60.Srinivasan S, Velusamy G, Munshi MAI, Radhakrishnan K, Tiwari RVC. Comparative Study of Antifungal Efficacy of Various Endodontic Irrigants with and without Clotrimazole in Extracted Teeth Inoculated with Candida albicans. J Contemp Dent Pract. 2020 Dec 1;21(12):1325-1330. PubMed PMID: 33893253.
Mathew P, Kattimani VS, Tiwari RV, Iqbal MS, Tabassum A, Syed KG. New Classification System for Cleft Alveolus: A Computed Tomography-based Appraisal. J Contemp Dent Pract. 2020 Aug 1;21(8):942-948. PubMed PMID: 33568619
Sahu S, Patley A, Kharsan V, Madan RS, Manjula V, Tiwari RVC. Comparative evaluation of efficacy and latency of twin mix vs 2% lignocaine HCL with 1:80000 epinephrine in surgical removal of impacted mandibular third molar. J Family Med Prim Care. 2020 Feb;9(2):904-908. doi: 10.4103/jfmpc.jfmpc_998_19. eCollection 2020 Feb. PubMed PMID: 32318443; PubMed Central PMCID: PMC7113948.
65.Izna, Sasank Kuntamukkula VK, Khanna SS, Salokhe O, Chandra Tiwari RV, Tiwari H. Knowledge and Apprehension of Dental Health Professionals Pertaining to COVID in Southern India: A Questionnaire Study. J Pharm Bioallied Sci. 2021 Jun;13(Suppl 1):S448-S451. doi: 10.4103/jpbs.JPBS_551_20. Epub 2021 Jun 5. PubMed PMID: 34447131; PubMed Central PMCID: PMC8375944.
Vohra P, Belkhode V, Nimonkar S, Potdar S, Bhanot R, Izna, Tiwari RVC. Evaluation and diagnostic usefulness of saliva for detection of HIV antibodies: A cross-sectional study. J Family Med Prim Care. 2020 May;9(5):2437-2441. doi: 10.4103/jfmpc.jfmpc_138_20. eCollection 2020 May. PubMed PMID: 32754516; PubMed Central PMCID: PMC7380795
Mittal S, Hussain SA, Tiwari RVC, Poovathingal AB, Priya BP, Bhanot R, Tiwari H. Extensive pelvic and abdominal lymphadenopathy with hepatosplenomegaly treated with radiotherapy-A case report. J Family Med Prim Care. 2020 Feb;9(2):1215-1218. doi: 10.4103/jfmpc.jfmpc_1125_19. eCollection 2020 Feb. PubMed PMID: 32318498; PubMed Central PMCID: PMC7113973.
36.Kesharwani P, Hussain SA, Sharma N, Karpathak S, Bhanot R, Kothari S, Tiwari RVC. Massive radicular cyst involving multiple teeth in pediatric mandible- A case report. J Family Med Prim Care. 2020 Feb;9(2):1253-1256. doi: 10.4103/jfmpc.jfmpc_1059_19. eCollection 2020 Feb. PubMed PMID: 32318508; PubMed Central PMCID: PMC7113959.
79.Ambika Hegde et al. Oral Microflora In Different Trimesters Of Pregnancy- An Original Research. Nat. Volatiles & Essent. Oils, 2021; 8(6): 1472-1476
70.Dayalan N, Kumari B, Khanna SS, Ansari FM, Grewal R, Kumar S, Tiwari RVC. Is Open Reduction and Internal Fixation Sacrosanct in the Management of Subcondylar Fractures: A Comparative Study. J Pharm Bioallied Sci. 2021 Nov;13(Suppl 2):S1633-S1636. doi: 10.4103/jpbs.jpbs_352_21. Epub 2021 Nov 10. PubMed PMID: 35018044; PubMed Central PMCID: PMC8686876.
75.Shaik I, Dasari B, Shaik A, Doos M, Kolli H, Rana D, Tiwari RVC. Functional Role of Inorganic Trace Elements on Enamel and Dentin Formation: A Review. J Pharm Bioallied Sci. 2021 Nov;13(Suppl 2):S952-S956. doi: 10.4103/jpbs.jpbs_392_21. Epub 2021 Nov 10. Review. PubMed PMID: 35017905; PubMed Central PMCID: PMC8686917.
