Section 1: Basic Surgical Principles and Perioperative Management

1. Clinical Approach to Oral and Maxillofacial Surgical Patients 3 � Case History 4 � Chief Complaint 4 � History of the Present Illness 4 � Medical History 4 � Social History 5 � Family History 5 � Review of Systems 6 � Examination of the Patient—General Procedure 6 � Vital Signs 6 � Craniofacial Region Examination 7 � Facial Structures 8 � Lips 8 � Cheeks 8 � Maxillary and Mandibular Mucobuccal Folds 8 � Hard Palate and Soft Palate 8 � Tongue 8 � Floor of the Mouth 8 � Gingivae 9 � Teeth and Periodontium 9 � Tonsils and Oropharynx 9 � Salivary Glands 9 � Neck and Lymph Nodes 10

2. Preoperative Care and Evaluation 12 � Preoperative Evaluation 12 � Systemic assessment 14

3. Principles of Postoperative Care 22 � Postoperative Care 22

4. Postoperative Complications and Management 27 � Pulmonary Complications 31 � Ophthalmological Complications 35

5. Medically Compromised Patient Preparation for Maxillofacial Surgery 36 � Cardiovascular System 36 � Diabetes mellitus 38

Contents

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� Hemophilia, Anticoagulation 39 � Thyroid Disorders 40 � Adrenal Diseases 41 � Renal Disease 41 � Hepatic Disease 41 � Respiratory Disease 42 � Immunocompromised Patient 42

Section 2: Examination of Maxillofacial Trauma Patient6. Initial Assessment and Emergency Care of Maxillofacial Trauma Patient 45

� Initial Assessment 45 � Preparation 45 � Triage 46 � Trauma Scoring Systems 47 � Primary Survey 49

7. Neurological Consequences Associated with Maxillofacial Injury 55 � Pathophysiology 55 � Classification of Head Injuries 55 � Primary Assessment 57 � Secondary Assessment 57 � Neurological Examination 59 � Cranial Nerves Examination 59 � Examination of Motor System 60 � Examination of Sensory System 60 � Imaging 61 � Unconscious Patient 61 � Critical Care in Head Injury 61 � Contribution of Neurosurgeon in Trauma Team 61

8. Maxillofacial Trauma: First 24 Hours in Intensive Care Unit 62 � Intensive Care Unit 62 � Prioritization 62 � Case Presentation 68

9. Basic Principles for the Management of Maxillofacial Trauma 75 � Approach to a suspected fracture 75 � Reduction 78 � Fixation 79 � Titanium Miniplates 80 � Newer Development in Osteosynthesis 82 � Locking Plates 83

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10. Dentoalveolar Fractures 85 � Etiology 85

11. Mid-facial Fractures 88 � Surgical Anatomy 88 � Classification 88 � Maxillary Fracture Management 91 � Zygomaticomaxillary Complex Fractures 95 � Treatment Indications for Surgery 98 � Timing of Surgery 98 � Surgical Approaches 98 � Open Reduction Techniques 99 � Fixation V/S Nonfixation 99 � Direct Fixation Techniques 99 � Indirect Fixation 99 � NasoEthmoidal Orbital fracture 99 � Nasal Fractures 102 � Orbital Blowout Fractures 103 � Clinical Cases 109 � Zygomatic Arch Fracture Right Side 113

12. Mandibular Fractures 114 � Anatomical Considerations 114 � Classification 114 � Clinical Assessment and Diagnosis 116

13. Condylar Fractures 121 � Etiology of Condylar Injuries 121 � Classifications 121 � Diagnosis of Condylar Injuries 122 � Clinical Features 122 � Radiography 123 � Management Goals 123 � Conservative and Functional Management 123 � Closed Reduction 124 � Open Reduction 124 � Complications 128 � Conclusion 128 � Some more cases 128

14. Cerebrospinal Fluid Rhinorrhea 130 � Classification of CSF Rhinorrhea 130 � Differential Diagnosis 131 � Management 133

