Publication - Abstract - ABG NPABG JMOS Supplemental Issue.pdf

1. ABSTRACTS
43rd National AOMSI Conference
The Association of Oral and Maxillofacial Surgeons of India 2018
Abstracts of Conference Proceedings –
Prize Category Papers
Category – Cleft and Craniofacial Anomalies
Abstract No: 0264
Retrospective analysis of preoperative secondary
nasopalatoalveolar cleft using 3D CT scan
Dr. Rahul Tiwari, Dr. Philip Mathew
Jubilee Mission Medical College Hospital and Research Institute,
Thrissur, Kerala
Abstract
Background
When a cleft alveolus is noticed and repaired, the repair also involves the
nasal base and palate. Three-dimensional Computed Tomography scan is
the most advanced method available to evaluate any anatomical structure
in all dimensions of space. For patients with clefts, pre-operative 3D CT
Scan is advised to evaluate the cleft in nasal, alveolar and palatal areas
which need reconstruction. It is also a useful tool for diagnosis and
treatment planning for future distraction and orthognathic surgeries.
Methods
3D CT Scan of 102 patients, taken from January 2016 to March 2018
in JMMCHRI, Thrissur, for repair of cleft alveolus were evaluated
in this study. Linear measurements were done to measure the cleft
alveolus in superoinferior and mediolateral dimension, the cleft palate
in anteroposterior and mediolateral dimension, and nasal cleft in
anteroposterior and mediolateral dimension. Data were tabulated and
descriptive statistical analysis was done using SPSS ver.21.
Results
The nasal cleft area showed a mean of 6.41 mm cleft in anteropos-
terior dimension, and 3.53 mm in mediolateral dimension. The
alveolar cleft area showed a mean of 11.28 mm in superoinferior
dimension and 8.49 mm in mediolateral dimension, and the palatal
cleft showed a mean of 6.86 mm in the anteroposterior dimension and
2.54 mm in the mediolateral dimension.
Conclusion
Previous literature gives a data analysis of cleft alveolus only, as it is
a major area of repair, and nasal and palatal areas are not usually
considered. Even though nasal and palatal regions are minor areas, its
repair carries a huge impact on function, stability and esthetics which
will increase the quality of life of patient. The authors suggest
changing the terminology of secondary alveolar bone grafting
(SABG) to secondary naso-palato-alveolar bone grafting. (SNPABG).
Abstract No: 0328
Alternate treatment modalities in cleft maxillary
hypoplasia - a preliminary study
Dr. S. Senthil Nathan, Dr. R. Manikandan
Jubilee Mission Medical College Hospital and Research Institute,
Thrissur, Kerala
Abstract
Background
Cleft palate, once operated will produce maxillary hypoplasia as the
patient reaches adolescence. The extent of maxillary hypoplasia will
depend on the type of cleft, nature of surgery performed, and the
number of interventions in the perioral/palatal region. Though inter-
ceptive orthodontics can improve the growth of maxilla in the
adolescent, the optimal management of maxillary hypoplasia is still
not clearly defined. The purpose of this study was to undertake dif-
ferent surgical combinations to produce optimal hard tissue as well as
soft tissue envelope.
Aims and Objectives
To assess and compare the esthetic outcomes of patients with alter-
nate treatment modalities, apart from Le fort I and BSSO, in patient
having cleft maxillary hypoplasia, relative mandibular prognathism
associated with retrognathic chin and everted lowerlip.
Methods
15 patients with maxillary hypoplasia were selected and divided into
three groups as per the following chart. Group I: Those needing a Le
fort I advancement with lower sub apical osteotomy; Group II:
Patients needing segmental maxillary distraction osteogenesis with
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J. Maxillofac. Oral Surg. (2018) 17(Suppl 1):S1–S229
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2. lower sub apical osteotomy; Group III: Patients treated with isolated
maxillary advancement by anterior maxillary distraction (AMD).
Results
Though all the three groups had optimal outcomes, Group II patients
had the best outcome in terms of maxillary fullness, correction of
lower lip eversion, and post surgical orthodontic finishing.
Conclusion
All the three groups in our study showed good results, but the simpler and
more cost effective method (Group II) proved to be an equally competent
technique, producing balanced and beautiful dental rehabilitation.
