-infrared fluorescent quantum dots (NIRF-QDs) on the invasion and metastasis of human tongue squamous cell carcinoma cell line Tca8113 in vitro: In this study, peptide-conjugated near-infrared fluorescent QD (QtrackerTM QD800) with a maximal emission of 800 nm are used to label human tongue squamous cell carcinoma cell line (Tca8113) through endocytosis. We then observed the proliferation, adherence and chemotaxis of the QD800-labeled Tca8003 cells. These results provided theoretical bases to reveal if the visualized tumour cells labelled by peptide-conjugated near-infrared fluorescent QDs reflected the actual genesis, development, infiltration and metastasis of tumours in vivo. Kai Yang, Fu-jun Zhang, Hong Tang, Cheng Zhao. In-vivo imaging of oral squamous cell carcinoma by EGFR monoclonal antibody conjugated near-infrared quantum dots in mice: Quantum dots with an emission wavelength of 800 nm (QD800) were conjugated to monoclonal antibodies against EGFR, resulting in the probe designated as QD800-EGFR Ab. OSCC cell line (BcaCD885) expressing high levels of EGFR was transplanted subcutaneously into nude mice cheeks to develop an OSCC animal model. QD800-EGFR Ab containing 100 pmol equivalent of QD800 was intravenously

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S248 injected into the animal model and in-situ and in-vivo imaging of cheek squamous cell carcinoma was analyzed at 10 different time points. Results Yang K, Cao YA, Shi C, et al. Quantum dot-based visual in vivo imaging for oral squamous cell carcinoma in mice. The minimum detectable counts of BcaCD885 cells for QD800-based in vivo imaging were 1—104 in the dorsum subcutaneous, back muscle and under the cheek oral mucosa. As tissue depth increased, the detectable fluorescence intensity dropped; as cell counts increased, the fluorescence intensity and the visual image duration also increased, especially for the QD800-labeled BcaCD885 cells in which counts of 1—106 were visual imaged in the dorsum subcutaneous, back muscle and under the cheek oral mucosa for 16 days. Yang K, Li Z, Cao Y, Yu X, Mei J, et al. Effect of peptide-conjugated nearinfrared fluorescent quantum dots (NIRF-QDs) on the invasion and metastasis of human tongue squamous cell carcinoma cell line Tca8113 in vitro. The results showed that there was no significant difference between the results of Tca8113 cells labelled with NIRFQD800 and those of unlabeled Tca8113 cells, suggesting that the proliferation, invasion, adherence and chemotaxis of Tca8113 cells were not affected by NIRF-QD800. These results provide a basis for the further utilization of NIRF-QDs in non-invasive imaging and tracking of tumour cells in vivo. Kai Yang, Fu-jun Zhang, Hong Tang, Cheng Zhao. In-vivo imaging of oral squamous cell carcinoma by EGFR monoclonal antibody conjugated near-infrared quantum dots in mice In-vivo imaging and immune-histochemical examination of the tumours showed that intravenously injected QD800-EGFR Ab probe could bind EGFR expressed on BcaCD885 cells. Fluorescence signals of BcaCD885 cells labelled with QD800-EGFR Ab probe could be clearly detected, and these fluorescence signals lasted for 24 hours. The most complete tumour images with maximal signal-tonoise ratio were observed from 15 minutes to 6 hours after injection of the probe. The authors conclude that the combination of nearinfrared quantum dots that are highly penetrating for tissues with EGFR monoclonal antibody has promising prospects in in-vivo imaging of OSCC and development of personalized surgical therapies. Conclusions The early detection of cancer is one of the key factors for cancer treatment. Currently, the methods with good sensitivity for early detection of cancer, such as CT and MRI, can only detect tumours consisting of millions of cells. As for BcaCD885/QD800 used by Yang et al., injection points in the dorsum subcutaneous, dorsum muscle and under the cheek oral mucosa were fluorescently detectable with as little as 1—104 cells. This finding suggested that QD800-based imaging, compared with traditional CT and MRI, increased the sensitivity of the early diagnosis of cancer by more than 100-fold. Gao et al. forecast that near-infrared QD-labeled cells would improve the sensitivity of detection to 10–100 cells with the development of stronger tissue- penetrating near-infrared QDs. At the same time, the QD800- based imaging methods are simple, safe, lowcost, easy-to-use and particularly suitable for direct visualization of cancer cells in surgery. At present, clinicians lack the visual screening method for the carcinoma edges during surgery and thus they can only define the tumour boundaries by palpation and experience, resulting in residual cancer cells around the carcinoma edges in up to 40% of patients with head and neck cancers, which greatly affects the survival rate of patients. It’s believed that with the development of quantum dot imaging technology, clinicians can make accurate visual identification on the carcinoma edges, the residual cancer cells and the lymph node metastasis of cancer cells in operation, with the aids of a conventional imaging device and a pocket sized near-infrared excitation light source and receiver, so as to achieve a real treatment tailored to the individual surgery.

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EPS00397 Medical Modelling: Revolutionizing Treatment Planning Dr. Abhirup Chatterjee, Dr. Abhay T. Kamath (Guide) Manipal College of Dental Sciences, Manipal, Karnataka Abstract Background/Introduction Medical modelling is a concept based on 3D medical imaging for diagnosis, planning and treatment. The technology of 3D printing using 2D and 3D C.T. imaging has been used for fabrication of surgical templates, and guides; for increasing the accuracy, saving OT time, and obtaining highly satisfactory results. We at MCODS Manipal, present a plethora of cases, wherein medical modelling has been used. Objectives To demonstrate the effectiveness and utility of 3D medical modelling in diagnosis, planning and treatment of oral and maxillofacial conditions. Methods Pictoral demonstration in form of poster depicting the various uses of 3D modelling in oral and Maxillofacial Surgery and Reconstruction. Results All the cases showed satisfactory results and restoration of function and aesthetics. Conclusions 3D Medical modeling has revolutionized surgical treatment planning and its outcome with advantages like replication of complex anatomical structures, anticipation of possible complications or prognosis, performing mock surgeries and patient education and motivation.

EPS00414 Study to Evaluate Two Alternative Alloplastic Materials in OMFS: Chorion vs. Amnion Dr Adrineel Banerjee Saraswati Dental College Abstract Background/Introduction Regeneration and reconstruction with alloplastic material is not a new concept but its role in various field of Oral and maxillofacial surgery is new. Amnion and chorion are the only two alloplastic material with the potential to heal a wound, act as a graft & has role in regeneration with no immune reaction. Amniotic membrane as a biological dressing material is being used for last 100 years with excellent results but no such study is done on chorion although studies have shown that chorion have more growth factors than amnion. Objectives To find, efficacy of Amnion vs. Chorion on the basis of graft dehiscence, epithelisation and post-operative mouth opening (oral submucous fibrosis). Methods Twenty five patients were randomly included for split mouth study. 15 oral submucous fibrosis patients were treated with amniotic and Chorionic membrane on either side of oral mucosa after fibrotic band removal. 10 patients having bilateral leukoplakia where treated with amnion on one side and chorion on other. Dried amnion and chorion membrane were acquired from Tata Memorial tissue bank Bombay.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Evaluation was done on the basis of pre-operative and post-operative 7, 14 and 21 days of follow up. Results Epithelisation was better in Amnion than Chorion. Wound healing was faster & Mouth opening achieved was good in Oral Submucous Fibrosis cases. Conclusions Amnion is more effective graft material than chorion.

EPS00418 Assessment of Self Medication Among Dental Students and Dental Practitioners in and Around Kancheepuram District R. Chinnaiah Adhi Parasakthi Dental College And Hospital Abstract Background/Introduction A non-doctor prescribing and self-medication of drugs is common in developing countries. People tend to act on their own for their health. Encouragement of self-care is seen as giving patients every opportunity to take responsibility and build confidence in their ability to manage their own health. Objectives This poster aims to gather information about the awareness and prevalence of self-medication in the dental student fraternity and also to educate people to ensure safe practices. Methods Study questionnaire was adapted from various similar studies conducted previously (17) Study site- the study was carried out in and round Kancheepuram district. Study population- was conducted on 900 peoples. No study was earlier conducted here. Data collection & analysis Data was collected from to participation was totally voluntary. Age, sex, year of study was noted. Ethical issue Operational definition-self medication is the selection and use of medicines by individuals to treat self recognized illness or symptoms. Results The study includes 900 dental students, faculty and practitioners in our questioning study in the consistency of 38% males and 62% females in that females majority in different age groups In this study 96% students and practitioners and faculty members are using selfmedication. The prevalence shows the high members of selfmedication. Conclusions Inevitable practice of self-medication’s merits and demerits is made aware through proper education and the channel or medium through which self medication reaches the public should be inspected regularly and properly channelized. Thus a holistic method of legally issuing medicines as per (sold on prescription only) basis be put in reality (16).

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EPS00424 Awareness About Oral & Maxillofacial Surgery Specialty Among Medical and Dental Professional’s Rs. Barathvikraman Adhiparasakthi Dental College and Hospital Abstract Background/Introduction Scope of Oral & maxillofacial surgery occurred in Egypt in the socalled Edwin smith papyrus (2700BC) [1]. The specialty of oral & maxillofacial surgery (OMS) is defined by the American Association of Oral & maxillofacial surgery (1948) as the specialty of dentistry that includes the diagnosis, surgical and adjunctive treatment, injuries and defects involving both the functional and the aesthetic aspects of the hard and soft of the Oral & maxillofacial region [2]. In mid1960’s OMFS is a specialty of dentistry recognized by Federal Dentistry Broadis responsible for the diagnosis, and clinical and surgical treatment of traumatic, congenital, developmental and iatrogenic lesions in the maxillofacial complex [3]. Objectives To access the Awareness about Oral & maxillofacial surgery among Medical and Dental students and staff members of Adhiparasakthi Medical and Dental institutions at Melmaruvathur, Tamilnadu, India. Methods A cross sectional questionnaire based study was conducted amongst the students and staff members of Adhiparasakthi dental and medical institutions. Anonymity and confidentiality of respondents were maintained and participation was voluntary. A 51 questions in 9 groups was prepared based on the previous studies. This questionnaire gathered the demographic details from the students and staff members, which included age, gender, year of study, stream, family monthly income, Parents education level. Results A Total of 900 questionnaire were handed out the Dental and Medical professional’s. Among that 800 questionnaire were collected back after completion and incomplete questionnaire were excluded from the study. Out of 800 participants 41% (n =329) belonged to Medical stream and 58.9% (n =471) belonged to Dental stream and this study comprises of 28.6% of males (n =229) and 71.4% of females (n = 571). Among 9 categories I belonged to Minor surgical procedures of mouth from Medical 5.75% (n = 46) were marked has other dental specialist and 35.3 % has chosen OMFS where has in Dental only 3% (n = 24) has chosen other dental specialist and 55.8% (n = 447). (P value 0.00). Conclusions Awareness of OMFS among the medical professionals remain slow. Therefore OMFS practitioners should take it upon themselves to be active promoters while being guardians and ambassadors for this specialty.

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EPS00434 Sialendoscopy: A New Diagnostic and Therapeutic Tool Karamjot Singh Ghotra Punjab Government Dental College and Hospital, Amritsar Abstract Background/Introduction Sialendoscopy is one of the innovations introduced in the last few years in the field of oral surgery. It is a recently developed minimally invasive diagnostic and therapeutic procedure for the management of obstructive diseases of the salivary glands. Sialolithiasis and sialadenitis are two of the most frequently presenting disorders of the salivary glands. Objectives Sialendoscopy allows for optical exploration of the salivary ductal system and extraction of the stones by a basket under endoscopic view. Methods The orifice of the duct is progressively dilated with dilatation probes. The endoscope is introduced within a fine diagnostic sheath with an operator channel connected to a foot controlled automatic irrigation system to dilate and wash out the gland. Results it is best in diagnosing and removing the stones within the duct. The complications and recurrence is quite low as compared to other procedures making it unique and good. Conclusions Sialendoscopy incorporates diagnostic with therapeutic procedures, as dictated by the clinical findings. This technique can be performed in most cases as an ambulatory, outpatient procedure under local anaesthesia.

EPS00439 Submental Intubation Dushyant Singh Janmeda Kamineni Institute of Dental Sciences Abstract Background/Introduction Securing an airway during the management of faciomaxillary injuries remains a challenge and is an important part of treatment. The surgeon needs access to an unobstructed field and, in most instances, maxillomandibular fixation is required intraoperatively for adequate reconstruction of facial fractures. Presence of fracture of the base of the skull& Comminuted midfacial fractures cause physical obstruction to the passage of nasotracheal tube. Surgical reconstruction often involves maxillo-mandibular fixation in the intraoperative period to restore the patient’s dental occlusion. This precludes the use of oral endotracheal intubation. Tracheostomy may involve a significant risk of iatrogenic complications, such as tracheal stenosis, internal emphysema, damage to the laryngeal nerves, tracheoesophageal fistula and scarring A useful alternative method of managing the airway intraoperatively is by submental endotracheal intubation, which allows tracheal intubation by passing the tube through the floor of the mouth. First reported by Francisco Hernandez Altemir in 1986 as a procedure that could avoid tracheostomy and allow for the concomitant restoration of occlusion and reduction of facial fractures in patients ineligible for nasoendotracheal intubation.

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Objectives Objective is to see the efficacy of submental intubation over other intubation technique in patients with panfacial trauma. Methods 1.5-2.0 cm skin incision was made in the Submental region in the midline 2.0 cm behind the symphysis. Followed by blunt dissection was done through the subcutaneous fat, platysma, investing layer of deep cervical fascia, anterior bellies of digastric, geniohyoid and genioglossus muscles. Mouth opening was maintained using a gag or dental prop and the tongue was retracted, exposing the floor of the mouth. Pair of medium-sized artery forceps was introduced into the submental incision, until the tip of the artery forceps tented the mucosa of the floor of the mouth. Then tented oral mucosa was incised to see the tip of the artery forceps into the oral cavity taking care to avoid damage to the sublingual and submandibular duct and lingual nerve. Blades of the artery forceps were separated to a distance equal to the diameter of the tube. Pilot tube was grasped by the artery forceps and pulled through the passage in the floor of the mouth. Patient’s lungs were ventilated with 100% oxygen for five minutes. Then tip of the artery forceps was quickly re-inserted through the submental incision. The tracheal tube was briefly disconnected from the breathing circuit and the universal connector was removed. Then the end of tracheal tube was grasped and pulled out in the oral-to-skin direction. The connector was re-attached, the cuff reinflated and the tracheal tube reconnected to the breathing circuit. The position of the tracheal tube was checked using capnography and chest auscultation. Results submental intubation is the best technique for intubation with least complications as compare to other intubation technique in patients with panfacial trauma. Conclusions The submento-submandibular intubation has proved effective in comparison to the more morbid and manpower intense tracheostomy and other techniques. Though on the face of it, it appears to be complex, the submento-submandibular intubation technique is quite simple, easy to learn and produces wonderful results in good hands.

EPS00447 Botulism to Botox Crupa Susan Mathews Pushpagiri College of Dental Sciences, Thiruvalla, Kerala Abstract Background/Introduction Botulinum toxin is a neurotoxin derived from Clostridium botulinum, which is used considerably across the globe due to its broadening treatment options in rejuvenating aesthetics as well as function, developed from its property to cause flaccid muscle paralysis by Sir Justinus Kerner. Objectives A transient, reversible, minimally invasive and relatively safe adjuvant therapy for many medical and dental conditions which do not have complete treatment modalities in conventional methods. TMJ disorders, bruxism, oromandibular dystonia, gummy smile are a few to list. Methods The drug is administrated as subcutaneous and intramuscular injection to the hyperactive muscle in therapeutic doses.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Results The drug causes transient and specific muscle paralysis. Conclusions The mechanism of action, indications, contraindications and the application of this miraculous toxin in oral and maxillofacial surgery will be listed in this poster.

EPS00449 Diagnostic Dilemma in Anterior Mandibular Lesion Dr. Abhishek Saraswat Dr. Abhishek Saraswat Abstract Background/Introduction Anterior mandibular lesion with unknown etiology creates dilemma in formulating the treatment protocol as well as unexpected treatment outcomes postoperatively. Objectives To know the importance of preoperative histopathological examination and its revaluation by one or more centers in lesions of unknown etiology. Methods A 50 years male presented with a swelling which was asymptomatic and sessile gingival overgrowth extending from mesial of 43 to distal of 33. Incisional Biopsy report revealed it to peripheral cementoossifying fibroma. Considering that patient had been planned for excision with extraction of teeth. Postoperative histopathology revealed the different result, one diagnostic center shows it peripheral cemento-ossifying fibroma but another diagnostic center shows malignant mesenchymal tumor. Results Preoperative and postoperative diagnosis were totally different and there was development of excessive tissue at the site of excision lesion suggestive to considered as a malignancies patient referred to higher center and biopsy revealed non-hodgkin lymphoma and patient undergone chemotherapy still on follow up with us. Conclusions It is advisable to have more than one histopathological examination opinion of incisional biopsy tissue in case of unknown etiology.

