DISSERTATION - SYNOPSIS
DR. RASHMI
Post Graduate Student
Department Of Oral and Maxillofacial Surgery
A.J. INSTITUTE OF DENTAL SCIENCES, KUNTIKANA,
MANGALORE.
2012-2013
Rajiv Gandhi University of Health Sciences, Karnataka,
Bangalore
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. / Name of the CandidatesAnd Address
(in block letters) / DR. RASHMI
POST GRADUATE STUDENT,
DEPARTMENT OF ORAL AND MAXILLOFACIAL SURGERY,
A.J. INSTITUTE OF DENTAL SCIENCES,
KUNTIKANA,
MANGALORE.
2. / Name of the institution / A.J. INSTITUTE OF DENTAL SCIENCES
3. / Course of study and subject / MASTER OF DENTAL SURGERY
ORAL AND MAXILLOFACIAL SURGERY
4. / Date of admission to course / 25.05.2012
5. / Title of the topic:
“EFFICACY OF PERCUTANEOUS TRANSNASAL WIRING IN NASO-ORBITO-ETHMOIDAL FRACTURES”
6. / 6.2 Review of literature:
Transnasal Fixation of NOE Fracture: Minimally Invasive Approach. Journal of Oral and Maxillofacial Surgery 2012;11:34-37.
Sridhar and Sarvesh performed the transnasal fixation for nasal bone fractures associated with multiple midfacial fractures on four patients and showed the excellent symmetry in the intercanthal to lateral canthal width with satisfactory restoration of the nasofrontal angle and nasal prominence.
Edward Ellis III. Sequencing treatment for naso-orbito-ethmoid fractures. Journal of Oral and Maxillofacial Surgery 1993;51:543-558.
Edward Ellis III drew a conclusion from their study that an accurate assessment of the injury is most essential and supported the theory of Rowe and Williams that it is difficult to repair NOE injuries if left untreated for longer than 2 weeks. Ellis presented a strategy involving 8 steps for the management of such injuries. Following these steps could make treatment outcomes more predictable.
Converse, J.M., and Smith,B. Naso-orbital fractures. Trans. Am. Acad. Ophthalmol. Otolaryngol. 1963;67:622.
Converse and Smith in their symposium on mid-facial fractures mentioned that fixation of the fractured NOE fragments is best obtained by through-and-through wiring over a perforated plate.
M.F.Stranc. Primary treatment of naso-ethmoid injuries with increased intercanthal distance..British journal of plastic surgery.1970;23:8.
M.F.Stranc stated that approaching to severe naso-ethmoid injuries as compared with blind percutaneous trans-nasal wires and lateral compression plates results in lower incidence of post-traumatic pseudohypertelorism, decreased incidence of epiphora and satisfactory contouring of the external nose.
James P. Paskert, Paul N.Manson,Nicholas T. Nasoethmoidal and orbital fractures.Clinics in plastic surgery-vol.15,no 2, April 1988.
According to James reduction is performed by direct bone repositioning with forceps and trans-nasal wiring is done with No 26 or 28 wire is placed trans-nasally through each medial orbital rim to serve as the mechanism for trans-nasal reduction of the medial orbital rim to obtain a superior esthetic results.
6.3 Objectives of the study:
To evaluate the esthetic and functional outcome of trans-nasal fixation of NOE fracture by minimally invasive approach.
MATERIAL AND METHODS:
Patient associated with isolated NOE fracture,Lefort II and Lefort III fractures visiting the Department of Oral & Maxillofacial Surgery at A J Institute of Dental Sciences.
Sample size: 10
Sampling technique: Convenience Sampling
Technique – closed reduction is performed by percutaneous transnasal wiring once the bony fragments are reduced.
Selection of Patients:
INCLUSION CRITERIA:
· Traumatic telecanthus following isolated NOE fracture within two weeks.
· Medial canthal detachment in Lefort II and Lefort III fracture.