More Related Content
More from CLOVE Dental OMNI Hospitals Andhra Hospital
60.Srinivasan S, Velusamy G, Munshi MAI, Radhakrishnan K, Tiwari RVC. Comparative Study of Antifungal Efficacy of Various Endodontic Irrigants with and without Clotrimazole in Extracted Teeth Inoculated with Candida albicans. J Contemp Dent Pract. 2020 Dec 1;21(12):1325-1330. PubMed PMID: 33893253.
Mathew P, Kattimani VS, Tiwari RV, Iqbal MS, Tabassum A, Syed KG. New Classification System for Cleft Alveolus: A Computed Tomography-based Appraisal. J Contemp Dent Pract. 2020 Aug 1;21(8):942-948. PubMed PMID: 33568619
Sahu S, Patley A, Kharsan V, Madan RS, Manjula V, Tiwari RVC. Comparative evaluation of efficacy and latency of twin mix vs 2% lignocaine HCL with 1:80000 epinephrine in surgical removal of impacted mandibular third molar. J Family Med Prim Care. 2020 Feb;9(2):904-908. doi: 10.4103/jfmpc.jfmpc_998_19. eCollection 2020 Feb. PubMed PMID: 32318443; PubMed Central PMCID: PMC7113948.
65.Izna, Sasank Kuntamukkula VK, Khanna SS, Salokhe O, Chandra Tiwari RV, Tiwari H. Knowledge and Apprehension of Dental Health Professionals Pertaining to COVID in Southern India: A Questionnaire Study. J Pharm Bioallied Sci. 2021 Jun;13(Suppl 1):S448-S451. doi: 10.4103/jpbs.JPBS_551_20. Epub 2021 Jun 5. PubMed PMID: 34447131; PubMed Central PMCID: PMC8375944.
Vohra P, Belkhode V, Nimonkar S, Potdar S, Bhanot R, Izna, Tiwari RVC. Evaluation and diagnostic usefulness of saliva for detection of HIV antibodies: A cross-sectional study. J Family Med Prim Care. 2020 May;9(5):2437-2441. doi: 10.4103/jfmpc.jfmpc_138_20. eCollection 2020 May. PubMed PMID: 32754516; PubMed Central PMCID: PMC7380795
Mittal S, Hussain SA, Tiwari RVC, Poovathingal AB, Priya BP, Bhanot R, Tiwari H. Extensive pelvic and abdominal lymphadenopathy with hepatosplenomegaly treated with radiotherapy-A case report. J Family Med Prim Care. 2020 Feb;9(2):1215-1218. doi: 10.4103/jfmpc.jfmpc_1125_19. eCollection 2020 Feb. PubMed PMID: 32318498; PubMed Central PMCID: PMC7113973.
36.Kesharwani P, Hussain SA, Sharma N, Karpathak S, Bhanot R, Kothari S, Tiwari RVC. Massive radicular cyst involving multiple teeth in pediatric mandible- A case report. J Family Med Prim Care. 2020 Feb;9(2):1253-1256. doi: 10.4103/jfmpc.jfmpc_1059_19. eCollection 2020 Feb. PubMed PMID: 32318508; PubMed Central PMCID: PMC7113959.
79.Ambika Hegde et al. Oral Microflora In Different Trimesters Of Pregnancy- An Original Research. Nat. Volatiles & Essent. Oils, 2021; 8(6): 1472-1476
70.Dayalan N, Kumari B, Khanna SS, Ansari FM, Grewal R, Kumar S, Tiwari RVC. Is Open Reduction and Internal Fixation Sacrosanct in the Management of Subcondylar Fractures: A Comparative Study. J Pharm Bioallied Sci. 2021 Nov;13(Suppl 2):S1633-S1636. doi: 10.4103/jpbs.jpbs_352_21. Epub 2021 Nov 10. PubMed PMID: 35018044; PubMed Central PMCID: PMC8686876.
75.Shaik I, Dasari B, Shaik A, Doos M, Kolli H, Rana D, Tiwari RVC. Functional Role of Inorganic Trace Elements on Enamel and Dentin Formation: A Review. J Pharm Bioallied Sci. 2021 Nov;13(Suppl 2):S952-S956. doi: 10.4103/jpbs.jpbs_392_21. Epub 2021 Nov 10. Review. PubMed PMID: 35017905; PubMed Central PMCID: PMC8686917.