ABS00450 Oral Cysticercosis: A Collaborative Study Dr Dolly PGIDS, Rohtak Abstract Background/Introduction Cysticercosis is a potentially fatal parasitic infection caused by Taenia solium. Taenia eggs may be ingested through undercooked/ raw pork, vegetables, contaminated water or by autoinfection in patients infected with adult T. solium. Frequently affected tissues are brain, muscles, liver, heart, lungs and subcutaneous tissues. Though oral cavity involvement is rare, it can appear as asymtomatic swelling in tongue, labial mucosa, buccal mucosa or floor of mouth. Objectives

S251 To study 21 cases of oral cysticercosis reported to PGIDS, Rohtak To discuss their clinical features and therapeutic considerations. Methods Records of 21 patients reporting to PGIDS, Rohtak in year 2012-2017 diagnosed as oral cysticercosis were taken. Clinical information i.e. age, gender, size and site of lesion, treatment and follow up was taken. Ultrasonographic and histopathologic findings were the diagnostic criteria. Most of the cases presented as asymptomatic submucosal nodules. Results Therapeutic management was done with Albendazole therapy in all patients. Mostly cases responded to the treatment. Treatment modality for the patients who did not respond to this therapy was surgical excision. Conclusions Though oral cysticercosis is a rare finding, it should be considered as a differential diagnosis of asymptomatic nodular swellings in the oral cavity so that early diagnosis is made and further systemic manifestations may be avoided.

EPS00452 Human Amniotic Membrane: Scaffolding Material in Reconstructive Surgery Dr. Rinsha Gireesh College of Dental Sciences Abstract Background/Introduction The amnion has been ascribed to function as its Greek name suggests. It has become an attractive biomaterial for all surgical disciplines. Amniotic membrane is the inner most lining of the human placenta that is normally discarded after parturition. The membrane has numerous growth factors, proteins and stem cell reserves that help in accelerating wound healing with regeneration of the lost tissues. Objectives This poster discusses the properties, mechanisms and the applications of this neglected tissue that makes it a potential material for regeneration in the field of oral and maxillofacial surgery. Methods Amniotic membrane is the inner most lining of the human placenta that is normally discarded after parturition; collected and preserved. Results Amniotic membrane has gained an acceptable position in the surgical armamentarium of maxillofacial surgery as it ensures a reliable and affordable option for surgeons and patients. Conclusions Due to its innate property of re-epithelialization and vascularization. Human amniotic membrane has proven to be a good dressing material for management of wounds in various regions of oral cavity.

EPS00456 Efficacy of Temporalis Muscle Flap in Reconstruction of Maxillary Defects Dr. Kunal Marwah Subharti Dental College, Meerut Abstract Background/Introduction

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The temporalis muscle flap, has been used as donor tissue for the repair of various head and neck defects because of its anatomic location. Objectives The present study was conducted to evaluate the efficacy of temporalis muscle flap in reconstruction of maxillary defects. Methods The short sample study includes 3 patients with maxillary defects that reported to the department of oral & maxillofacial surgery Subharti dental college Meerut. In which we compared nasolabial, radial forearm flap and temporalis muscle flap in reconstruction of maxillary defects. Results Temporalis muscle flap is more desirable in reconstruction of maxillary defects upto the midline as it provides large surface to cover. Conclusions The temporalis muscle is an attractive option for maxillary reconstruction for several reasons: (1) the donor site and the defect are within the same operative field and therefore the need for more complex free tissue transfers can be avoided; (2) there is considerable tissue available; (3) the flap remains well vascularized; (4) cosmetic deformity is limited and (5) the flap can be used to correct defects upto the midline.

Objectives Objectives of this case report are to discuss a case of oral myiasis and to understand the occurence, presentation, treatment of this condition. Methods In this report, a case of oral myiasis in 55 year female patient with rural background and poor oral hygiene has been described and also its clinical features, management and treatment are discussed. The treatment given was tablet Ivermectin 6mg OD. Cotton swab impregnated with turpentine was placed near the defect area for 5- 10 minutes and Maggots were removed with the help of forceps. Wound was debrided and slough was removed. Results The condition of the patient’s oral health improved after one month of the treatment. Patient is further recalled after 5 months for the six month follow up. Conclusions To conclude, myiasis affects low socioeconomic level individuals with poor hygiene habits and unhealthy patients with psychiatric disorders, diabetics, and immunocompromised patients. Undoubtedly, preventive approach measures, including basic health care, hygiene, access to primary health service, and safe water and drainage, are fundamental to prevent cases such as this one.

EPS00458 Submental Intubation in OMFS

EPS00494 Follicular Unit Extraction Presentation Hair Transplant

Dr. Mukhallat Qazi, Dr. Gunachandra Rai Dr. Ashok Kumar Abstract Background/Introduction Yenepoya Dental College. Objectives In any surgical procedure under general anesthesia, the choice of intubation technique requires a thorough assessment and multidisciplinary approach, especially in case of craniomaxillofacial trauma. Nasotracheal intubation, which is the mainstay in various maxillofacial surgeries is contraindicated in fractures involving the middle third of the face, especially the median structures. Similarly orotracheal intubation becomes obsolete when we require the occlusion in maxillomandibular fixation as a guide to optimally reduce and fix the skeletal structures. This necessitates the need for knowledge of submental intubation technique. The maxillofacial surgeon needs to be confident and well-versed with this method of intubation, as well as any associated complications.

EPS00473 Oral Myiasis: A Case Report Dr. Anurag Agarwal Institute of Dental Sciences, Bareilly Abstract Background/Introduction Myiasis is the infestation of tissues and organs of animals and humans by certain Dipteran fly larvae or maggots. Oral myiasis is a rare condition occurring more frequently in underdeveloped countries or hot climate regions and is associated with poor oral hygiene, suppurative oral lesions.

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Jaipur Dental College Abstract Background/Introduction For androgenic alopecia, the only permanent available solution is surgical hair restoration. Techniques have evolved dramatically, with FUE as the most recent advancement in minimally invasive surgical hair restoration. Objectives Restoration and transplantation of hair. Methods IN FUE, individual units are removed from the scalp and prepared for direct transplantation into recipient scalp. Results This process leaves little scar, and thus creates a natural, aesthetically pleasing result and patients experience minimal downtime before returning to normal activity. Conclusions Follicular Unit Extraction is the preferred option in many patients seeking surgical hair restoration. FUE is usually practiced in patients with androgenic alopecia, but has successfully restored a natural hair appearance in patients with a number of other alopecia types. Currently available methods include manual and automated systems, offering the benefit of increased efficiency without the noticeable occipital line scar implicated in traditional surgical techniques.

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EPS00496 Use of Autogenous Dentin Graft in Extraction Sockets Dr. Akhilesh Kumar Pandey Goa Dental College & Hospital Abstract Background/Introduction Extracted teeth are still considered a clinical waste therefore discarded. It is evident that chemical composition of dentin is similar to bone. Following tooth replantation the tooth is replaced by bone followed by root resorption, ankylosis and finally integrated in surrounding alveolar bone. Objectives To present novel procedure in clinical setting that employs freshly extracted teeth that are processed into bacteria free particulate dentin, and grafted immediately in extraction site. Methods The process consists of reducing any restorations, caries or debris after extraction. The clean, dry tooth is grinded using ‘Smart Dentin Grinder’ The dentin particulate of 300-1200 um is sieved through special sorting system, and immersed in basic alcohol cleanser to dissolve organic debris, bacteria Particulate is washed by sterile saline, and is ready for immediate grafting into extraction socket. Results Autogenous dentin graft helps in preservation of alveolar bone. It has been observed implant insertion has been possible in 2-3 months post grafting. On X-rays & biopsy of grafting site a dense dentin-bone composite is found. Conclusions Autogenous mineralized dentin particulate grafted immediately after extraction should be considered as gold standard for socket preservation.

EPS00506 Advanced Virtual Reality: Haptics A True 3D Experience for Maxillofacial Surgeons

S253 they feel ligaments, manipulating fracture segments, contouring bone grafts as if working directly on the patient. Haptic technology simulate operations and allow surgeons for precise preoperative planning especially in maxillofacial trauma, oncosurgery, orthognathic surgeries, palpating myofacial trigger points and also helps to simulate surgery for training purposes for surgical students to practice and train more.

EPS00509 Medico-Legal Cases Prospective in Oral and Maxillofacial Surgery Practice: A Conundrum Resolved Dr. Priyanka M. Tapsale Maharashtra Institute of Dental Sciences & Research, Latur Methods An Oral and Maxillofacial surgeon (OMFS) is highly likely to face plethora of medico legal cases (MLC) in day to day practice. However there are vast lacunae in recording, analysing and understanding of the correct method of dealing with such cases. Medical jurisprudence is interesting and serious. Correct interpretation of an injury in MLC needs utmost level of objectivity, observation skill, analytical ability and integrity. The OMFS should have an understanding of the law and legal system and can be a good witness in deciding true justice. However practitioners get anxious and apprehensive as they have to interact with individuals and systems outside the normal realm of practice. In today’s arena, it is of utmost importance to be aware of legal system and law of particular country. The OMFS needs to have thorough understanding in recording and maintenance of the details of all MLCs and should have through knowledge of presenting the same in court. Professional guidelines for expert witness are often not well recognised as those relating to the clinical practice. This presentation provides a bird’s eye view into the details of registration of MLC, examination and recording of injuries, collecting medicolegal evidences and writing a medico legal report. Also it highlights the court proceedings and possible questions that may be faced by the surgeon in the court.

Dr. Ashish S. Satpute Maharashtra Institute of Dental Sciences & Research, Latur Abstract Background/Introduction Haptics, a term that was derived from the Greek word ‘‘haptesthai’’ meaning ‘‘pertaining to the sense of touch’’ which is added to present virtual reality technology which provides a true 3D experience for maxillofacial surgeons. Methods ‘‘In virtual reality surgeons interacts with two dimensional sensory modalities that is visual and auditory but in advanced virtual reality of haptic technology adds third dimension by recreating the sense of touch through applying forces, vibrations or motions to the user along with visual and audio aids. Since 2013 research focused on tactile interaction with holograms and distant objects by adding haptic feedback, which is successfully applied in advancements in medical, surgical, educational and other industries. Haptic technology provides tactile and resistance feedback to surgeons, as they makes an incision

EPS00511 Recent Advances in Local Anesthesia Chetna Yadav Rungta College of Dental Sciences Bhilai Chattisgarh Abstract Background/Introduction Pain and its successful management have been one of the cornerstones of Dentistry worldwide since time immemorial. The successful use of local anesthetic solutions and their diligent administration have helped patients overcome their fears and displeasure towards dentistry. Although local anesthesia remains the backbone of pain control in dentistry, researches are going to seek new and better means of managing the pain. Most of the researches are focused on improvement in the area of anesthetic agents, delivery devices and technique involved. Newer technologies have been developed that can assist the

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S254 dentist in providing enhanced pain relief with reduced injection pain and fewer adverse effects. This poster gives an overview and will enlighten the practicing dentists regarding newer devices and methods of rendering pain control comparing these with the earlier used ones on the basis of research and clinical study available. Objectives This review focuses on the most recent developments in dental LA techniques and devices. Methods This section will discuss vibrotactile devices, computer-controlled local anesthetic delivery (CCLAD) systems, jet injectors, safety dental syringes and devices for Intra-Osseous (IO) anesthesia. Results Conflict of Interest: None declared. Conclusions Local anesthetics have made a great advancement in dentistry and have changed patients’ perspectives of dental procedures to a great extent. There is still room for the improvement of painless techniques in administrating local anesthetics. It is important for clinicians to be familiar with all the local anesthesia devices and techniques available for dental procedures to best exploit them.

EPS00526 Odontology: Bite Mark Analysis Dr. Supriya Dombre Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur Abstract Background/Introduction An objective analysis which can withstand vigorous cross-examination in High Courts is essential if perpetrators are to be matched to bite marks. The comparison of bite marks with dentitions of possible perpetrators must be regarded as a scientific analysis in which a degree of concordance is either demonstrated or rejected. The minimum requirements for any analysis are the recognition of individual dental features, quality of the bite mark registration in the skin or in animate object bitten and the quantity of evidence available for analysis. Objectives To rule-out bit mark assessment in crime investigation. Methods 1. Photograph the bite mark. 2. DNA swabs of the bite marks along with Impressions of the marks. 3. Silicone impressions of the bite mark should be taken 4. Documentation of all actions related to the collection of bite mark evidence. Results A determining role in the scientific analysis of the bite marks as the pool of suspects may have only one suspect who would fit the pattern. Conclusions Bite mark analysis is a multi-faceted approach to the matching of tooth marks left at the crime scene with the dentition of a suspect in which the quality, quantity, presence or absence of dental features, warping, shrinkage and distortion in open and closed populations are examined and reported on.

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EPS00531 Dilemma in Treating Oral Ulcer Dr Shifa Yenepoya Dental College Abstract Background/Introduction Oral ulcers are generally painful lesions that are related to various conditions developing within the oral cavity. They can be classified into acute or chronic according to their presentation and progression. Acute oral ulcers can be associated with conditions such as trauma, recurrent aphthous stomatitis, behcets disease, bacterial and viral infections, allergic reactions and adverse drug reactions. Chronic oral ulcers are associated with conditions such as oral lichen planus, pemphigus vulgaris, mucosal pemphigoid, lupus erythematosus, mycosis and some bacterial and parasitic diseases. Objectives The correct differential diagnosis is necessary to establish the appropriate treatment, taking into account all the possible causes of ulcers in oral cavity.

EPS00554 Fabrication of Customized Tongue-Displacing Stents: Considerations for Use in Patients Receiving Head and Neck Radiotherapy Dr Abhinav Neog Abstract Background/Introduction Conformal or intensity-modulated radiation therapy can be improved by using a customized tongue-displacing (CTD) stent. These stents are designed to either move healthy oral tissues out of the path of the radiation beam or stabilize mobile tissues to allow more precise field control. Objectives This poster presents a review of the current applications of customized intraoral stents which can help to prevent the unnecessary irradiation of surrounding normal tissues, thus reducing the severity of the reaction and also throws Light on the various types of stents that can be fabricated, their uses and its importance. Methods The authors describe CTD stent construction for both tongue-deviating and tongue-depressing applications. Results CTD stents enable clinicians to achieve more predictable and consistent radiation dosimetry planning while sparing greater volumes of healthy tissue from damage. They have been well tolerated by patients. Conclusions Use of CTD stents results in increased oral mucosal sparing, ensures reproducible immobilization and is incorporated readily into the clinical practice of radiation oncology.

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EPS00557 Adipose Stem Cells Used to Reconstruct CranioMaxillofacial Hard Tissue Defects Dr Sanchaynee Pathak Abstract Background/Introduction Cranio-maxillofacial skeletal defects arise as a consequence of congenital malformations such as cleft lip and palate, are due to traumatic avulsion, result from tumor resection, or follow severe infection. The use of autogenous bone is still considered to be the gold standard for the reconstruction of cranio-maxillofacial skeletal defects. An alternative approach is that of tissue engineering vital bone-forming cells, growth factors, and a scaffold to promote the formation of new bone in a desired location and with particular precise dimensions and shape. Objectives The aim of this poster is to review consecutive cases of craniomaxillofacial hard-tissue defects reconstructed with a variety of scaffolds seeded with adipose-derived stem cells (ASCs) and in some cases with the addition of the growth factor. Methods The authors describe the use and efficiency of Adipose Stem Cells in treatment of Cranio- maxillofacial deformities. Even in some cases the combination of adipose stem cells and biomaterials is been used and is been considered to be an advanced therapy. Results The success criterion for the grafts at the four different sites, frontal sinus, cranium, mandible, and nasal septum healed hard-tissue grafts in their recipient bed, functioning according to the demands of their new native sites during the follow-up period show good results corresponding to bone growth. Conclusions The use of adipose-derived stem cells (ASCs) along with other combinations has proven to be very useful for cranio maxillofacial reconstruction.

EPS00559 Management of Patients with Congenital Bleeding Disorders in Dental Clinic Dr Dipesh Gawri Rungta College of Dental Science Abstract Background/Introduction Oral and maxillofacial surgeons must be aware of the impact of bleeding disorders in the management of such patients. Initial recognition of a bleeding disorder, which may indicate the presence of a systemic pathologic process, may occur in dental practice. Furthermore, prophylactic, restorative and surgical dental care of patients with bleeding disorders is best accomplished by practitioners who are knowledgeable about the pathology, complications and treatment options associated with these conditions. The purpose of this poster is to review the recent advances in management of pre and post-oper-

S255 ative patients suffering from congenital bleeding disorders The common bleeding disorders like hemophilia and von willebrand’s disease and their effects on the delivery of oral health care are also included in this poster. Various lab test used for diagnosing such disorders are also discussed in poster. Objectives objective of this poster is to make people aware of recent advances in management of patients suffering from congenital bleeding disorders. Methods objective of this poster is to make people aware of recent advances in management of patients suffering from congenital bleeding disorders. Results Objective of this poster is to make people aware of recent advances in management of patients suffering from congenital bleeding disorders. Conclusions Objective of this poster is to make people aware of recent advances in management of patients suffering from congenital bleeding disorders.