· Comminuted nasal bone fractures without laceration of tissues.
EXCLUSION CRITERIA:
· NOE Fracture older than two weeks
· Lefort II and Lefort III fracture without canthal dettachment
· Comminuted nasal bone fractures with laceration of tissues.
7.2 Methods of collection of data( including sampling procedure, if any)
Pre-operatively and post-operatively following variables will be collected from the patients on a data sheet and will be analyzed statistically:-
a) Intercanthal distance will be measured on a graduated millimeter scale.
b) Frontonasal angle will be measured using a protractor.
Post-operative data will be collected in 4 phases:-
a) Immediate post-op
b) Two weeks post-op
c) 1 month post-op
d) 3 months post-op
The pre-op and post-op intercanthal distance and frontonasal angles obtained will be subjected to statistical analysis using student paired t- test based on the normality of distribution of the values.
7.3 Does the study require any investigations or interventions to be conducted on patients or other humans or animals?
If so, please.
describe briefly.
Yes, this is an in-vivo study and hence requires interventions to be carried out in patients. The study will evaluate the efficacy of percutaneous transnasal wiring in naso-orbito-ethmoidal fractures. The patients will undergo pre-operatively routine hematological and radiographic investigations. Following this, patient will undergo the procedure of transnasal wiring under local/general anesthesia with antibiotics and analgesics.
7.4 Has ethical clearance been obtained from your institution in case
of 7.3?
YES, Approved
INVESTIGATION DESIGN
1. Adams M (1942) Internal wiring fixation of facial fractures, surgery 12:523
2. Converse JM, Smith B (1963) Naso-orbital fractures . Trans Am Acad Ophthalmol Otolayngol 67:622
3. Mustarde JC (1964) Epicanthus and telecanthus . Int Ophtholmol clin 4:59-76.
4. Dingman RO, Grabb WC, Oneal RM (1969) management of Injuries of naso-orbital complex, Arch surg 98:566-571
5. Stranc MF (1970) Primary treatment of naso-ethmiod injuries with increased intercanthal distance. Br J Plast Surg 23:8
6. Gruss JS (1985) Naso-ethmoid –orbital fractures: classification and role of primary bone grafting. Plast Reconstr Surg 75:303
7. Ellis E (1993) Sequencing treatment for naso-orbito-ethmoid fractures. J Oral Maxillofac Surg 51:543-558.
8. Marciani RD, Gontry AA (1993) Principles of management of comlex craniofacial trauma. J oral Maxillofac Surg 51:535-542.
9. Bartkiw TP, Pynn BR, Brown DH (1995) Diagnosis and management of nasal fractures. Int J Trauma Nurs 1:11-18.
10. Cox AJI (2000) Nasal Fractures – the details. Facial Plastic Surg 16:87-94
11. Papadopoulos H, Salib NK (2009) Management of naso-orbital –ethmoidal fractures. Oral maxillofacial Surg Clin N Am 21: 221-225.
12. Journal of Maxillofacial and Oral Surgery Volume 11 / Number 1 / Jan-March (2012) (Page No. 34 – 37)
9. / Signature of candidate
10. / Remarks of the guide:
11. / Name & Designation of
(in block letters):
11.1 Guide: / Dr Naveen Rao,
Professor ,
Department of Oral & Maxillofacial Surgery,
A J Institute of Dental Sciences,
Mangalore
11.2 Signature:
11.3 Co-Guide (if any) / Dr Nandesh Shetty,
Professor and Head,
Department of Oral & Maxillofacial Surgery,
A J Institute of Dental Sciences,
Mangalore
11.4 Signature:
11.5 Head of Department / Dr Nandesh Shetty,
Professor and Head,
Department of Oral & Maxillofacial Surgery,
A J Institute of Dental Sciences,
Mangalore
11.6 Signature
12. / Remarks of the Chairman &
Principal:
Dr. DEEPAK NAYAK U.S.
Signature