More from CLOVE Dental OMNI Hospitals Andhra Hospital (20)
2. Mathew, et al.: Unilateral SSRO by IIG
65
Volume 7 / Issue 1 / January‑June 2020
Journal of Cleft Lip Palate and Craniofacial Anomalies
a unilateral sagittal split ramus osteotomy (SSRO)
was performed on the right side, and a single chunk
of cancellous iliac bone graft was harvested and was
interpositioned between proximal and distal segments.
The superoinferior dimension of mandible was
measured in orthopantomogram. The cancellous graft
was reshaped into correct form to prevent impingement
of the graft on soft tissue, which can cause esthetic
compromise. The width of graft was of only 3 mm, so
as not to cause any deformity in the condylar deviation
due to the flaring achieved in the proximal segment
after placing the cancellous inlay graft [Figure 2]. For
stabilizing the graft, rigid fixation technique was used.
A six‑hole plate with gap was selected, and it was
given two bends of 90° in the gap area when the plate
traverse from proximal to distal segment to adapt it
in desired position in the sound bone [Figure 3]. This
bend is designed in such a way that the thickness of
graft and bend are equal to maintain the thickness
and prevents compression of graft between segments.
The other benefit of this bend is it will help the graft
to stay in position and prevent the graft from moving
anteriorly between the segments and maintain the
desired position. Placing a cancellous bone or inlay
graft rather than cortical or onlay graft will increase
the chances of take up and reduce resorption. After
reduction of swelling in the postoperative week, we
have achieved patient’s expectations too.
DISCUSSION
Facial asymmetry as a diagnosis implies esthetic
imbalance which deeply affects the psychological
status of patients. Fulfilling patient’s expectations
is the prime consideration for prompt management.
Hence, it is a matter of utmost importance to diagnose
the correct classification of deformity and replace
it with the same kind of tissue. History, clinical
examinations, sagittal, coronal, and axial section
are certain helpful diagnostic aids which add up
for the betterment of treatment plan.[3]
Frontal view
photographic examination and posteroanterior view
of skull as radiographic examination carries crucial
and significant evaluation criteria.[4]
A hyperextended
45° superior submental view is useful in measuring
projection and symmetry of anterior cranial vault,
orbit, and cheeks. The study models elicit occlusal
cants.[5]
Computed tomography (CT), cone‑beam
CT, three‑dimensional (3D) CT, magnetic resonance
imaging, and skeletal scintigraphy are also used for
better precision and reproducibility.[6]
Not every
mandibular asymmetry is a rotational asymmetry. There
may be a lateralization of the entire mandible which
requires bodily movement of the distal mandible away
from the original side. Malformations, deformations,
and disruptions can be interrelated for producing
asymmetries. Management of facial asymmetry has
a vast extension. The reason for this is its extensive
etiology. In spite of acquired defects, developmental
Figure 2: Iliac interpositional graft placed
Figure 1: Posterior-anterior skull showing mediolateral ramal distance
Figure 3: Rigid fixation and plate adaptation
[Downloaded free from http://www.jclpca.org on Friday, January 24, 2020, IP: 123.201.170.234]
3. Mathew, et al.: Unilateral SSRO by IIG
Journal of Cleft Lip Palate and Craniofacial Anomalies
66 Volume 7 / Issue 1 / January‑June 2020
defects also are its cause. Hemifacial microsomia,
Treacher Collins syndrome, and Goldenhar syndrome
are the genetic‑related defects causing orofacial clefts
which lead to facial asymmetry. Hard‑ and soft‑tissue
procedures, autogenous or synthetic graft materials as
well as Botox and fillers are preferred choices. Botox
and derma fillers are not very reliable techniques for
such deformities due to their poor substantiation on the
anatomical site. Orthognathic surgery and distraction
osteogenesis are dynamic processes to facilitate 3D
correction of facial asymmetry. In addition, various
modified surgical techniques have been documented in
the literature.[7]
Other options include grafting through
patient‑specific implant, onlay bone graft, Medpor
implant, or major corrections through orthomorphic
surgery. Although several articles have been written
for correction of facial asymmetry by unilateral
sagittal split osteotomy, the published data on bone
grafting to correct deformity is scarce.[8,9]
Correction
of midline deviations of 2 mm or smaller has little
effect on the condylar/proximal segment position,
and modifications of the sagittal split osteotomy do
not seem necessary.[9]
Bone shim placed between
segments is a reliable technique with a pitfall of delayed
healing in the bone shim area. In our procedure, we
used a chunk of cancellous iliac graft which has been
interpositioned between the split segments. The reason
is that interpositional graft due to cancellous contact
has an immense better take up when compared to an
onlay graft. Other benefits are blood supply, rate of
resorption, and contour with exteroception is unaltered.