EPS00571 Surgical Management of Elongated Styloid Process: A Review of Cases Dr. Shruti Sunil Patil Abstract Background/Introduction Pain is the most frequent cause of suffering and disability. The etiology of orofacial pain is still elusive. However, the etiology has to be ascertained for definitive treatment. Only after a systematic and careful evaluation can a treating surgeon be aware of the underlying cause. Though dental causes predominate in the diagnosis of orofacial pain, the rare cause of facial pain have to be excluded, which would prevent unnecessary and fruitless dental treatment. Pain is the most frequent cause of suffering and disability. Misdiagnosis and multiple failed treatments are common in some patient population. Patients with orofacial pain frequently undergo numerous dental procedures that fail to eliminate symptoms, and are often referred to the oral and maxillofacial surgeon for evaluation and treatment. Facial pain can be the presenting, and sometimes the only, complaint of many disorders that originate from cranial structures. Patients with pharyngodynia, neck, and facial pain can lead to an extensive differential diagnosis. Vague orofacial pain associated with elongation of the styloid process or calcification of the stylohyoid ligament has been known as Eagle syndrome may be taken in account. American otorhinolaryngologist Watt Weems Eagle in 1937 defined ‘‘stylalgia’’ as an autonomous entity related to abnormal length of the styloid process or to mineralization of the stylohyoid ligament complex. Eagle described two possible clinical expressions attributable to elongated styloid process as follows: 1. Classic styloid syndrome 2. Styloid carotid syndrome. Objectives To demonstrate cases of elongated styloid process can be managed intraorally without tonsillectomy. Methods Cases operated in the department of oral and maxillofacial surgery with an intraoral approach for elongated styloid process. Results Cases of elongated styloid process can be managed intraorally without tonsillectomy. Conclusions Surgery was uneventful, Follow ups revealed that the patients had remained symptom free after surgery.

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EPS00575 Socket Shielding Technique: Boon to Implant Dentistry Dr. Rupam BRS Dental College & Hospital, Distt Panchkula Abstract Background/Introduction Extraction of a tooth inevitably brings the loss of alveolar bone width and height, impeding the esthetic outcome of immediate implants. A clinical technique was developed where the buccal portion of the root is retained to preserve the periodontal ligament and bundle bone. Objectives To evaluate the potential of socket shielding technique in preserving tissue and bone loss at extraction site for immediate implant placement. Methods: A Medline (Pubmed) search was performed using the terms; ‘‘socket shielding technique’’, ‘‘partial extraction’’, ‘‘socket preservation for immediate implants’’,: case reports for socket shielding technique ‘‘from 2000 to 2017. Results Various authors confirmed the reduced bone loss. Preservation of buccal bone contour after healing in case of socket shielding technique in comparison when implants were placed without using this technique. Conclusions Socket shield technique meets the demands of minimal invasion, tissue preservation, and no need of bone substitute materials. Thus, it is a viable and safer method for preserving alveolar bone and can be employed for successful immediate implant placement.

EPS00588 Role of Nuclear Medicine in Diagnosis of Oral and Maxillofacial Diseases Dr. Dibya Falgoon Sarkar Abstract Background/Introduction Medical healthcare has been using nuclear medicine for a long time now but the use of it in dentistry is poorly understood, underutilized, underexplored. In recent time procedures like PET, SPECT, lymph node scintigraphy /sentinel lymph node has made nuclear medicine as adjunct in modern diagnostic arena and justifies its use in dental disease as well. Nuclear medicine utilizes the accumulating action of radioisotopes in cells and so after injecting them, with a help of a specialized gamma camera images are taken at a certain time interval to detect distribution and quantification of isotopes and hence metabolic activity. Head and neck tumors, salivary gland disease, and various metabolic as well as infectious processes of the head and neck region are the areas where radio isotopic scanning can be used in oral and maxillofacial disorders. Plain films radiographs, CT scan and MRI scan are able to provide good soft and hard tissue imaging only when morphological change have occurred but nuclear scanning precede them in diagnosis by detecting metabolic changes earlier than to be seen as morphological changes. With all these observations a dentist must be aware of this specialty and discussion and emphasis should be laid on this for a successful diagnostic and therapeutic implications.

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Objectives To provide an overview of modern nuclear medicine and exemplify its application in the diagnosis and treatment of oral and maxillofacial diseases. Methods Bone Scanning Bone scan uses a radiopharmaceutical technetium99m labeled with diphosphonates having half-life of six hours and emission of 140kev gamma energy. Since the adsorption of diphosphonates to hydroxyapaptite is 40 times more than organic matrix its uptake correlates with degree of mineralization. Areas of increase uptake is called ‘hot spot’ whereas areas of decrease uptake is called ‘cold spot’. Lesions resulting from radiation treatment, local vascular compromise, prosthetic joint, early osteomyelitis, multiple myeloma, and avascular necrosis which causes area of decrease uptake or cold spot is also seen on bone scan. Positron Emission Tomography (PET) 18F-fluorodeoxyglucose (FDG) is the radiopharmaceutical most commonly used in PET scanning. FDG is a glucose analog that is transported into cells and phosphorylated like glucose, but the metabolism stops at this point and the phosphorylated FDG becomes trapped in the cell and starts to accumulate. Most tumors, with a more rapid growth rate, have an increased rate of glucose use due to an increased rate of glycolysis compared to normal tissue or scar tissue. Consequently, FDG preferentially accumulates in tumor cells and demonstrates an increased uptake especially in poorly differentiated tumors. The accumulated FDG is detectable to the PET camera. Lymphoscintigraphy Technetium 99m sulfur-colloid is injected in four to six subcutaneous sites around the neoplastic lesion. The radioactive colloid will be carried away in the lymphatic channels to the first echelon lymph node draining that area, the so-called sentinel node. The sentinel node is felt to be the best predictor of nodal spread of the tumor. The pattern of lymphatic spread and the sentinel node can then be imaged using a gamma camera. One to two hours later, in the operating room, the surgeon using a hand held gamma counter is able to localize the node and remove it. Salivary Gland Studies The major salivary glands with a functioning parenchyma have the ability to take up technetium 99m pertechnetate in sufficient quantities to be imaged, since the Te99 mimics chloride influx into the acinar cells. Scintigraphy involves administering a radioactive tracer with an affinity for the organ or tissue of interest; the distribution of the radioactivity is then recorded with a scintillation camera. SPECT It is an extension of conventional bone scan as it utilizes tomographic technology to provide 3-dimensional images (axial, coronal and sagittal) which thereby facilitates more accurate interpretation and better localization of bone pathology, Results Bone scanning (Dale, Baur et al.) Bone scans can be used to diagnose and differentiate osteomyelitis from cellulitis, as well as detect primary and metastatic malignant disease. They can also be used to assess the vascularity of bone grafts and contribute to the diagnosis of various metabolic bone diseases such as fibrous dysplasia, Paget’s disease, TMJ osteoarthritis, and rheumatoid arthritis (RA). It is important to keep in mind a bone scan can detect 10-15% mineral loss, while standard radiographs will only visualize a bony defect after 35-50% mineral loss. Overall the scan has a high sensitivity but low specificity, Positron Emission Tomography (PET) (Dale, Baur et al.) PET can be used to assess the response of a tumor to treatment, diagnose recurrence, detect residual disease, or detect distant unknown metastases. PET scanning is helpful in evaluating a neck mass or evaluating a neck without palpable adenopathy (staged as a N0 neck) in oral squamous cell carcinoma. PET is especially useful when trying to localize an occult primary tumor. PET has not shown any usefulness in pre-operative evaluation of salivary gland neoplasms. In OSCCA, there has been a great deal of interest in using PET to evaluate the clinically N0 neck for occult or micrometastasis

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 before any changes are visible on CT or MRI. False positives can also occur in conditions such as tuberculosis and sarcoidosis. Overall, while the sensitivity can be lacking, the specificity is high. Lymphoscintigraphy (Goyal, Khanna, et al.) Sentinel node mapping is a technique which uses the property of carcinomas to spread via lymphatics. Sentinel node is first draining node of a particular anatomical area. In carcinomas, sentinel node is primary node carrying metastatic cells via lymphatics which further drain into subsequent nodes. If sentinel node is diagnosed to be involved then chances of lymphatic spread to other nodes is present. It prevents unnecessary surgical intervention if sentinel node is found to be negative for metastases. Salivary Gland Studies (Dale, Baur et al.) Scintigraphy of these glands is used for functional evaluation and evaluating mass lesions. Mass lesions in a gland usually present as areas of decreased uptake, with the notable exception of Wharthin’s tumor and oncocytomas which demonstrate increased uptake and decreased washout time. Patients with Sjogren’s Syndrome may have poor uptake of the radiopharmaceutical and poor response to stimulation. Acute inflammation of the glands usually demonstrates increased uptake and increased washout, whereas chronic inflammation shows decreased uptake. SPECT Various uses of SPECT includes assess the mandibular invasion of squamous cell carcinoma (SCC) determining in the therapeutic course in patients with asymmetrical mandibular condylar hyperplasia and to assess the osseous integration process of dental implants. Bone grafting (Goyal, Khanna t al.) Use of bone scans/PET scans to determine viability of bone graft is useful in predicting graft failure. Since clinical monitoring of these vascularized grafts is difficult bone scans are useful studies done by Karcher et al (35), Harbert et al (34), Schimming (36) have shown significant role of nuclear medicine in deterring success/failure of bone grafts. Conclusions Radionuclide imaging is a patient-friendly, non-invasive technique for detecting various disease processes in dentistry. It includes techniques which are sensitive and specific for imaging inflammation, infection, and malignancies. It is able to deliver objective measurements before and after intervention, surgery or any other treatment modalities so that outcome analysis can be performed quantitatively. Interpretation of the scan results, as well as the pitfalls involved is important to understand, as they may be required at times to be done by the dental surgeons. Bone scan, SPECT imaging and PET scans are the techniques that help in diagnosing oral/dental pathologies and tumors. In the present era, since nuclear diagnostic techniques are being used commonly in dental practice, it is important for the dentists to be familiar with these scans in nuclear medicine and also to be well versed with the various indications for nuclear imaging techniques in oral/dental pathologies.

EPS00606 Maxillofacial Prosthetic Rehabilitation After Oncology Surgery Dr. Swati Jadhav MIDSR Dental College Latur Abstract Background/Introduction Tumor processes compromising the head and neck region can particularly affect the identity of the human being. There are different therapeutic alternatives to treat this cancers, which generate

S257 functional sequels affecting phonation, deglutition and mastication. Therefore, approach for cancer patients is not only based on control of the disease, but also the rehabilitation and reinsertion in society. Objectives Surgery is first choice for early cancers and for cancers that do not respond to radiation and chemotherapy in the form of salvage. Surgery can result in cosmetic, functional and psychological impairment greatly affecting the patient’s quality of life. Presently the thrust in cancer care is not simply on survival but on rehabilitation, which aims to improve multiple impairments and Quality of Life (QOL). Conclusions Health related QOL refers to a multidimensional concept, which encompasses perception of both negative and positive aspects of four dimensions of physical, emotional, social and cognitive function. The team of rehabilitation usually comprises of otorhinolaryngologist, radiation oncologist, medical oncologist, maxillofacial prosthodontist, speech therapist, psychologist, and nursing staff amongst the other disciplines for specific problems of the cancer patient. As a critical member of the team the maxillofacial prosthodontist co-ordinates the effort in many facets of patient care. Rehabilitation goals are focused on the restorative, supportive and palliative aspects of treatment. The primary objective of this poster is to showcase various post-operative prosthesis following oncology surgery of head and neck cancers that rehabilitate to preserve and restore the function of speech, swallow and esthetics.

EPS00672 The Cutting-Edge in Oral and Maxillofacial Surgery Dr Amol Dubey YMT Dental College Kharghar, Navi Mumbai Abstract Background/Introduction Abstract The vision for the future with advanced technology and science for easy and better treatments outcome motivating the clinicians to look forward the cutting edge tactics in the oral and maxillofacial surgery. The results will be providing patients with first class medical services with the reduction of treatment morbidity. Greater progress has been made in the field of oral and maxillofacial surgery. In the last decades the researchers were concentered for the improvement of the preoperative planning as it plays vital role in success rate of the surgical procedures. Now as the result of the advanced computer technology, the researches extend beyond the scope of planning and moving toward the surgical procedures itself Evolution over the last decades focused towards the improvement of preoperative planning, minimally invasive approaches and minimizing the operation time. All aiming to decrease surgical complications and post operative pain and rapid return to normal life style activities. As a result; remarkable recent advances in surgical and computer technology are evolving every day. Innovation in oral and maxillofacial surgery have allowed the professions to progress at very fast rate for more every day. The increased accuracy and speed of treatment along with reduced discomfort, and decreased the complications will always be the actual advantage to our patients. The of our current review is to give an insight about the cutting edge in the field of oral and maxillofacial surgery to provide a more detailed physical manifestation of your mental picture and new dimension of insight into the clinical situations you encounter every day:

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EPS00680 Demineralised Dentin Matrix for Alveolar Bone Engineering Dr. Akansha Kandoi Sinhgad Dental College, Pune Abstract Background/Introduction Autogenous bone graft is considered the gold standard for the repair of alveolar bone defects, but it is associated with donor complications and morbidity and also suffers from a limited supply. To avoid and overcome these disadvantages, bone substitutes are under development as an alternative to autogenous bone. Dentin and bone having same biochemical similarities led to the idea of using it as a bone regenerative material. Objectives This poster discusses the development and clinical use of demineralized dentin matrix (DDM) produced from the patient’s own extracted teeth, to repair alveolar bone defects. Methods Both vital and non vital extracted teeth after removal of soft tissue and callus, where rinsed twice in phosphate buffered saline. The teeth was then crushed in a dentin grinder, the resultant particle were washed in 1. oM sodium chloride and partially demineralised for sometime. This was then mixed with PRF and used as grafts. Results Appreciable amount of bone regeneration was seen in the patients. Conclusions A tooth is the simplest thing one could think of to be used as a bone substitution material. The easy availability makes the job even easier. DDM with larger particle size induced prominent bone regeneration and can be easily used as a bone substitute.

EPS00712 Current Trends O Forensic Odontology Dr. Patel Mamta Rungta College of Dental Sciences and Research Abstract Background/Introduction Forensic odontology is currently defined as forensic dentistry which is a branch in dentistry dealing with proper handling, examination, and evaluation of dental evidence, which will be then presented in the interest of justice. The current scenario of forensic dentistry is that though there are many researchers working on various aspects of forensic odontology, applications of dental findings in personal identification still lack significant practical applications. Objectives The purpose of this study was to determine age, sex, and ABO blood group of individual from a single tooth, to determine the effect of different environmental conditions, and to extract maximum information also at the same time preserving some tissue for the further investigation whenever needed. Methods The teeth were sectioned longitudinally in the buccolingual plane along the midline. Longitudinal ground sections of each tooth were prepared for age determination from cemental lines. Pulp removed was divided into two halves thereafter sex and blood group was

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 determined. Statistical Analysis: For correlation of age between estimated age and actual age, using cemental lines Pearson’s correlation coefficient was applied. Results A strong positive correlation was found between the estimated age and actual age. Blood groups obtained from the pulp were compared with those obtained from the study subjects. Conclusions The evaluations of fingerprints, lip prints, and palatal rugae showed fractal dimensions, occurring variations in dimensions according to the complexity of each structure. Even though a minute self-repetition in the patterns of lip, thumb, and palate among the three consequent generations in a family was observed considering the sample size, these results need to be confirmed in a larger sample, either to establish the role of chaos theory in forensic science or identifying a particular pattern of the individual in his family hierarchy.

EPS00721 Cyberknife: A Stereotactic Radiosurgery for Head n Neck Tumors & Trigeminal Neuralgia Dr. Mehta Payal (Trainee) Guided By: Dr. Nimisha Desai Karnavati School of Dentistry, Uvarsad, Gandhinagar Abstract Background/Introduction The CyberKnife System is a non-invasive alternative to surgery for the treatment of a number of cancerous and non-cancerous tumors. It focuses on minimizing and eliminating tumors within the body. CyberKnife cancer treatment does not require any cutting, needles, or anesthesia. Instead, the system sends concentrated doses of radiation directly to the tumor. This means the CyberKnife cancer treatment option minimizes exposure to healthy tissue and reduces side effects because of the beam’s increased accuracy. It has become the leading radiosurgery system. Objectives To report outcomes of stereotactic radiosurgery CyberKnife for head & neck tumors, trigeminal neuralgia and to evaluate them. Methods Stereotactic radiosurgery is delivered with the CyberKnife an X-band linear accelerator with an overall system targeting error of less than 1 mm. The lightweight linear accelerator is capable of irradiating the target from 120 different directions using image-guidance based on a treatment plan created using a CT volume. Treatment is administered depending upon the configuration and volume of the tumor as determined by the treating radiation oncologist, neurosurgeon and oral and maxillofacial surgeon. Dose constraints are applied to nearby critical structures based upon the total dose and fractionation scheme. Results Show the benefit of CyberKnife salvage treatment for advanced, recurrent lesions, without lymph node metastases in previously irradiated head and neck cancer and trigeminal neuralgia. Conclusions Demonstrates the effectiveness of CyberKnife stereotactic surgery in providing safe and effective pain relief as an alternative to invasive surgical procedures in cases of head n neck tumors and trigeminal neuralgia. It focuses on providing the most comfortable experience in the outpatient center. Treatment with it is completed within 5 days, allowing the patient to carry on with their everyday lives.