Abstract No: 0383
Role of hamulotomy on hearing ability of non
syndromic cleft palate patients: a prospective single
blind comparative study
Dr. Anuj Jain
All India Institute of Medical Sciences
Abstract
Background
The primary goal of palatoplasty is to achieve a tension free palatal
closure, ensuring no post-operative complications. Many surgeons
fracture the pterygoid hamulus to minimize tension during palato-
plasty. However, this maneuver has gained criticism by some authors
on the grounds that it may lead to eustachian tube dysfunction. Our
study intended to figure out the relationship of hamulus fracture with
the postoperative state of middle ear in cleft palate children.
Methods
Fifty consecutive cleft palate patients, with an age range of 10 months
to 5 years were recruited. All the patients were assigned to either
hamulotomy or nonhamulotomy group preoperatively. All the
patients were subjected to otoscopic examination and auditory func-
tion evaluation by brainstem evoked response audiometry (BERA)
preoperatively and 1 month and 6 months postoperatively.
Results
Otoscopy revealed that the difference in the improvement of middle
ear status in both the groups was statistically insignificant. Moreover,
there was no significant difference in the BERA outcomes of the
fracture and non fracture populations. Complication rates in both the
groups was also not statistically significant.
Conclusion
It can be concluded that hamulotomy does not have any effect on the
hearing ability in cleft palate population. Therefore, hamulotomy can
be performed for tension free closure during palatoplasty.
Abstract No: 0519
Primary Rhinoplasty: Beneficial or Not?
Dr. Aditi Garg
All India Institute of Medical Sciences
Abstract
Background
Primary nasal repair in cleft lip and cleft palate (CLCP) patients has
been a topic of controversy. Initially, primary nasal repair was left for
preschool age, citing reasons of growth retardation. Since Salyer,1
and
Mc comb, 2
reported excellent improvements in nasal appearance after
longitudinal studies of primary rhinoplasty without affecting the
midfacial growth, primary rhinoplasty has been accepted as the
treatment plan. Despite this, primary rhinoplasty has not become a
norm at many centres. We wanted to authenticate that primary
rhinoplasty improves the nasal symmetry in CLCP patients.
Aims and objectives
To compare nasal symmetry in CLCP patients undergoing only pri-
mary cheiloplasty, with those undergoing primary cheiloplasty with
primary rhinoplasty.
Methods
This was a prospective randomised control study with 70 patients.
The patients were randomly divided into: Group A,which underwent
only primary cheiloplasty, and Group B, which underwent primary
rhinoplasty with cheiloplasty. Basal photographs were taken preop-
eratively and 6–12 months postoperatively to compare nasal
symmetry using 4 linear and 3 angular parameters. ImageJ software
was used for the calculations. Paired t test and independent sample
test were used for the statistics.
Results
Statistical analysis showed that nasal symmetry was better in patients
in group B than in group A. Improvement was seen in 3 out of 7
parameters. There was no difference in relation to the other 4
parameters.
Conclusion
This study showed that doing primary rhinoplasty improves nasal
symmetry compared to cases where primary rhinoplasty was not
done.
References
1. McComb H (1985) Primary correction of unilateral cleft lip nasal
deformity: a 10- year review. Plast Reconstr Surg 75(6):791–9.
2. Salyer KE (1986) Primary correction of the unilateral cleft lip
nose: a 15 year experience. Plast Reconstr Surg 77(4):558–68.
Abstract No: 0531
Vector guided anterior maxillary distraction
for midface hypoplasia in cleft patients
Dr. Ankur Thakral
Army Dental Corps
Abstract
Background
Early surgical corrections for cleft lip and palate tend to result in a
poor skeletal and dental growth in the transverse and anteroposterior
planes. Anterior maxillary distraction (AMD), an alternative to Lefort
I distraction, is a technique of advancing the anterior part of the
maxilla. However, the precision of distraction orientation is vital for
final skeletal and occlusal results. The aim of this study was to
evaluate the results of vector guided anterior maxillary distraction for
correction of midface hypoplasia in cleft patients.
Methods
110 patients were included in the study for whom clinical, intraoral
and cephalometric examination were carried out. Maxillomandibular
relationship was transferred using facebow and semi-adjustable arcon
type articulator was used for model surgery and fabrication of the
distractor. After anterior maxillary osteotomy, distraction was carried
out from the fourth day by customised vector guided intraoral
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