Condylar displacement is one of the most common
complications after SSRO and can induce relapse and
temporomandibular joint dysfunction symptoms. The
study shows that there is the presence of condylar
movement after SSRO and grafting. The condylar
displacement had no relationship to the rotation of the
mandible.[10]
Kang et al. have proven that the amount
of mandibular rotation <4 mm did not influence the
position of the condyle significantly which was studied
by various section of 3D computed tomography.[10]
It
is important to keep the intersegmental space intact
for postoperative surgical stability by the use of an
autogenous bone graft with ease and simplicity. In our
case, we have followed the same. Moreover, we have
also performed a rigid fixation by bending the plate and
adapting it to the required and desired position on the
sound cortical bone which helped our interpositional
graft to sustain its from function to position.
CONCLUSION
The fundamental cognition of facial asymmetry is a
substantive requisite to critically analyze the feature
involved in deformity and correctly measure the
magnitude of disparity. This facilitates to articulate
satisfying treatment plan to achieve maximum esthetics
and function deliberating patient’s perception and
expectations. In summary, we demonstrate an authentic
and dependable technique to use single chunk of
interpositional iliac cancellous bone graft to align the
proximal and distal segment, maintaining the baseline
position of condyles for correction of unilateral facial
asymmetry by unilateral SSRO.
Declaration of patient consent
The authors certify that they have obtained all
appropriate patient consent forms. In the form the
patient(s) has/have given his/her/their consent for his/
her/their images and other clinical information to be
reported in the journal. The patients understand that
their names and initials will not be published and
due efforts will be made to conceal their identity, but
anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
REFERENCES
1. Srivastava D, Singh H, Mishra S, Sharma P, Kapoor P, Chandra L,
et al. Facial asymmetry revisited: Part I‑ diagnosis and treatment
planning. J Oral Biol Craniofac Res 2018;8:7‑14.
2. Srivastava D, Singh H, Mishra S, Sharma P, Kapoor P, Chandra L,
et al. Facial asymmetry revisited: Part II‑conceptualizing the
management. J Oral Biol Craniofac Res 2018;8:15‑9.
3. Cheong YW, Lo LJ. Facial asymmetry: Etiology, evaluation, and
management. Chang Gung Med J 2011;34:341‑51.
4. Legan HL. Surgical correction of patients with asymmetries. Semin
Orthod 1998;4:189‑98.
5. Wolford LM. Facial asymmetry: Diagnosis and treatment
considerations. In: Turvey TA, editor. Oral and Maxillofacial Surgery.
2nd
ed., Vol. 3. St. Louis, MO: Saunders; 2009.
6. Epker BN, Stella JP, Fish LC. Diagnosis and treatment planning for
correction of asymmetric dentofacial deformities. In: Epker BN,
Stella JP, Fish Dentofacial LC, editors. Deformities‑Integrated
Orthodontic and Surgical Correction. 2nd
ed. Vol. 4. St. Louis, MO:
Mosby; 1958.
7. Choi JY, Choi JP, Lee YK, Baek SH. Simultaneous correction of
hard‑and soft‑tissue facial asymmetry: Combination of orthognathic
surgery and face lift using a resorbable fixation device. J Craniofac
Surg 2010;21:363‑70.
8. Zhu SS, Feng G, Li JH, Luo E, Hu J. Correction of mandibular
deficiency by inverted‑L osteotomy of ramus and iliac crest bone
grafting. Int J Oral Sci 2012;4:214‑7.
9. Peacock ZS, Lee JS. Modification of the bilateral sagittal split
osteotomy for the asymmetric mandible. J Oral Maxillofac Surg
2011;69:2437‑41.
10. Kang MG, Yun KI, Kim CH, Park JU. Postoperative condylar position
by sagittal split ramus osteotomy with and without bone graft. J Oral
Maxillofac Surg 2010;68:2058‑64.
[Downloaded free from http://www.jclpca.org on Friday, January 24, 2020, IP: 123.201.170.234]