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EPS00726 Different Treatment Modalities for Oro Antral Communication Dr. Rayan Malick Abstract Background/Introduction Oro-antral communication and fistula can occur as a result of inadequate and improper treatment. Inadvertent communication with the maxillary sinus can occur during certain surgical procedures in the maxillary posterior region. Though, spontaneous healing may occur in defects which are smaller than 2 mm but larger communications require immediate attention and should be treated without delay, in order to avoid sinusitis and further complications leading to patient discomfort. Objectives Oro-antral communications and fistulas (OACs & OAFs) are complications frequently encountered by oral and maxillofacial surgeons. Other causes of OAC/OAF include tuberosity fracture, dentoalveolar/ periapical infections of molars, implant dislodgement into maxillary sinus, trauma (7.5%), presence of maxillary cysts or tumors (18.5%), osteoradionecrosis, flap necrosis, dehiscence following implant failure and sometimes as a complication of the Caldwell-Luc procedure. Methods A presentation on management of cases of oroantral communication/ Fistula with different surgical and nonsurgical modalities. Results A wide range of techniques has been proposed for the management of oroantral communication but the surgical closure of oroantral communication remains the better treatment of choice. Conclusions Oro antral fistula/communication should be managed promptly by creating a barrier between oral cavity and maxillary sinus. Different treatment modalities should be offered to the patient considering both surgical and non surgical options.

ABS00734 Management of Trigeminal Neuralgia Dr. Neelam Yadav, 1st Year Post Graduate, Dr. Pravesh Mehra, HOD & Prof LHMC, New Delhi Abstract Background/Introduction Trigeminal neuralgia is a paroxysmal and severely disabling facial pain. The diagnosis is usually made on the basis of a typical history and the exclusion of secondary causes. Initial management of the pain is medical. Carbamazepine is the drug of choice although some patients respond to other drugs including phenytoin, baclofen, sodium valproate and clonazepam. Invasive therapy (Nerve block and surgical excision of nerve) should be considered if medical treatment fails or cannot be tolerated. Objectives To review the efficacy and safety of Glycerol Injection as an invasive treatment option in the management of Trigeminal Neuralgia. Methods A series of 50 cases diagnosed with trigeminal neuralgia and treated with glycerol injection in the peripheral branches of the nerve were reviewed. The patients were followed up for at least 1 year and intensity of pain was assessed.

S259 Results Significant long-term relief was observed in the patients with no reported morbidity. Conclusions Glycerol injection has been used as one of the treatment options for the management of trigeminal neuralgia due to simplicity of procedure and long-term results with minimal complications.

ABS00739 Efficacy of Polidocanol Sclerotherapy for the Management of Venous Malformation in Maxillofacial Region Dr. Arun Kumar Mehta Rama Dental College Hospital and Research Centre, Kanpur Abstract Background/Introduction Venous malformations in maxillofacial region are common and need to be treated conservatively in smaller low-flow superficial lesions. Sclerotherapy with Polidocanol provides better results with minimal complications. Objectives To evaluate the efficacy of polidocanol sclerotherapy in the management of venous malformation in maxillofacial region. Methods 25 patients were selected with symptoms of pain, swelling, discoloration functional limitations and discoloration in maxillofacial region. They were treated with polidocanol sclerotherapy. The outcome were evaluated on the basis of color, swelling, ongoing growth, and assessment by parents and physician. Serial photographic records were maintained. The response were graded as excellent, good, poor, or nil. Results All patients reported ‘‘good response’’ in pain 60% (3/5), swelling (87%; 20/23), functional limitation (81%; 17/21), and cosmetic disfigurement (73%; 11/15). None of the patients responded to ‘‘No change’’ or ‘‘worse’’ for any symptoms. In addition, 17 of 25 patients (68%) reported being ‘‘very satisfied’’ with the treatment; these patients were defined as the ‘‘satisfaction’’ group. Conclusions Efficacy of polidocanol sclerotherapy for the treatment of low flow venous malformations in maxillofacial region produces excellent results with minimal complications.

ABS00747 Role of Sialoendoscopy in Management of Non Stone Disorders of Salivary Gland Dr Chirag Chamria, Dr Gokul Venkateshwar Dept. of OMFS, D Y Patil University, School of Dentistry, Navi Mumbai Abstract Background/Introduction Eligible articles that reported on the use of sialendoscopy in the treatment of non-stone disorders were identified using Pubmed,

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S260 Science Direct, NCBI, & Google Scholar. The search used key words sialendoscopy, salivary endoscopy, salivary scope, salivary duct stenosis, salivary duct stricture, salivary duct obstruction, sialadenitis, chronic sialadenitis, juvenile recurrent parotitis, parotitis. Objectives Review the current literature on the use of sialendoscopy in the treatment of non-stone disorders of the major salivary glands. Methods Full-length prospective and retrospective original articles; systemic reviews; and meta-analysis, including adults and children with adequate data for evaluating the sialendoscopy for non-stone disorders, were included. Results There is an increasing trend for the use of sialendoscopy for salivary obstruction caused by a wide variety of non-stone disorders worldwide. The studies of sialendoscopy for non-stone disorders are often retrospective, of smaller sample size, and more subjective in measurement of patient outcome. The most common indications currently for the procedure are scars, juvenile recurrent parotitis, radioiodine sialadenitis, and Sjogren syndrome, respectively. Conclusions Although the initial evidence for the use of sialendoscopy for nonstone disorders is not as established as that for stones, it remains a promising gland-preserving tool in the management of non-stone disorders of major salivary glands.

EPS00748 Boron Neutron Capture Therapy !!!!!!!!!!! Dr. Rubi Gupta RCDSR Bhilai Abstract Background/Introduction BNCT, a kind of radiotherapy, is a revolutionary treatment method which enables to kill only the cancer cells selectively by generating a nuclear reaction. The target substance, the boron compound, which is absorbed into cancer cells and exposed to irradiation from a neutron, which is harmless to the human body. The Boron reacts to this exposure and kills the cancer cells. Objectives As alternative to conventional radiation therapy for malignant brain tumors, recurrent head and neck cancer, and recurrent sarcomas. To estimate safety and effectiveness of BNCT for patient with recurrent head and neck cancer for which there were no other treatment option. Methods From December 2001 to February 2013, total of 35 patient with recurrent HNC by means Of 52 applications of BNCT. Histopathologically, there were 24 patients with squamous cell carcinomas. 7 with salivary gland carcinomas and 4 with sarcomas. All of them had received standard therapy and subsequently developed recurrent disease for which there were no other treatment options. All of the patient received intravenously either a combination of two boron containing drugs, sodium borocaptate (BSH, 5g) and borophenylalanine (BPA, 250mg/kg) or BPA (500mg) alone. In this report, the clinical results and outcomes of 35 patients with HNC who had received BNCT at either the Kyoto University research reactor institute (KURI) or Japan Atomic Energy Agency (JAEA) nuclear reactor. Results Regression rates were CR:18 Cases (51%), PR:13 (37%), PD:3 (9), NE:1. 1) The overall response rate 88%. 2) The mean Survival Time

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 was 24.2 Months and the 4 year and 7 year OS rates were 42% and 36% respectively. 3) Survival times following BNCT ranged from 1 to 95 month 4) BNCT improved quality of time and survival time. 5) The primary adverse events were brain necrosis, osteomyelitis and transient mucositis and alopecia. Conclusions All cases were advanced and 17 of 35 (49%) had regional lymph node metastases and 10 Out of 35 (29%) had distant metastases. Boron concentration rations of tumor/normal tissue as determined by 18FBPA- PET imaging were 1.8-7.0 for SCC, 2.5-4.0 for sarcomas and 2.5-7 for parotid tumor.

EPS00776 Evolution of Dressing Materials: Then and Now Dr. Nitesh Chhikara Bapuji Dental College & Hospital, Davangere, Karnataka Abstract Background/Introduction Throughout history, from the ridiculous to the ingenious, various interventions have been utilized to enhance healing in acute wounds and to overcome the unique challenges posed by chronic wounds. Objectives This presentation discusses the evolution of the types of dressing materials and methods from the past to the most advanced technologies of the present that are used in order to enhance wound healing and stave off infections. Methods PolyMem polymeric membrane range of dressings is multifunctional and comprises a hydrophilic polyurethane matrix that contains a mild, non-toxic wound cleanser (F-68 surfactant), soothing moisturizer (glycerin), a superabsorbent starch co-polymer and a semi-permeable backing film and lead to a giant evolution in dressing materials history. Another key feature is their ability to combine wound cleansing, debridement and fluid handling (absorption and retention of fluid) which makes them highly suitable for a wide variety of wounds and cost-effective approach to healing and pain relief. Results Combination of dressings with drugs or active agents was done to prevent or treat infection, stimulate the healing process, or control the production of scar tissue and favorable results were obtained. Conclusions The development of newer materials like polymer dressings along with nano-crystalline technology and advancement of the existing methods can result in better outcomes and improve concordance with the care plan and simplifying the dressing choice.

EPS00781 Augmented PRF in the Management of Cystic Lesions Dr. Shreepriya Miskin Abstract Background/Introduction platelet rich fibrin is a autologous biomaterial, which is second generation platelet concentrate which possesses favourable biological properties like inducement of new blood vessels, support of immune response, helps in hemostasis, wound coverage and accelerate both

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 soft tissue and bone healing. Bone grafts have excellent bone conductive properties and permit outgrowth of osteogenic cells from existing bone surface into the adjacent bone structure. Objectives To evaluate the outcome with use of PRF in isolation or in combination with bone graft material in the management of peri apical lesion. Methods In the patients who diagnosed with cystic lesion, after enucleation, bony defect filled with PRF in isolation and in combination with graft material to evaluate the healing and bone formation post operatively. Results PRF in combination with graft gives better healing. Conclusions PRF in combination with graft, will improve handling properties, graft stabilization, hemostasis, promote wound healing, bone growth and maturation.

EPS00788 Stem Cells: The Future of Dentistry Dr. Ankita Mutha ACPM Dental College, Dhule Abstract Background/Introduction Stem cells have become a mainstay in future research in dentistry. In humans, dental stem cells are relatively easily obtainable and exhibit high plasticity and multipotential capabilities. This will be a benchmark in the future Oral and Maxillofacial Surgery. Objectives The objective of this poster is to highlight the types of stem cells, methods of harvesting stem cells and its uses in Oral and Maxillofacial Surgery. Methods Mechanically dissociate the pulp tissue and filter through a 70um strainer and culture in alpha-minimal essential medium (MEM) with 20% FBS and medium changed twice a week. At day 21 cells were detached and analyzed at Fluorescence Activated Cell Sorter (FACS) for stem/progenitor antigen expression in good manufacturing practice (GMP) conditions. Cells will be detached using 0.02% EDTA solution, centrifuged and incubated with 1ll of antibody in 100ll of phosphate buffered saline (PBS) solution for 1hour at 4C. Antibodies were anti CD34 and anti-flk-1. Conclusions Stem cells of dental origin have multiple applications, nevertheless, there are certain limitations as well. Like other powerful technologies, dental stem cell research poses challenges as well as risks. If we are to realize the benefits, meet the challenges, and avoid the risks, stem cell research must be conducted under effective, accountable systems of social-responsible oversight and control, at both the national and international levels.

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EPS00818 Effectiveness of 4% Articaine for Maxillary Posterior Tooth Extraction Dr. Mohd Athar Iqbal, Dr. Shefali Ghodeswar, Dr. Vrinda Kolte, Dr. S.R. Shenoi, Dr. Anoop Garg VSPM Dental College Abstract Background/Introduction Research shows that most of the population may avoid dental care because of fear of injection. 1 Palatal injection are most painful and known to be poorly tolerated. The posterior buccal maxilla is thin and porous, and facilitates the diffusion of local anesthetic, especially articaine, a local anesthetic agent, which is known to be highly diffusible. Objectives To demonstrate effectiveness of articaine as an anesthetic agent used on buccal side only. Methods The data will be collected from 180 sites. - In the experimental side 1.7ml 4% articaine hydrochloride with epinephrine was given buccal. - On the control side an identical protocol was applied for buccal injection; and palatal infiltration - Pain will be assessed with VAS and VRS scale. Results In the experimental side 71/80 patients (88.7%) indicated that the pain was ‘‘less than expected’’, 8 patient indicated that the pain was ‘‘as expected’’ and 1 patient rated it as ‘‘greater than expected’’. On the control side, 74/80 patients (92.5%) indicated that the pain was ‘‘less than expected’’, 4 patients indicated that the pain was ‘‘as expected’’ and 2 patients rated it as ‘‘greater than expected’’. Conclusions Articaine hydrochloride 4% demonstrated relatively good buccal palatal diffusion and hence to provide analgesia owing to high diffusing property of articaine hydrochloride; thus discomfort associated with injection can be avoided.

EPS00822 Oral and Maxillofacial Surgery: Perception & Referral Patterns of Various Medical and Dental Health Care Professionals in Nagpur City: An Observational Cross Sectional Study Dr. Nilima Surve, Dr. S.R. Shenoi, Dr. Vrinda Kolte, Dr. Nikhil Moriwal, Dr. Sapna Vadera VSPM’s Dental College and Research Centre, Nagpur Abstract Background/Introduction People in today’s world are more health conscious and are aware of the different medical specialties. Despite the tremendous advancements in the field of dentistry, there seems to be a limited knowledge among the general public and also among medical professionals regarding the areas of specialization in dentistry. Oral and maxillofacial surgery (OMFS) receives referrals from dental and medical professionals and also from emergency services. This remains the only specialty in dentistry to be closely associated with other medical departments. 1 Patients regularly present to their dentists or

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S262 emergency departments with abnormalities that require the expertise of specialists in OMFS. Our medical and dental colleagues need to have the necessary knowledge to make informed decisions about their patient’s management. 3 It has been found that very few studies have collected data concerning the dental knowledge of medical practitioners. Objectives To main objective of the study is to evaluate the referral pattern in OMFS by various medical and dental health care professionals. - To ascertain how knowledgeable the medical and dental health care professionals are about the diverse scope of surgical procedures that the oral and maxillofacial surgeon performs. Methods An observational cross sectional study was conducted in 2 months duration. Medical Health Care Professionals and Dental Health Care Professionals in the institution and various private practitioners in Nagpur city were included in the study. MBBS: 50 MS: 50 BDS: 50 MDS: 50 Data was collected using printed pre tested, semi-structured questionnaire. The data collected is to be analyzed using the Statistical Package for the Social Sciences statistical software (SPSS version 16.0). Results Results are awaited as the study is under statistical evaluation. Conclusions The term ‘oral and maxillofacial surgery’ (OMFS) evolves from the anatomical region with which it deals. Contrary to common belief, the work performed by an oral and maxillofacial surgeon (OMS) does not start and end with teeth. It expands to incorporate procedures that are life saving, as well as those that enhance the quality of life by providing better function and aesthetics. In the Indian scenario, OMFS as a specialty till date is far removed in the thoughts of medical professionals and the general public. Our medical and dental colleagues need to have the necessary knowledge to make informed decisions about their patient’s management.

EPS00825 PRP in Oral and Maxillo-Facial Surgery

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Conclusions The efficacy of PRP in improving wound healing makes it a useful adjunct in Oral and Maxillo-Facial surgery. PRP can be used in a wide variety of surgeries and its versatility can make it a helpful addition.

Section: Scientific Innovations INV001 Intermaxillary Fixation Technique Dr. Abdul Ahad Khan Intermaxillary fixation [tying/alignment of upper and lower teeth together in a prespecified position (satisfactory dental occlusion/maximum intercuspation)] is one of the treatment modalities employed in the management of facial jaw fractures since times immemorial. It has also been used to orient the upper (maxilla) and lower jaw (mandible) in various other surgical procedures such as orthognathic surgery, tumor/cancer resection surgery etc. There are various ways of achieving intermaxillary fixation (IMF) mentioned in the literature viz., Gilmer’s wiring, Risdon’s wiring, arch bar wiring, Ivy eyelet wiring, intermaxillary fixation screws, orthodontic brackets, bracket bars bonded to the teeth, adhesive cast and thermoforming splints, buttons or beads and wires, Dimac wires, Rapid IMF etc. The technique mentioned here is novel, innovative and has bare minimum disadvantages as compared to all the previous techniques. Technique: A pre-specified 26 gauge Stainless Steel wire of 6 inches/ 15cm length is stretched and straightened to release the inner stresses. Wiring involves one corresponding tooth on each side (right and left), in both upper and lower arches, say 2nd premolar and/or central incisor. For demonstration purposes, we use artificial dental models and consider 2nd premolar of left upper (maxillary) and lower (mandibular) arch. Both ends of the straightened wire are passed from buccal (outer) to palatal (inner) side through the mesial and distal interdental spaces (as shown in photograph no. 1).

Dr. Siddhant Pradhan/Dr. Mukul Padhye/Dr. Gokul V Abstract Background/Introduction During the past several years, much has been written about a preparation called platelet-rich plasma (PRP) and its potential effectiveness in Oral And Maxillofacial Surgery. PRP is now widely used in OMFS to augment wound healing in various situations. Objectives The objective of this presentation is to shed light on the various uses of PRP in Oral and Maxillo-Facial Surgery and its efficacy in improving the post operative results. Methods A review of literature was conducted for PRP in Oral and maxillofacial surgery. A number of articles were reviewed and compared. Results The results of these studies demonstrate that PRP is effective in soft tissue healing and bone regeneration. There was no significant advantage to the use of PRP when combined with other materials with regards to sinus lifting but the results can vary depending on the material used.

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Now the wire that was passed from the mesial interdental space of maxillary left 2nd premolar should be directed through the distal interdental space of mandibular left 2nd premolar while coming out from lingual (inside) to the buccal (outside) and the wire that was passed through the distal interdental space of maxillary left 2nd premolar was brought buccally (outside) from the lingual (inside) side through the mesial interdental space of mandibular left 2nd premolar (as shown in photograph no. 2).

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The length of the wires are adjusted suitably after achieving satisfactory dental occlusion (as shown in photograph no. 3) and IMF (Intermaxillary fixation) is done by tying both the buccal wires together over the facial/buccal surface of mandibular left 2nd premolar (as shown in photograph no. 4).

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The passage of the wires lingually/internally (towards the side of the tongue) creates an ‘X’ shape because of crossing over (as shown in photograph no. 6).

One important point to mention here is that wires are to be placed on both right and left sides initially and IMF (intermaxillary fixation) should be done simultaneously on both the sides. The end result is shown in photograph no. 7A, 7B and 7C (as seen from both sides and from behind) below.

Photograph no. 7A

Photograph no. 7B

Photograph no. 7C

Left IMF

Right IMF

As seen from the back (inside)

Advantages

Excess wire will be cut and tucked interdentally (as shown in photograph no. 5).

1. It takes very less time for application and removal (an average of 5 minutes, each for doing IMF & removal). 2. It remains stable over a time span of 3–4 weeks if taken care of. (i.e. the patient should voluntarily bite the teeth into occlusion forcefully, while sneezing/ coughing, so that bare minimum pressure is transferred to the wires).

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3. It reduces intra-operative surgery time (required for doing IMF as compared to other techniques). 4. No pre-operative preparation needed (i.e. arch bar/ ivy eyelet application). 5. In addition to Maxillofacial trauma, it can be used in all surgeries related to jaw reconstruction (orthognathic surgery, jaw resection/reconstruction surgery) wherever IMF is needed. 6. It permits better oral hygiene maintenance. 7. It reduces possibility of glove perforation (as compared to other prevalent techniques). 8. It reduces possibility of needle stick injury per se (as compared to other prevalent techniques), thus less possibility of transmission of infection. 9. It reduces iatrogenic trauma (due to less no. of wires used and less no. of teeth involved). 10. It is very economic and easy to master. Disadvantages: 1. Its utility is questionable in cases where the teeth have open inter-proximal contacts. 2. Its utility is limited when the involved teeth are also compromised (mobile/fractured). 3. Even if any one of the wires gives way (breaks), then we will have to repeat the wiring on both the sides.

INV002 Newer Technique of Third Molar Removal in Trismus Due to Oral Submucous Fibrosis Dr. Abhishek Akare Abstract In oral submucous fibrosis, to avoid chronic mechanical irritation in posterior part of buccal mucosa adjacent to the malposed upper and lower third molar, extraction of malposed third molar is necessary. Trismus caused by fibrosis makes it difficult for the removal of third molar. Any attempt to open the mouth forcefully during extraction may tear the buccal mucosa leading to excessive bleeding and further aggravating the fibrosis in that region. To avoid and overcome these problems this technique can be adopted so that the extraction of malposed third molar becomes easier. Technical Note Oral Submucous Fibrosis (OSF) is characterized by chronic, insidious fibrotic change causing stiffening of oral mucosa, oropharynx and trismus. In advanced cases thick fibrotic bands extend from subepithelial connective tissue to muscle layer.1 Chronic mechanical trauma due to sharp remaining teeth, less than ideal fillings prosthesis and loose anchoring attachments have been report etiology for oral squamous cell carcinoma in OSF patients.2 Trauma to mucosa acts as a promotional stimulus in inducing epithelial dysplasia or carcinoma initiated with carcino-gen like with betel nut, tobacco.3 In order to avoid chronic mechanical irritation in posterior part of buccal mucosa adjacent to the malposed upper and lower third molar, extraction of malposed third molar is necessary. Trismus caused by fibrosis makes it difficult for the removal of third molar due to reduced mouth opening, limited access and reduced visibility.

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Improper instrumentation due to the inadequacy of intraoral space leads to the difficulty of anaesthetizing the region, inability to place the forcep etc. Any attempt to open the mouth forcefully during extraction may tear the buccal mucosa leading to excessive bleeding and further aggravating the fibrosis in that region. To avoid and overcome these problems the following measures can be adopted so that the extraction of malposed third molar becomes easier: 1. Vazironi Akinosi block should be used instead of inferior alveolar nerve block for mandibular third molar. Posterior superior alveolar nerve and greater palatine nerve block should be used for maxillary third molar. 2. The adjacent buccal mucosa is to be anaesthetized topically. 3. 24-guage standard stainless steel wire is to be used. This wire is to be cut obliquely and introduced through the interdental space of the second and third molar. The two ends of the wire are then twisted tightly around the crown to prevent them from slipping. 4. The tooth is elevated with the help of an elevator. While elevating the tooth, precaution should be taken that the adjacent buccal mucosa is in a relaxed position. This can be accomplished by asking the patient to close the mouth while elevating the tooth. 5. After elevating the tooth, it is pulled out of the socket with the help of a twisted wire instead of applying the forceps. Advantages 1. It does not tear buccal mucosa as the mucosa is in relaxed position. 2. No space is required for placing the wire in the third molar region. 3. Patients experience relatively less pain. Disadvantages 1. It is not used in stage 4 cases of OSMF because of the difficulty of access to the distal to the third molar. Hence placing the wire in that region can be difficult. 2. It is a time-consuming process as it takes a lot of time to place the wire in the third molar region. 3. This technique is used only in completely erupted third molars. Acknowledgements Funding: No funding was required. Conflict of interests: No conflict of interest. Ethical approval: Not required. Patient consent: Informed consent has been obtained. References 1. Lai DR, Chen HR, Lin LM, Huang YL, Tsai CC: Clinical evaluation of different treatment methods for oral submucous fibrosis. A 10 year experience with 150 cases. J Oral Pathol Med 24:402, 1995. 2. Thumfart W, Weidenbecher M, Waller G, Pesch HJ: Chronic mechanical trauma in the aetiology of oropharyngeal carcinoma. J Maxillofac Surg 6: 217, 1978. 3. Bhonsle RB, Murti PR, Daftary DK, Gupta PC, Mehta FS, Sinor PN, Irani RR, Pindborg JJ: Regional variations in oral submucous fibrosis in India. Community Dent Oral Epidemiol 15:225, 1987.

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INV004 Posterior Belly of Digastric Muscle Flap for Contour Deformity Correction After Superficial Parotidectomy Anuj Jain & Anshul Rai Department of Trauma and Emergency Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India Reconstruction of the hollowing defect after parotidectomy becomes essential part of the surgery now days. The percentage of Frey’s syndrome (FS) postoperatively [1] was between 12.5 to 62%. FS and contour deformity (CD) significantly reduces a quality of life of the patient [2]. Many space filling techniques to prevent CD and FS have been documented in the literature after parotidectomy. They are Sternocleidomastoid (SCM) muscle flap, Platysma muscle flap (PMF), Temporoparietal fascia (TPF), Superficial musculoaponeurotic system (SMAS), Buccal fat pad (BFP). Non-vascularized tissues such as dermal fat graft, fat injections at subdermal layer, acellular dermal allograft and artificial material such as ethisorb or gore-tex [3]. SCM muscle flap creates a hollow deformity of the upper neck at the donor site, especially in thin and young patients. When large inferiorly based flap was raised and when the patient turns his or her head away from the donor side it becomes more obvious (Fig. 1) [4]. PMF is very thin and required expertise. All other techniques required another incision or dissection which increases post-operative discomfort of the patients. To eliminate all these complications, we recommended posterior belly of digastric muscle (PBDM) flap (Fig. 2) after superficial parotidectomy to prevent CD and FS.

Fig. 2 Photograph showing posterior belly of Digastric muscle within the surgical site We have used this technique successfully in 5 patients without any complications. After identification of facial nerve trunk, the conventional anterograde nerve dissection was carried out carefully followed by superficial parotidectomy. The digastric tendon was incised at the greater cornu of the hyoid bone (Fig. 3) and the flap was reflected easily. The PBDM was sutured to the remaining dense fascia of the parotid bed and tendon was sutured in the pre auricular area just above the auriculotemporal nerve course to prevent FS post-operatively (Fig. 4).

Fig. 1 Postoperative photograph of the patient showing hollowing defect Fig. 3 PBDM flap

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Fig. 4 Photograph represents sutured tendon of muscle at the pre auricular region just above Fig. 6 Bilateral symmetrical postoperative result Advantages of PBDM PBDM originates from the mastoid notch lies between the mastoid and styloid process, very close to the stylomastoid foramen and inserted on the digastric tendon. It is considered by many as a landmark to identify the facial nerve [5]. It is encountered during the surgery and that’s why easy to dissect. No extra incision or dissection required. The branch of occipital artery which supplies the muscle was preserved. It can be easily used without any complications in young patients and patients with thin neck. There was no donor site morbidity and no post-operative contour deformity was noticed. Excellent postoperative results were noticed after reconstruction with PBDM flap (Figs. 5, 6).

Disadvantage PBDM is short in comparison to other flaps but eliminates all the drawbacks of other flaps mentioned above. In conclusion, we present an innovative and simple method of PBDM transposition to eliminate the CD after superficial Parotidectomy. References 11. Li C, Yang X, Pan J, Shi Z, Li L. Graft for prevention of Frey syndrome after parotidectomy: a systematic review and metaanalysis of randomized controlled trials. J Oral Maxillofac Surg. 2013;71:419–27. 12. Arden RL, Miguel GS. Aesthetic parotid surgery: evolution of a technique. Laryngoscope. 2011;121:2581-5. 13. Hayashi A et al. Effectiveness of platysma muscle flap in preventing Frey syndrome and depressive deformities after parotidectomy. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2016;69:663–72. 14. Edward W. H. Sternomastoid muscle flap for parotidectomy: the pros and cons. British Journal of Plastic Surgery. 2002;55:88–93. 15. Kanatas AN, McCaul JA. Use of digastric branch of the facial nerve for identification of the facial nerve itself in parotidectomy: technical note. British Journal of Oral and Maxillofacial Surgery. 2011;49:493–494.

INV005 A Novel Approach to Treat Markowitz Type 1 and Type 2 Naso-Orbito-Ethmoidal FracturesMinimally Invasivetranscutaneo-Periosteal Plates Dr Arjun Shenoy, M.D.S Fig. 5 Excellent postoperative result after turning the head Fellow in CMF Trauma (AOMSI) Introduction Displaced Fractures of the Naso-Orbito-Ethmoidal complex have always stood out as a challenge for surgeons owing to their complex articulation in the central midface from the anatomic, aesthetic and

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functional perspective. In Maxillofacial Trauma, the evolving trends have shown a steady paradigm shift towards minimally invasive procedures when approaching facial fractures from the extra-oral approach. The aim of these minimally invasive procedures has been to achieve restoration of original form and function without compromising the aesthetic outcome. Conventional surgical approaches to the central midface describe incisions which allow for proper visualisation of the fracture fragments to aid in their reduction and fixation. The attachment of the medial canthal ligament to the NOE Complex and its disruption during the fracture play a vital role in the treatment planning and surgical intervention. Markowitz Type 1 and Type 2NOE fractures can be unilateral or bilateral and are characterized by the medial canthal ligament being attached to a bone fragment which may or may not have significant displacement. The innovative novel approach of transcutaneo-periosteal plates (TCPP system) was conceptualized by the authors as a minimalistic but effective design template to aid in anatomic reduction and dynamic fixation without the need for placing an incision in the treatment of Markowitz Type 1 & 2 fractures of the NOE complex fractures. The dynamic fixation refers to the fixation principle which allows for real time manipulation of the template by digital compression in the postoperative period allowing for the moulding of the NOE Complex into its desired form and function. A detailed clinical study of the versatility and viability of the TCCP System was undertaken as a one year fellowship scientific study by the author during his one year AOMSI fellowship in Cranio-Maxillofacial Trauma at a Tier 1 Trauma Centre. Materials and Methods To have an universal and appealing application, the TCCP System has been modelled on a template that was readily available and inexpensive. The 4 hole with gap stainless steel and titanium plates served as the basic rigid splint upon which the displaced NOE complex could be re-suspended both with antero-posterior traction and horizontal vector traction. After the plate was in flush mimicking the intended framework to be restored, sutures 4-0 vicryl or nylon is passed through the skin and negotiated through the periosteum of the NOE complex and suspended over the template with positive traction. The traction suspension allows for post-operative manipulation by digital compression to aid in dynamic remodelling to res tore the anteroposterior projection and disrupted intercanthal distance.

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Methodology of Research The clinical study was performed over a period of one year as a part of the fellowship project as instructed by the AOMSI from 2015–16. The sample size of cases were 20. The cases included both displaced Type 1 markowitz and type 2 Markowitz fractures of the NOE Complex.

NOE fracture type

Patients

Markowitz type 1 with displacement

10

Markowitz type 2

10

Clinical Parameters

Antero-posterior projection

Pre-op & post op

Inter medial canthal distance

Pre-op & post op

Functional nasal airflow

Post op only

Subjective Patient satisfaction index

Post op only

Post operative radiographic measurements

Pre-op and post op

Why this Study Fits in the Innovative Bracket Having stepped into a year of fellowship in Cranio-maxillofacial trauma at a tier 1 unit, there existed an urge to design a simple yet brutally efficient template which could minimise the time required to fix the Type 1 and 2 fractures which did not necessarily need canthopexy. Since most of the patients who presented with these classification of fractures were usually the ones with pan-facial fractures, saving time using this radical yet simple design was a breath of fresh air. Clinically backed by a year long clinical original research study which confirmed the efficacy of the TCPP system in restoring the lost form and function, the author felt the need to advocate the simplicity and universal appeal of this innovation which could be beneficial to many units who deal exclusively in facial trauma surgery, hence saving time and increasing productivity of the unit. Patents None. Special Interests None.

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INV007 Transoral Gap Arthroplasty for Temporo Mandibular Joint Ankylosis Dr Dinesh Jhawar, Professor, Dr Ritesh Rajan, Professor and Head Dept of OMF Surgery, SVS Institute of Dental Sciences, Mahabubnagar Abstract This paper describes the technique of performing gap Arthroplasty in Temporomandibular Joint Ankylosis (TMJA) by transoral access. Treatment of TMJA by creating an adequate gap is paramount in preventing any future recurrence and this can be achieved only when good access is gained to this complex anatomical joint. Five patients with eight TMJA were treated by gap arthroplasty using intraoral approach. The average mouth opening before surgery was 8.6mm and an average mouth opening achieved post surgery was 37.9mm. The average follow up time was 9 months and none of the patient had any recurrence or significant complications during or after surgery. Our technique relies on using a stable landmark to trace the superior most extent of the Ankylotic mass and thereby facilitate in removing the entire mass including the medial extent. We found that even though transoral access is technically challenging and took an average time of 84 minutes, it has many advantages over conventional extra oral approaches in terms of facial scar or facial nerve injuries. Authors also emphasise on the importance of good post operative physiotherapy and pre surgical patient counselling to prevent future recurrence. Transoral Gap arthroplasty for Temporo Mandibular Joint Ankylosis Temporomandibular joint ankylosis (TMJA) is a common condition in India. In spite of attempts to prevent its incidence by timely and appropriate management of mandibular condyle fractures in both pediatric and adult populations, it is still seen quite rampantly. Ankylosis of temporomandibular joint is an extremely debilitating condition especially when it affects the joint in its growing stages. Apart from causing severe facial disfigurement, it also alters the patients eating habits and speech ability. It aggravates psychological stress, prevents the patient from maintaining good oral hygiene resulting in dental decay, loss of multiple teeth and hampers the quality of life 1. Treatment of ankylosis is often challenging and many surgical techniques have been reported in the literature. Since the times of Esmarch, 1851 who was credited with performing first ever osteotomy for ankylosis to the times of Abbe (1880) and Risdon (1934), who introduced the concepts of gap arthroplasty and interpositional arthroplasty respectively, to today’s times, the debate still rages on, on the choice of ideal treatment 2, 3. Kaban and et al. 4 outlined the protocol for management of TMJA in 1990 which is universally followed and was later modified by the same author 5 in 2009. Accessing the temporomandibular apparatus or the ankylotic mass, by choosing from myriad of extra oral incisions and techniques so far reported, had always been an impending challenge to the surgeon in terms of i) gaining adequate visibility, ii) minimizing facial scar, iii) negotiating facial nerve and auriculotemporal nerves to prevent their injuries, iv) to reduce intra-operative and postoperative hemorrhage, v) occasional anatomic deformity of the ear vi) surgical infection vii) salivary fistula and sialocele 6. Many authors tried to circumvent these complications approaching the joint trans orally. However, E. C. Ko and S. Lai 7 in 2009 were the first and only authors to report transoral access for the treatment of TMJA. In this article we report our experiences with transoral access to the TMJA and describe our

S269 surgical technique which differs from that of E. C. KO et al on certain important aspect. Patients and Methods Eight TMJA in a series of 5 patients were operated for gap arthroplasty transorally between February 2012 and August 2013. The average age of the patient at the time of surgery was 14.4 yrs and none of them were recurrent cases. Two of the patients had Sawhney’s class I type of ankylosis and three of them had type II ankylosis. The average mouth opening at the time of surgery was 8.6mm with the lowest being 4mm and the highest 14mm. All patients had history of trauma to the mandible with two of them reporting with history of prolonged Maxillomandibular fixation. Follow up ranged from 3 months to 20 months with mean follow up of 9 months. No interpositioning material or substance was used in any of the cases. Physiotherapy and mouth opening exercises were started on 1st post operative day with increasing intensity towards the 7th day. Patients were generally discharged on 3rd post operative day and reviewed once a week for the first month and once a month for the rest of follow up period. Condylar reconstruction is contemplated after one year of ankylosis free period and this is achieved using ramus distractors. (Table 1). Surgical Technique Nasotracheal intubation was done to administer anaesthesia on all five patients with the aid of blind awake technique. Following this, the incision site was infiltrated with 10 cc of lignocaine and adrenaline of 1: 200000 concentrations. With adequate retraction, mucosal incision was made along the external oblique ridge beginning from mandibular 1st molar, posteriorly along the anterior border of ramus. Mucoperiosteal flap was raised on lateral and medial surface of mandible down to the angle region and superiorly until the inserting fibers of temporalis muscle were visualized. They were incised and retracted upwards with the aid of forked ramus retractor almost till the tip of coronoid. A malleable retractor is then placed at the inner aspect of the ramus to protect the internal maxillary artery that lies immediately deep to the condylar neck and the channel retractor moved upwards for better access to the ankylosed area. An osteotomy was performed at the base of coronoid process running obliquely upwards towards the sigmoid notch. The osteotomy was completed with the aid of osteotomes and the coronoid was retrieved transorally after detaching the remaining fibers of temporalis. Once the coronoid was out, an attempt was made to increase the mouth opening with the aid of Hiesters mouth opener. In bilateral ankylosis, the same was attempted after completing coronoidectomy on both the sides. It was observed that mouth opening improved by an average of 3 mm after unilateral coronoidectomy and 5mm after bilateral resections. A mouth prop was placed interocclusally on the contra lateral side to maintain the mouth opening. The dissection was carried out superiorly towards the zygomatic arch and once it was identified, a periosteal incision was made at its inferior border and subperiosteal dissection was carried out along the arch posteriorly to trace the anterior and superior extent of the ankylotic mass and glenoid fossa. Once the superior extent of the ankylotic mass was delineated, an osteotome or surgical bur was used to separate it from the glenoid fossa. Another osteotomy was initiated at about 1.5 cm below the previous one to create an adequate gap. The entire ankylotic mass was removed in one piece or in piece meal pattern depending on the medial extent of the exuberant mass. In bilateral cases, the similar procedure was repeated on the opposite side. After release the mandible was vigorously opened and mobilized to release any leftover fibrous union. Postoperative physiotherapy was begun on 1st post operative day with gradual increasing intensity by the end of first week. Results The targeted minimum mouth opening at the end of surgery on table was 35 mm and we could achieve that mouth opening in all patients except one (Patient no:4). The mouth opening achieved

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85 mins 2mm 39mm 3 Months 41mm 4mm II Trauma Bilateral 12 5

M

80 mins

90 mins

Significant Decrease In Post 120 mins Op Mouth Opening

4mm

7mm 26mm

38mm 8 Months

6months 33.6mm

42mm 12mm

5mm II

I Trauma

Trauma Bilateral

Unilateral F

4

M

24

16

3

-

3mm

2mm 36mm

32mm 20 Months

8 Months 38mm

35mm 8mm Trauma

Trauma Unilateral

Bilateral M

M

II

12 2

123

I

8 1

14mm

Complications Mouth Opening of Amount of The Last Follow-Up Decrease In Mouth Opening Mouth Opening FollowImmediate Post-Op up Period Pre-Op Mouth Opening Age Sex Ankylosis Etiology Type (Sawhney) Patient No.

Table 1 Details and outcome of the patients treated

45 mins

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ranged from 33.6mm to 42 mm with the mean mouth opening of 37.9mm. All the patients presented slight decrease in mouth opening during follow up periods but none of the patients had any recurrence or significant decrease in post operative mouth opening. One patient (patient no 4) had decrease of mouth opening by 7mm at 2 months follow up which was the maximum decrease among all the patients, and was subsequently maintained with active physiotherapy. The mean decrease in mouth opening at the last follow up as compared to that achieved at the time of surgery was 3.6mm. Apart from one patient showing significant decrease in mouth opening, none of the patients had any intra operative or post operative complications. The superior most extent of the ankylotic mass was traceable in all the patients using this technique irrespective of the size and extent of the mass. The duration of surgery ranged from 45 minutes to 120 minutes with a mean duration of 84 minutes. Discussion The ultimate goals of treating TMJA is to restore mouth opening to at least 35 mm, prevent any further recurrence and to restore as near normal ramal height as possible either by reconstruction or by distraction osteogenesis. To achieve these goals, the foremost important thing is to gain a good access to the joint area which helps in adequate resection of the ankylotic mass. The variety of incisions and techniques described in the published data on approaches to the condyle 8, reflects the complexity of the anatomy of this region and the importance of preservation of vital structures in the pathway. The classical pre auricular approach described by Blair 9, Dingman 10 and the modified versions of Al-Kayat, Bramley 11 and popowich 12 carry the risk of injuring peripheral branches of facial nerve and an unsightly scar on the face. The post auricular incision described by Alexander 13 gives the best cosmetic result as it is hidden in the post auricular crease. Injuries to the facial nerve are minimal with this approach but in cases of massive ankylosis, it might be difficult to reach the anterior extent of the ankylotic mass and also could result in residual ear deformity or auricular stenosis. Vishal Bansal et al. 6 in comparing the pre auricular approach with post auricular in 30 joints with TMJA have outlined many benefits of this approach but also suggested that this approach might lead to more intra operative hemorrhage and the prolonged time to expose the joint as chief disadvantages. Politi et al. 14 proposed a surgical technique called ‘‘deep subfascial approach’’, in which they claimed no transient or permanent facial nerve injury by developing an additional protective fascial layer when the dissection was performed deep to the deep temporalis fascia. The bicoronal approach flap described by Pogrel et al.15, in bilateral ankylosis cases carries no special advantage over two separate bilateral preauricular incisions with temporal extensions. In our view it has additional burden of more blood loss, longer duration and has no advantage of wider exposure and access to the ankylosed mass as compared to the conventional pre auricular approach. Although many authors16,17 in the past have described intra oral approach to the condyles, to treat various problems related to it, it was E. C. Ko et al7 who first published this technique to treat TMJA. We observed similar advantages and disadvantages with our technique as described by Ko et al which are, absence of facial scar, less possibility of injuring the facial nerve and the auriculotemporal nerves, no sialocele, simultaneous coronoidectomy via the same incision, ability to protect internal maxillary artery by placing a retractor on medial surface of ramus and thus reducing chances of hemorrhage. The disadvantages with this technique like, limited surgical field, the requirement to have a good sense of orientation and the limitations regarding the selection of interpositional material are also agreed upon. We differ from Ko et al in terms of surgical technique, in which they advocate retaining the superior part of the ankylotic mass without any attempt at removing it to prevent possible risk of middle cranial fossa perforation. Salins3 clearly reiterated the importance of complete excision of ankylotic mass to prevent chances of reankylosis. He stated that partial excision of the ankylotic bone often results

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 in reorganization of the entire mass and complete encapsulation of materials used for interposition. The bridging ankylotic mass continues to grow without any signs of remodeling and is augmented on the medial side by tough fibrous scar which makes the second intervention even more challenging. Similarly Kaban4 and Raveh et al18 emphasized on complete excision of the ankylotic mass to prevent reankylosis. Our technique of complete removal of the ankylotic mass relies on tracing the superior most extent of the mass at its junction with the cranial base by using the inferior border of zygomatic arch as a key anatomical landmark. In our case series we did not use any interpositioning material, not for the reason that it is technically more challenging by transoral approach but for the reason that we believe aggressive post operative physiotherapy and proper counselling of the patient prior to surgery are the most important factors in preventing reankylosis. Our views are shared by Katsnelson et al2 in a systematic review and Meta analysis published by them in 2012. Similarly Ajoy Roy Choudary et al19 in their series of 50 cases of TMJA, emphasized the crucial role of post operative physiotherapy over interpositioning. Application of endoscopic technique in transoral approach to TMJA is irrefutable as described by Sembronio et al20. It is easy to check the medial aspect of the resection and intraoral endoscopic guidance may be useful to safely remove the ankylotic mass and anchor the temporalis muscle and fascia flap more accurately, reducing the risk of re-ankylosis. Though transoral approach cannot be employed in every case of ankylosis, especially in massive and recurrent cases, the option of using it should always be borne in mind whenever possible and should be augmented with an endoscope to improve the accuracy when available. References 1. Keqian Zhi, Wenhao Ren, Hong Zhou, Ling Gao, Lu Zhao, Chengqun Hou, Yincheng Zhang. Management of temporomandibular joint ankylosis: 11 years’ clinical experience. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009: 108: 687–692. 2. Alexander Katsnelson, Michael R. Markiewicz, David A. Keith, Thomas B. Dodson Operative Management of Temporomandibular Joint Ankylosis: A Systematic Review and MetaAnalysis. J Oral Maxillofac Surg 2012: 70:531–536 3. Salins PC. New perspectives in the management of craniomandibular ankylosis. Int J Oral Maxillofac Surg 2000: 29:337. 4. Kaban LB, Perrott DH, Fisher K. A protocol for management of temporomandibular joint ankylosis: J Oral Maxillofac Surg 1990 48: 1145. 5. Kaban, Bouchard, and Troulis. Management of Pediatric TMJ Ankylosis. J Oral Maxillofac Surg 2009: 67: 1966–1978. 6. Vishal Bansal, Sanjeev Kumar, Apoorva Mowar, Anurag Yadav, Gagan Khare. The post-auricular approach for gap arthroplasty - A clinical investigation. Journal of CranioMaxillo-Facial Surgery 2012 40: 500–505 7. E. C. Ko, M. Y. Chen, M. Hsu, E. Huang, S. Lai. Intraoral approach for arthroplasty for correction of TMJ ankylosis. Int. J. Oral Maxillofac. Surg 2009:38: 1256–1262. 8. G.J. Knepil, A.N. Kanatas b, R.J. Loukota. British Journal of Oral and Maxillofacial Surgery. 2011: 49: 664– 665. 9. Blair VP. Operative treatment of ankylosis of the mandible. Surg Gynec Obstet 1914: 19: 436 10. Dingman RO, Grabb WC. Intracapsular temporomandibular joint arthroplasty. Plast Reconstr Surg 1966: 38: 179–185. 11. Al-Kayat A, Bramley P. A modified pre-auricular approach to the temporomandibular joint and malar arch. Br J Oral Surg 1979: 17: 91–103.

S271 12. L. Popowich, R. M. Crane. Modified preauricular access to the temporomandibular apparatus: Experience with twenty-eight cases Oral Surgery, Oral Medicine, Oral Pathology 1982: 54: 257–262. 13. Alexander RW, James RB. Postauricular Approach for Surgery of the Temporomandibular Articulation. J Oral Surg 1975: 33: 346–350. 14. Massimo Politi, Corrado Toro, Roberto Cian, Fabio Costa, Massimo Robiony. Deep Subfascial Approach to the TMJ. J Oral Maxillofac Surg 2004. 62: 1097–1102. 15. M.A. Pogrel, D.H. Perrott, L.B. Kaban. Bicoronal flap approach to the temporomandibular joints. International Journal of Oral and Maxillofacial Surgery 1991: 20: 219–222 16. Moose SM. Surgical correction of mandibular prognathism by intra-oral subcondylar osteotomy. Br J Oral Surg 1964: 2: 172–176. 17. Shevel E. Intra-oral condylotomy for the treatment of temporomandibular joint derangement. Int J Oral Maxillofac Surg 1991: 20: 360–361. 18. Joram Raveh, Thierry Vuillemin, Kurt La¨drach, Franz Sutter. Temporomandibular joint ankylosis: Surgical treatment and long-term results. Journal of Oral and Maxillofacial Surgery 1989: 47: 900–906. 19. Ajoy Roychoudhury, Hari Parkash, Anjan, Trikha, DA. Functional restoration by gap arthroplasty in temporomandibular joint ankylosis: A report of 50 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999: 87: 166-9. 20. Salvatore Sembronio, Alberto Maria Albiero, Francesco Polini, Massimo Robiony, Massimo Politi. Intraoral endoscopically assisted treatment of temporomandibular joint ankylosis: preliminary report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007: 104: e7–e10 Captions to Illustrations 1. Table 1: Details and outcome of the patients treated. 2. Pic 1: Pre Operative OPG of left unilateral ankylosis 3. Pic 2: Pre Operative 3-D Reconstructed Image of Let Unilateral ankylosis 4. Pic 3: Intra Operative Picture of Tran oral Access and Gap Arthroplasty 5. Pic 4: Picture Showing resected coronoid and ankylotic Mass. 6. Pic 5: Post Operative OPG of the same patient at follow up.

Pic 1 Pre Operative OPG of Left Unilateral Ankylosis

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Pic 4 Picture Showing Resected Coronoid and Ankylotic Mass

Pic 2 Pre Operative 3-D Reconstructed Image of Let Unilateral Ankylosis

Pic 5 Post Operative OPG of the same patient at follow up

INV008 An Innovative and Novel Tool for Maxillo-Mandibular Fixation: Orthodontic Brackets and Fiber-Reinforced Composite Pic 3 Intra Operative Picture of Tran oral Access and Gap Arthroplasty

Dr. Gursimrat Brar Abstract Introduction Maxillo-Mandibular Fixation (MMF) is used in a variety of clinical situations, including the management of mandible and midface fractures, maintenance of occlusion during mandible reconstruction and maintenance of occlusion after elective orthognathic surgery. Stabilisation, immobilization and maintenance of occlusion are the primary goals accomplished in placing the patient into maxillo-mandibular fixation. Various methods for maxillomandibular fixation are prevalent; wiring alone or wiring of archbar being the most commonly used method. But this exposes the operator to many communicable viral and bacterial infections by perforating injuries as well causes considerable insult to the periodontium and is painful and uncomfortable for the patient. As a safer alternative, orthodontic brackets and elastics or elastomeric chain has been reported in literature, however, it may cause extrusion of the teeth. But combining it with some splinting technique may provide a satisfactory solution.

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Purpose of the study Clinical and radiological evaluation of the results of using orthodontic brackets and Fiber-Reinforced Composite for maxillo-mandibular fixation and also to evaluate the efficacy of this method in preventing perforating injuries to the operator. Methodology The present study included 30 patients who required maxillo-mandibular fixation as a part of their treatment for maxillofacial injuries. Maxillo-mandibular fixation using orthodontic brackets and fiber-reinforced composite was done and patients were followed up for 8 weeks. Occlusion, inter-incisal mouth opening, Loe and Sillness gingival index, incidence of debonding, any perforating injury to the operator were assessed during the study. Results Satisfactory occlusion was achieved in all the patients at 8 weeks post-operatively, mean mouth opening achieved at the end of 2 months was 39.2 mm, mean gingival index was below 1, incidence of debonding was 23.33% and incidence of glove perforation was 0. Conclusion Application of fibre-reinforced composite and orthodontic brackets behave more like a customized archbar where the fibre-reinforced composite provides horizontal stability and brackets act as cleats for application of elastics. From this study, we conclude that this method is highly beneficial in preventing perforating injuries to the operator, especially in cases of patients with positive viral markers. The respect for periodontal tissues, bloodless application and removal and ease of oral hygiene maintenance are other advantages of this technique. Introduction Trauma to the facial region frequently results in injuries to soft tissue, teeth and major skeletal components of the face. One of the main challenges in the management of maxillofacial trauma is to consistently restore patients back to their pre-injury form and function. In the proper reduction of fractures of tooth-bearing bones, it is important to place the teeth into the pre-injury occlusal relationship. Maxillo-mandibular fixation is used in a variety of clinical situations, including the management of mandible and midface fractures, the maintenance of occlusion after elective orthognathic surgery. Stabilization, immobilization, and maintenance of occlusion are the primary goals accomplished in placing the patient into MMF. Currently, rigid internal fixation techniques are widely used for the treatment of fractures. Even with rigid fixation, a proper occlusal relationship must be established before reduction, stabilization and fixation of the bony segments. Use of orthodontic brackets and elastics or elastomeric chain as an alternative technique for maxilla-mandibular fixation has been widely reported in literature. However, theoretically, bonding brackets on to the teeth alone and applying elastic traction may cause the extrusion of the teeth, so use of orthodontic brackets as a method for maxillamandibular fixation must be combined with some splinting technique. The development of fiber-reinforced composite (FRC) technology has brought a new material into the realm of metal-free, adhesive aesthetic dentistry. It has not only shown to have significant benefits in terms of mechanical properties, the possibility of direct chairside application and the ability to bond to the tooth structure make FRC an attractive choice for a variety of dental applications including splinting of the teeth. Orthodontic brackets bonding and intermaxillary elastics in combination with a splinting technique is a useful alternative method of maxilla-mandibular fixation in the management of maxillofacial trauma. Material and Methods The present study was undertaken in 30 patients who reported to the outpatient Department of Oral and Maxillofacial Surgery, Dasmesh Institute of Research and Dental Sciences, Faridkot and required maxillo-mandibular fixation as part of their treatment for maxillofacial injuries. The patients were selected irrespective of sex, caste, religion and socioeconomic status.

S273 Diagnosis and decision of the treatment method of maxillofacial fractures was made on the basis of detailed history, clinical and radiological examination. Routine laboratory investigations which include complete blood count, urine analysis, glycemic index and viral markers were carried out to assess systemic condition of selected cases before the procedure. All the procedures were performed by the same surgeon. The inclusion criteria for the study were: Patients of age 10 years and above with dentoalveolar fractures, mandibular fractures, both associated with unilateral or bilateral condylar fractures, midface fractures requiring maxillo-mandibular fixation, TMJ disorders requiring maxillo-mandibular fixation or restricted mouth opening. The exclusion criteria were: Patients with a decreased level of consciousness, learning difficulties or history of significant psychiatric disease, with compromised respiratory status, with associated head injury, edentulous patients and those with multiple missing teeth on either side of fracture line or in the opposing arch. All the patients were evaluated for the cause requiring maxillomandibular fixation. Mouth opening was assessed by measuring the inter-incisal distance in millimeters between central incisors in each arch. Assessment of gingival condition was made by Loe and Sillness gingival index (GI). All the teeth were assessed. Following pre-operative assessment, patient was admitted. Medications (antibiotics, anti-inflammatory drugs and analgesics) were administered prior to the procedure, if required. Operative Procedure Step 1 Under complete aseptic conditions, patient was painted with antiseptic solution and draped, exposing the area to be operated upon. Local anaesthesia was administered using 2% Xylocaine with 1: 80,000 concentration adrenaline. Oral cavity was thoroughly irrigated with saline and 0.02% chlorhexidine solution and all the loose debris and blood clots were removed, if present. Figs. 1, 2.

Fig. 1 Pre-operative photograph

Fig. 2 Pre-operative radiograph

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S274 Step 2 The teeth were cleaned with saline soaked gauze to remove superficial debris. Corresponding opposing teeth in both the arches were selected. After thorough drying with air spray, the selected teeth in one quadrant were etched with the application of 37% phosphoric acid etching gel for 15 seconds. Step 3 Selected teeth were thoroughly irrigated with copious amounts of distilled water to remove the etchant gel. Teeth in that quadrant were isolated with cotton rolls to prevent moisture contamination and dried with the help of air spray till frosted surface of the etched teeth became evident. Step 4 Bonding agent was applied on the frosted surface of the teeth with the help of applicator and light cured for 30 seconds. Step 5 Required length of bondable reinforcement ribbon was cut with scissors and wetted with bonding agent. Flowable composite was applied on the etched teeth and bondable reinforcement composite placed on the selected teeth with flowable composite and cured for 30 seconds with light cure unit. Step 6 Orthodontic brackets were held in a bracket holding forceps and bonded to the selected teeth over the bondable ribbon. Same procedure was repeated for each quadrant Figs. 3, 4.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Step 7 Occlusion was achieved with gentle manipulation of the fractured segments and maxillo-mandibular fixation was done using short orthodontic elastic chain Figs. 5, 6.

Fig. 5 MMF with orthodontic Elastic chain

Fig. 6 Immediate post-operative occlusion achieved

Fig. 3 Fibre-reinforced composite with orthodontic brackets bonded over teeth

Fig. 4 Fibre-reinforced composite and orthodontic brackets placed in all quadrants

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Patients with unfavourable fractures in which occlusion could not be achieved with manual manipulation, internal fixation was planned under general anaesthesia. After exposing the fractured segments, anatomical reduction was achieved by manual manipulation and point reduction forceps, maxillo-mandibular fixation was done with short orthodontic elastic chain and internal fixation was done. Patients treated with closed reduction were put on maxillomandibular fixation for 4 to 6 weeks and patients treated with open reduction and internal fixation were put on MMF for minimum of 7 days post-operatively. Patients with condylar fracture were put on MMF for 2 weeks followed by guiding elastics. Glove perforations and percutaneous injuries during the procedure were recorded. The same type of gloves (Surgicare) were used, double gloving technique was used but only perforations of the outer glove were noted. When it was noticed that gloves were perforated they were changed immediately. All skin perforations, even minor ones, were noted. Glove integrity was tested using the water-inflation technique described by Brough et al. Post-operative Care All patients were prescribed dispersible analgesic tablets and 0.02% chlorhexidine mouth rinse. Antibiotics were prescribed post-operatively, if required. Orthodontic elastic chain was changed every week post-operatively during the period of MMF to maintain the elastic strength. All patients were encouraged to maintain good oral hygiene and brush their teeth daily. Patients were put on a liquid diet for the

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period of maxillo-mandibular fixation. Patients were asked to avoid smoking and abstain from consuming alcohol at least for the period of maxillo-mandibular fixation. Post-operative Assessment Patients were followed for a minimum period of 8 weeks post-operatively and observations were made. 1. Interarch occlusal relationship of teeth was assessed every week for the period of follow-up. 2. Any incidence of debonding of brackets, time of debonding during the period of MMF was documented. 3. Loe and Sillness gingival index for assessing gingival health was noted every week during the follow-up period. MMF was released for assessing lingual surfaces of teeth for gingival index and MMF was done again with new orthodontic elastic chain. 4. Inter-incisal mouth-opening in millimetres following the release of MMF was assessed every week for the period of follow-up. 5. Any other complications like non-union, malunion, delayed union, need of an alternate method of MMF, breakage of elastic chain or elastics was also noted during the follow-up period. Case – I

Distribution of patients according to cause requiring MMF was as follows. Out of 30 patients, 20 patients were treated with closed reduction and 10 patients were treated with open reduction and internal fixation followed by MMF for 7 days (Table 1). Table 1 Distribution of patients according to cause requiring MMF and method of treatment Cause MMF

requiring No. of Percentage Method of treatment Patients

Parasymphysis Fracture

Pre-operative Occlusion

Pre-operave OPG

Fibre-reinforced composite and orthodontic brackets placed

2 months post-operative mouth opening

Pre-operative mouth opening

Post-operave OPG

MMF achieved with orthodontic elastic chain

9

Body fracture with 1 Condylar fracture Parasymphysis 12 fracture with Concomitant other fracture

30%

Closed reduction in 6 patients & open reduction and fixation in 3 patients

3.33%

Closed reduction

40%

Closed reduction in 5 patients & open reduction in 7 patients

Condylar fracture

5

16.66%

Closed reduction

Maxillary dentoalveolar component

3

10%

Closed reduction

Total

30

100%

Closed reduction in 20 patients and open reduction in 10 patients

Satisfactory occlusion was achieved in all patients post-operatively; out of 30 patients, 26 patients (86.66%) had disturbed occlusion and in 4 patients (13.33%) occlusion was not disturbed preoperatively. Satisfactory mouth opening was achieved 2 months post-operatively in all patients, with mean mouth opening of 28.83 mm one month post-operatively and 38.96 mm two months post-operatively. (Graph I)

2 months post-operative occlusion

Observations and Results In the present study, out of 30 patients, 24 were males (80%) and 6 were females (20%). Age of the patients ranged from 10 years to 52 years with the maximum number of patients (43.33%) in their third decade.

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S276 Graph I Mean inter-incisal mouth opening in mm Gingival index was recorded pre-operatively. i.e. baseline, 1 week, 2 weeks, 3 weeks, 1 month and 2 months post-operatively. Mean gingival index at baseline was 0.39, at 1st week post-operatively was 0.51 and then decreased gradually over 8 weeks to 0.23. (Graph II)

Graph II Mean Gingival Index of Patients In the present study, out of 30 patients, 4 patients were HCV positive and 2 patients were HBsAg positive and were treated successfully without any incidence of glove perforation or percutaneous injury. No glove perforation was observed in any of the 30 patients during the study. Out of total 512 brackets bonded in 30 patients, 10 brackets debonded during the period of MMF in 7 patients. Days of MMF ranged from 7 days to 28 days with mean of 17.96 days. Discussion In the present study, satisfactory occlusion was achieved in all patients post-operatively which was assessed by asking the patient to occlude teeth in maximum intercuspation. Satisfactory mouth opening was achieved in all patients post-operatively in this study. Mean mouth opening of 38.96 mm was obtained 2 months post-operatively, which depicts recovery of mandibular function and is comparable with 38mm to 42mm at 6 weeks post-operatively reported by Gaylord S. Throckmorton, Edward Ellis III (2000)8 and other studies. In the present study, mean gingival index of patients pre-operatively was 0.39. Initially, 1 week post-operatively, mean gingival index increased to 0.51 which may be due to difficulty in maintaining oral hygiene in early post-operative period because of pain and discomfort, it gradually reduced to 0.25 one month post-operatively and then to 0.23 two months post-operatively. Overall low scores of gingival index indicate healthy gingival tissues and good oral hygiene maintenance. It must be kept in mind that maxillo-mandibular fixation patients are unique because of restricted access to all surfaces of the teeth for oral hygiene measures. With the inherent difficulty of maintaining proper oral hygiene and the necessity to penetrate the interdental papilla with the circumdental wire in tight interproximal embrasures, some degree of gingival inflammation and damage is always expected with the use of wiring techniques and archbars. A Thor, L. Andersson (2001)7 reported few deep pockets or severe marginal bone loss from periodontitis in 5 patients in their study. They also reported gingivitis and bleeding from inflamed gingiva around the wired teeth at the time of removal of the wires. Bonded orthodontic brackets on the other hand, are far more hygienic and are free from penetrating injury to interdental papilla and thus lead to better maintenance of

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 oral hygiene. Further their removal is painless and comfortable for the patient without any periodontal injury. As there is little hardware in the oral cavity this appliance causes minimum, if any, irritation or injury to buccal and labial tissues which is a continuous problem with archbars. In case of favourable fractures with minimal displacement this method can be used to achieve MMF with minimal use of local anaesthesia, without causing any pain, discomfort to the patient further it also reduces the chances of any needle stick injury to the operator. Avoiding penetrating injuries remains a vital aspect of protecting the surgeon against exposure to blood-borne diseases. The incidence of surgical glove perforation during the treatment of some maxillofacial fractures may be as high as 50%, with over 80% going unnoticed at the time of operation. Percutaneous injuries may also occur in upto 21% of operations. Needlestick injuries are a serious occupational hazard for surgeons, particularly during MMF. Avery and Johnson (1999)1 showed an incidence of glove perforation 50% when wiring techniques were employed. Ayoub And Rowson (2003)2 Studying different methods of maxillomandibular fixation found a rate of skin penetrating injuries of 27% when archbars were used. Outer glove perforation rate of 37.5% was reported by Gaujac et al (2007)4 during archbar placement. A perforation rate of 1.5 per operation was reported by N. Pigadas et al (2008)6 during eyelet wiring. Incidence of needlestick injuries during MMF was 23% in a study reported by Rishi Bali et al (2011)3. During the present study, no glove perforation was noticed as reported by several other studies during MMF. In our study, out of 30 patients, 4 patients were HCV positive and 2 patients were HBsAg positive. So, this technique is highly efficient in preventing needle stick injuries and spread of blood-borne diseases to the operator during MMF especially in light of present day high prevalence of HCV and HBsAg positive cases in the area where this study was conducted. There was no evidence of any orthodontic movement or discrepancy in occlusion observed in any patient during the study. Orthodontic movement of teeth was absent maybe, because forces were applied for a short period of time as maximum intercuspation was achieved in all patients within 48 hours of application of elastic chain and once intercuspation of teeth was achieved, chances of any orthodontic tooth movement became very minimal as discussed by P Magennis et al (1990)5. Further teeth on which brackets were applied were splinted together with fibre-reinforced composite. When conventional archbar wiring is done, maximum number of teeth are involved with wiring, but in this method, only few teeth on either side of fracture line are involved which makes this fixation appliance more aesthetic, comfortable for the patient, improves the social acceptability (early return to work). Aesthetic appearance of this appliance can further be increased by using ceramic brackets which are far less noticeable and can be used in patients with active social life. Conclusion Application of fibre-reinforced composite and orthodontic brackets behave more like a customized archbar where the fibrereinforced composite provides horizontal stability and brackets act as cleats for application of elastics. From the results of this study, we conclude that this method is highly beneficial in preventing perforating injuries to the operator, especially in cases of patients with positive viral markers. Due to painless application and removal, this method is highly advantageous in paediatric and adolescent patients as the armamentarium required and the appliance itself appear far less threatening. The respect for periodontal tissues, bloodless application and removal, and ease of oral hygiene maintenance is another advantages of this technique as low mean gingival index was noticed in our study. Hence, this

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 technique could be a useful alternative to conventional wiring techniques. Though this technique is highly beneficial, it has its own set of limitations. It is technique sensitive, requires a good level of moisture control which is sometimes difficult to obtain in trauma patients, it is expensive than the conventional wiring techniques and cannot be used in patients with deep bite. Also it is difficult to use in patients with metal or porcelain crowns on teeth, patients with multiple missing teeth on either side of fracture line and it cannot incorporate single alone standing tooth. It is also difficult to achieve MMF with this technique in unfavourable and grossly displaced fractures as maximum incidence of debonding of brackets occurred in such cases during the study as discussed earlier. Furthermore, this technique involves etching of teeth which causes small amount of demineralization. In spite of the above listed limitations, advantages of this technique are significant. With the advent of better bonding and splinting methods, we can further enhance the efficacy of this technique making the procedure less technique sensitive as well. References 1. Avery CME, Taylor J, Johnson PA 1999, ‘Double gloving and a system for identifying glove perforations in maxillofdacial trauma surgery’, British Journal of Oral and Maxillofacial Surgery; vol. 37, pp. 316–319.3 2. Ayoub AF, Rowson J 2003, ‘ Comparative assessment of two methods used for interdental immobilization’, Journal of CranioMaxillofacial Surgery; vol. 31, pp. 159–161.6 3. Bali R, Sharma P, Garg A 2011, ‘ Incidence and patterns of needlestick injuries during intermaxillary fixation’, British Journal of Oral and Maxillofacial Surgery; vol. 49, pp. 221–224.4 4. Gaujac C, Coccheti MM, Yonezaki F, Garcia IR, Peres MPSM 2007, ‘Comparative Analysis of 2 Techniques of DoubleGloving Protection During Arch Bar Placement for Intermaxillary Fixation’, Journal of Oral and Maxillofacial Surgery; vol. 65, pp. 1922–1925.5 5. Magennis P, Craven P 1990, ‘Modification of orthodontic brackets for use in intermaxillary fixation’, British Journal of Oral and Maxillofacial Surgery; vol. 28, pp. 136–137. 8 6. Pigadas N, Whitley SP, Roberts SA, McAlister K, Ameerally P, Avery CME 2008, ‘ A randomized controlled trial on crossinfection control in maxillofacial trauma surgery: A comparison of intermaxillary fixation techniques’, Int. J. Oral Maxillofac. Surg; vol. 37, pp. 716–722.7 7. Thor A, Andersson L 2001, ‘Interdental wiring in jaw fractures: effects on teeth and surrounding tissues after a one-year followup’, British Journal of Oral and Maxillofacial Surgery; vol. 39, pp. 398–401.2 8. Throckmorton GS, Ellis III E 2000, ‘Recovery of mandibular motion after closed and open treatment of unilateral mandibular condylar process fractures’, International Journal of Oral and Maxillofacial Surgery; vol. 29, pp. 421–427.1

INV009 Modified Submental Intubation: A Useful Adjunctive in Maxillofacial Trauma Dr. Sharanbasappa Introduction: Airway management is a difficult task in complex craniomaxillofacial trauma. The choice of intubation technique depends on good

S277 assessment from the neurosurgeon, maxillofacial surgeon as well as the anaesthetist. Nasal intubation after severe craniomaxillofacial may result in meningitis or it can also lead to passage of tube intracranially in patients with frontobasilar fractures. To avoid this complication, oral intubation may be preferred, but this may interfere with the placement of intermaxillary fixation (IMF) to establish the patient’s occlusion in the intraoperative period. To enable IMF to be placed, tracheostomy may be indicated but this carries significant morbidity. An alternative to tracheostomy i.e. submental intubation was first described by Hernandez Altemir in 1986. The submental intubation with conventional Altemir’s technique and few of its modification has been used largely in maxillofacial injury cases. This paper highlights a modification of submental intubation incision in patients with panfacial injuries, to treat complex mandibular fractures. Modified Submental Intubation Technique In cases of panfacial trauma wherein open reduction and internal fixation was planned, in view of the surgical consideration and need for IMF, nasal intubation and orotracheal intubation was excluded. In cases of comminuted mandibular symphysis fractures subsequent modification of the conventional technique of submental intubation was planned. Conventional oral intubation was carried out using flexo-metallic endotracheal tube. Using aseptic technique the skin of the neck and submandibular area was scrubbed and prepared. The conventional incision of submental intubation was modified to gain better access and to avoid a second intraoral surgical wound to reduce and fix mandibular symphysis and parasymphysis fractures. The conventional submental incision was marked and bilaterally lateral extensions were marked at an obtuse angle from the conventional incision, along the curvature of the mandible 2cm below the inferior border of mandible. Length of these horizontal lateral extensions were modified depending on the fracture site and exposure needed. After local infiltration of LA, the incision was made using no 15 surgical blade. Blunt dissection was carried upto the inferior border of mandible. A curved hemostat was passed along the lingual surface of mandible to reach the floor of the mouth, taking care to avoid injury to submandibular gland duct, and an incision was taken in the floor of the mouth to pass the hemostat in the oral cavity. ET tube was disconnected and shifted along with the cuff from oral cavity to submental region through the intraoral incision. After reconnecting the ET Tube it was secured to the inferior flap with 1-0 mersilk for stabilization. Full thickness skin flap was raised to expose the mandibular symphysis fracture. The fracture site was exposed, reduced and fixed with miniplates. Discussion Airway management for patients afflicted with panfacial fractures is a challenge for the anaesthetic team. In addition, the maxillofacial surgeon requires intraoperative MMF to achieve satisfactory surgical outcomes. This necessitates modification of the standard anaesthesia techniques. Submental intubation with midline incision is used frequently, but modifying the incision for treatment of mandibular fractures has been rarely mentioned. It has various advantages like a second intraoral incision is not required for management of mandibular fractures in symphysis, parasymphysis and body regions. It reduces surgical time. It provides an extraoral approach for fixation of the fracture, hence providing good accessibility, with minimal scar. In edentulous patients stripping of periosteum intraorally compromises blood supply to mandible hence this extraoral approach is preferred. In case of comminuted fractures involving both the cortices, extraoral approach is preferred as managing lingual cortex is difficult intra orally and needs separation of geniohyoid and genioglossus muscle which is avoided extraorally. Loss of sulcus depth and ptosis of mentalis muscle may also be reduced.

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Conclusion The successful use of a same single extraoral incision made it possible to perform submental intubation as well as to reduce and fix the mandibular symphysis fracture in cases where oral and nasal intubations were either contraindicated or not possible. This technique has great advantage and can be used with ease.

There are various bottles are recommended for feeding babies with clefts. Each feeding system has advantages with their disadvantages. Some feeder bottles requires continuous involvement and close attention of the parent to maintain actuate flow at regular intervals. Another challenge that families encounter is the cost associated with specialty feeding systems. The associated cost can add additional stress to the families and caregivers of cleft children.2 Ultimately, parents of most cleft palate babies take to feeding with spoon. By this method, very small quantities of fluid are administered at a time hence it is time consuming and has potential for the baby to remain undernourished.3 To overcome these challenges, study was to design assistive devices of cleft palate and formulated the following objectives •

CT scan images showing displaced lingual and buccal cortex in mandibular symphysis fractures

Marking Of Modi

d Incision

Stabilizing Et Tube

Placement Of An Incision

EtTube Through Submental Region

Raising Of Skin Flap

Fixaon With Miniplate

•

Designing an affordable feeding bottle or add-ons for an existing bottle that allow adjustable flow control Reducing dependence of flow rate of milk on intraoral negative pressure. It is to ensure that the patient with the most severe cleft deformity can consume fluid at the optimum flow rate without causing fatigue.

Material and Methods A normal pigeon feeder was bought and the set of restriction orifice plates were fabricated from acrylic sheets using a laser cutting machine. A total of five plates were made with the only difference being in the number and position of holes in them. The diameter of the plates were decided such that they fit into the neck of the feeding bottle and the diameter of holes was decided by following calculations. In order to ensure smooth entry and removal of plates the inner diameter chosen was 3.15 mm. Five orifice plates having diameter of 3.15 mm and different hole profiles were fabricated by laser cutting of 2mm thick acrylic sheets. Notches were given on diametrically opposite ends for securing the plates in the fixtures.

Post Operave Submental Scar By Modified Technique

INV015 An Innovative Modification of Feeding Bottle for Cleft Palate Babies Dr. Surendra Daware, Assistant Professor, Dr. Abhay Datarkar, Professor and Head, Dr. Rashmi Uddanwadiker, Jugal Shah, Sukhada Joshi Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Nagpur, India, [email protected], Ph-9860207478, [email protected], Ph-9822698145; Department of Mechanical Engineering, Visvesvaraya National Institute of Technology (VNIT), Nagpur; VNIT, Nagpur Introduction Cleft lip and palate deformity is one of the most common deformities among Indian children. A majority of cleft births occur in rural India where poverty, illiteracy and misinformation are rampant and access to medical resources is scarce. Feeding challenges are among the biggest concerns that parents and caretakers have in the early stages of diagnosis.1

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These plates were fitted in the Pigeon Feeder one by one and the volume of milk leaving the bottle in a minute was measured using a vacuum machine as source of suction. It was observed that the flow rate with all the plates was same inspite of using orifice plates due to leakage through the cut notches. Hence it was realised that a new method of fastening was to be used.

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The surgical vacuum pump was used to generate suction and the flow rate with use of each plate was recorded. Each plate was fixed in the bottle and the nipple was connected to the inlet pipe. The pump was switched on for one minute. The difference in volume was noted using the graduations already present on the bottle. Thus flow rate in ml/min was calculated. Theoretical Calculation An attempt has been made to analyze the proposed model using principles of fluid mechanics and some basic assumptions. A healthy baby is said to be capable of creating -50 to -197 mm Hg suction while suckling for milk. Also the rate at which a healthy baby consumes milk is observed to be between 10 to 25 ml/min.4 This is subject to hunger, age and other physiological characteristics of the individual baby. Thus the bottle (without restriction orifices) should be designed to allow the baby who can create least vacuum (say 10 mm Hg) to drink fluid up to a maximum of 25 ml/min. Then the flow rate can be stepped down with subsequent addition of orifice plates in the path of flow of milk.

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Fig. 3.4 Schematic for calculations For milk as working fluid: l= 3cP q=1035kg/m3 On application of Bernoulli’s equation we get Patm?qgH=Pmouth?(0.5*q*V22) ?qghf Formula for head loss is given as qghf= (128*l*L*Q)/pD4 From above two equations V2 can be calculated Q=A2V2 A2= (p/4)*D22 The above two equations can be used to evaluate D2 which is the diameter of nipple hole. The hole size of the nipple should be increased to the calculated value in order to satisfy the baby capable of producing only 10 mm Hg of suction. Now use of an orifice plate to reduce the flow from 25ml/min to 15ml/min Q=AiVi =A2V2 Hence V2 can be found Applying Bernoulli’s equation between orifice plate and tip of bottle; Pi?qgh?(0.5*q*V2i )=Pmouth?(0.5*q*V22) Pressure drop across the orifice; DP = Patm?qg(H-h)-Pi …..(1) Formula for pressure drop across an orifice is given as DP (across orifice)= (32*l*Vi*L)/D2……(2) Q=AiVi …..(3) Thus for a certain thickness of orifice plate (L) the above three equations give us two independent equations in Vi and D. On solving these two equations we obtain the effective diameter of holes in the plate. Discussion Oro-facial clefts, particularly cleft lip with (CLP) or without (CL) cleft palate and cleft palate alone (CP) are a major public health problem affecting 1 in every 500 to 1000 births worldwide.5 With the diagnosis of cleft palate/lip, feeding is a major concern for parents.

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S280 Feeding difficulties appear at birth, due to impairment of the suction and swallowing mechanisms resulting from the alteration in the anatomical structures. At this early stage, the priority is monitoring infant nutrition and weight gain.1 Surgery is the initial treatment for CLP. Adequate nutrition is also important for the child to be able to undergo the cleft repair surgery, i.e., stable weight gain with no health alterations and the capability to safely receive anaesthetics.6 Several devices and methods have been tried in order to allow the infant to get nourishment. Prior art has produced a feeding plate which fits into the palate and seals off the cleft in both the lip and the palate. This enables the infant to generate intraoral negative pressure to pull nourishment from conventional bottles.3 Next, it has used long feeders on a bottle such that the milk is directly injected into the infant’s throat so that he may swallow the milk without sucking. This method is an attempt to bypass the problem of the infant’s inability to suck and causes frequent choking and aspiration and prevents the child from developing the muscles of the mouth which are believed to aid in language articulation in later life.7 Parents of such infants have to take extra care while feeding the babies; the correct angle has to be maintained to prevent entry of food into the nasal passage. There are three types of bottles that are recommended for feeding babies with clefts: 1. Haberman Feeder 2. Pigeon Feeder 3. Mead Johnson Nurser The Pigeon Feeder and Mead Johnson Nurser, both need to be pressed in order to actuate flow at regular intervals. Hence it requires continuous involvement and close attention of the parent. The Haberman Bottle fits the bill when it comes to utility as it regulates flow without any intervention. The Haberman Feeder is activated by tongue and gums. A one-way valve separates the nipple from the bottle. Milk cannot flow back into the bottle and is replenished continuously as the baby feeds. A slit valve opening near the tip of the nipple shuts between jaw compressions, preventing the baby from being overwhelmed with milk. Stopping or reducing the flow of milk is controlled by rotation of the nipple in the baby’s mouth. However the cost of Haberman feeder is too much in Indian Scenario. Several flow restricting mechanisms were considered in order to design the modified feeding bottle. Ultimately it was decided to make use of restrictive orifice plates for flow control. The mechanism employs multi-hole restrictive orifices for flow control. A choice can be made from a set of plates based on the extent to which flow rate has to be changed. The highest flow rate will be achieved when there is no orifice plate. As milk flows through orifice plates, the effective pressure head of the flowing milk is decreased, and flow rate at outlet of orifice is controlled. The orifice plates can be inserted by the parent in the neck of any conventional milk bottle based upon age, hunger and other characteristics of the patient. The choice of plates will majorly be a function of severity of the cleft. As are the variations in cleft formation, feeding difficulties in patients with clefts are equally diverse.2 An insert and turn locking arrangement accounts for sturdy nature of the assembly and it is very convenient to remove, clean and reassemble at the time of feeding. Restriction orifice is mainly used to achieve controlled or restricted flow of process medium. The orifice offers a restriction to the process flow and the pressure head drops from the upstream to the downstream. The area of the orifice determines the rate of flow at the outlet of a given process fluid for the specified pressure. A restriction orifice plate may be single hole or multi hole. In a multi hole orifice plate, the flow at the inlet is channelled into several

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J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 streams through the multiple holes and this reduces the noise which would be otherwise will be above the acceptable limit if a single hole device is used. However, the suction machine did not maintain a constant vacuum reading during the testing hence the set up could not exactly replicate the suction of a baby. Inspite of unsteady value of vacuum we can render the experiment as fairly analogous to reality as exactly the same pressure variation was observed for each experiment when the pump was turned on. The vacuum machine dial read suction pressures from 10 mm Hg to 400 mm Hg, which was more than the range of suction created by a baby. Conclusion Keeping in mind that cleft with various variations, this study validated the hypothesis of flow control using orifice plates as the expected trend in flow rate was adhered to. This study when scaled down to the suction range and suckling speed of a baby can help calculate area of holes corresponding to very high, high, medium, low, very low flow rate between 10ml/min and 30ml/min. It is also seen that higher flow rate is observed as number of holes increases and when holes are located closer to the centre. References 1. Arts-Rodas D, Benoit D. Feeding problems in infancy and early childhood: Identification and management. Paediatrics & Child Health. 1998;3(1):21–27. 2. David G. Gailey Feeding Infants with Cleft and the Postoperative Cleft Management Oral and Maxillofacial Surgery Clinics of North America, Volume 28, Issue 2, Pages 153–159 3. Devi ES, Sai Sankar AJ, Manoj Kumar MG, Sujatha B. Maiden morsel - feeding in cleft lip and palate infants. Journal of International Society of Preventive & Community Dentistry. 2012;2(2):31–37. 4. C. R. Prieto, H. Cardenas, A. M. Salvatierra, C. Boza, C. G. Montes, and H. B. Croxatto Sucking pressure and its relationship to milk transfer during breastfeeding in humans. J Reprod Fertil 108 (1) 69–74. 5. Reddy SG, Reddy RR, Bronkhorst EM, et al. Incidence of cleft Lip and palate in the state of Andhra Pradesh, South India. Indian Journal of Plastic Surgery: Official Publication of the Association of Plastic Surgeons of India. 2010;43(2):184–189. 6. Duarte GA, Ramos RB, Cardoso MC. Feeding methods for children with cleft lip and/or palate: a systematic review. Braz J Otorhinolaryngol. 2016;82:602–9.

INV016 Murva: A Biotic Strand for Biological Healing Dr Ashutosh Thorat & Dr Pravin Lambade Introduction The success of any surgical procedure depends upon healthy healing, which in turn depends upon the suture material used & the method employed for the closure. Many synthetic materials have replaced the natural materials, which were once used for suturing in the ancient times, and Murva is one of them. There are references of Murva (SansevieriaroxburghianaSchult. and Schult.f.) (Fig 1). at various contexts of ‘‘SushrutaSamhita’’ where it has been used as a suture material. It is a xerophytic herbaceous plant occurring abundantly in the eastern coastal region of India. This study is carried out to compare the efficacy of murva fibre with Silk as suture material.

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Fig. 1 Murva plant Objective The objective of this study is to compare the efficacy of Murva fibers (Fig 2) with Silk (Fig 3) as a suture material in closure of intraoral incision in third molar surgeries.

Fig. 3 Silk suture Methods Fifty incisions (Wards incision) placed for the surgical removal of mandibular third molar were sutured with Murva and fifty incisions with Silk. Patients were evaluated for pain, swelling, hemostasis, infection, wound dehiscence, local tissue irritation, and bacterial colonization. Follow-up were scheduled on postoperative 1st, 2nd, 3rd, and 7th day. Result On comparing these two suture materials, in terms of post-operative pain, swelling, hemostasis, infection, wound dehiscence, local tissue irritation and bacterial colonization, the results were in favour of Murva as compared to Silk. Conclusion This study indicates that Murva can be effectively used as an alternative suture material to Silk as it is natural, economical and biocompatible with an antimicrobial activity.

Fig. 2 Murva suture

Fig. 4 Surgical site post-op 7 day (murva suture)

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INV011 Modification of Ryle’s Nasogastric Tube Dr. Manay Roshini Srinivas Abstract Anasogastric tube is a narrow bore tube passed into the stomach via the nose. It is used for short- or medium-term nutritional support in patients, young or old, who are not able to feed on their own either due to congenital defect in the oro-pharynx region or during the post-operative healing period. Although the current design of Ryle’s tube has been used over decades. One-third of the tube, which is seen externally can not only be a source of infection but also have a psychological impact on the patient’s well-being. Hence to overcome this, a modification of the current design is done where the external segment of the tube can be detached and attached only when feeding is required.

Fig. 5 Surgical site post suture removal (murva suture)

Keywords Enteral Feeding catheter, Nutritional Support in Primary Care, Nutritional Support in Hospital, Nasogastric tube, Ryle’s nasogastric tube I.

Field of invention

The invention is based on a modification of the design of eternal feeding tube used in the field of medicine II. Description of the prior art A nasogastric tube is a temporary tube placed through the nose into the stomach. It is be used to remove fluid from the stomach, or used for nutritional support in patients who are not able to feed on their own either due to congenital defect in the oro-pharynx region or during the post-operative healing period after a surgery or during radiation therapy in patients diagnosed with cancer. III.

Drawback of the existing state of art

The current design of Ryle’s nasogastric tube has been used over decades all over the world, especially in patients undergoing going oncology (cancer) treatment. One-third of the tube is left hanging from the patient’s nostrils through which liquid food/supplement is passed. This can harbour infection if not maintained well. And also have a psychological impact of being diseased on the patient. IV.

Novelty

Fig. 6 Surgical site post-op 7 day (silk suture) The proposed design is such that the external tube can be detached and easily snapped on to the internal tube which is inserted into the patient nostrils at the time of extubation by anaesthetist The internal tube is positioned at the level of the nostrils with semi-rigid support with the help of the two external nose clips which adhere to the alar and collumela respectively. External tube can be detached and attached only when required to the internal tube. This allows the patient to be free of an external tube hanging outside their nostrils (Fig. 1).

Fig. 1 A schematic representation of nasogastric tube in a human aero-digestive tract view Fig. 7 Surgical site post suture removal (silk suture)

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A detailed description

S283 D.

The proposed design is a user friendly, hygienic and aesthetically appealing nasogastric tube for feeding nutritional solution to patients who are unable to feed on their own. The tube is devoid of fixed external extension of the tube from the nostrils unlike the current design, thereby eliminating the problems of infection and psychological stigma. It comprises of the following. A hollow flexible internal tube of predetermined length comprises of two ends, closed top end and opened bottom end wherein plurality of tiny holes disposed on circumferential surface at predetermined length above the bottom end of the internal tube for easy discharge of nutritional solution into stomach and the closed top end is closed by means of thin layer with a slit. B. A hollow cylindrical rigid support of predetermined length disposed on outer circumferential surface on the top end side of the internal tube (Fig. 2).

A hollow flexible detachable external tube (Fig. 4) of predetermined length adapted to be inserted into the top end of the internal tube through the slit during feeding

A.

Fig. 4 External tube inserted E.

A storage container (Fig. 5) for storing the external tube when feeding is complete is provided along with the set

Fig. 2 Internal tube C. An aesthetic nose clip (Fig. 3) comprises of a ring with pair of clips wherein the ring is disposed on outer circumferential surface on the top end of the internal tube in front of the rigid support.

Fig. 5 Storage box with 20 ml syringe The internal tube is to be inserted into the patient nostrils at the time of extubation. The bottom end of the internal tube is positioned inside the stomach and the top end of the internal tube is positioned at the level of the nostrils with the rigid support with the help of the two clips that adhere to the alar and collumela region. The rigid support ensure the support of the internal tube to nostrils and comfortability to patient The slit on the top end of the internal tube opens when the external tube being inserted during feeding and the slit closes when the external tube is removed after feeding thereby preventing the infection to enter into the internal tube The nasogastric tube - internal tube and external tube is made of materials comprising of polyvinylchloride (PVC). The diameter of the external tube is lower than the diameter of the top end of the internal tube which aids in the easy-snap fit insertion of the tube. Fig. 3 Internal tube inserted and positioned at the nostrils

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S284 VI.

J. Maxillofac. Oral Surg. (2017) 16(Suppl 1):S1–S284 Summary

With the change in design, it is not only user friendly and hygienic, it also helps those who are on it for long term to re-integrate themselves into the society and carry forward their routine activities by demolishing the stigma the patients carry on themselves (Fig. 6). The simplicity of the proposed design will definitely bring about a change in the quality of lives of our patients.

Fig. 6 A comparison of the external appearance with the current (left) design and proposed (right) design

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