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15. Maxillofacial Trauma: Case Presentation 135 � Case number 1 135 � Case Number 2 136 � Case Number 3 139 � Case Number 4 141 � Case Number 5 142 � Case Number 6 144 � Case Number 7 144 � Case Number 8 144 � Case Number 9 145 � Case Number 10 145

Section 3: Carcinomas of Oral Cavity16. Examination of an Ulcer 149

� Parts of an Ulcer 149 � Classification 150 � History 151 � Differential Diagnosis 151 � Causes of Oral Ulcers 152 � Biopsy 153 � Intraosseous or Hard Tissue Biopsy Technique and Surgical Principles 157

17. Cancer Biology 158 � Modes of Tumor Spread 158 � Process of Bone Metastasis 160 � Biology of Invasion and Metastasis 161

18. Surgical Treatment Plan for Oral and Maxillofacial Cancers 166 � Epidemiology 166 � TNM Definitions 166 � Management 167 � Maxillary Approach 168

19. Management of Neck in Oral and Maxillofacial Carcinoma 179 � History 179 � Anatomical Divisions 179 � Various Incisions for Neck Dissection 182 � Sentinel Node Biopsy 184 � Classification of Neck Dissections 184 � Comprehensive Neck Dissection 184 � Selective Neck Dissection (SND) 189

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20. Role of Chemotherapy and Radiotherapy in Oral and Maxillofacial Carcinoma 191

� Biological Response Modifiers 194 � General Principles in the Treatment of Cancers 194 � Components of Chemotherapy 194 � Case Study 197 � Panoramic Radiograph 198 � Etiology 200 � Pathogenesis 200 � Classification 200 � Revised European-American Lymphoma [REAL] 201 � Recommended Procedure for Staging 202 � Spread of Oral Lymphoma 202 � Treatment Options 202 � Chemotherapy 202 � Roles of Radiotherapy 202

21. Reconstructive Options in Oral and Maxillofacial Cancer 216 � A Multidisciplinary Approach 217 � Goals of Reconstruction 217 � Timing of Reconstruction 217 � Current Approach 217 � Primary Closure 218 � Skin Grafts 218 � Flaps 218

22. Clinical Cases of Cancers in Oral Cavity 237 � Case Number 1 237 � Case Number 2 238 � Case Number 3 240 � Case Number 4 242 � Clinical Case 5 243 � Case Number 6 246 � Case Number 7 249 � Some More Clinical Cases 252

Section 4: Cysts and Tumors of Odontogenic Origin23. Odontogenic Cysts 257

� Classification 257

24. Keratocystic Odontogenic Tumors 275 � Pathophysiology 275 � Clinical Presentation 275

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� Signs and Symptoms 276 � Radiological Features 276 � Histological Features 276 � Treatment 277 � Conclusion 278 � Case Presentation 278 � Discussion 281 � Some More Cases 282

25. Odontogenic Tumors 285 � Classification 286 � Ameloblastoma 287 � Unicystic Ameloblastoma 290 � Ameloblastic Fibrosarcoma 297 � Odontogenic Myxoma 301 � Case Presentations 301 � Cases of Odontogenic Myxoma 308

26. Clinical Cases of Odontogenic Cysts and Tumors 310 � Case Number 1 310 � Case Number 2 312 � Case Number 3 313 � Case Number 4 315 � Case Number 5 316

Section 5: Maxillofacial and Cervical Swellings27. Maxillofacial and Cervical Swellings: Differential Diagnosis 323

� Embryology of Neck 323 � Clinical Examination of Neck Swellings 325 � Superficial Swellings 326 � Investigations for Head and Neck Masses 326 � Unknown Neck Mass 328 � Branchial Cyst 328 � Case Presentation 330

28. Salivary Gland Disorders 335 � Parotid Gland 335 � Clinical Case of Parotid Swellings 337 � Clinical Case Presentation 339 � Head and Neck Examination 340 � Sublingual Glands 341 � Minor Salivary Glands 341 � Saliva 341

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� Clinical Examination and Classification of Salivary Gland Diseases 342 � Classification of Salivary Gland Disorders by Who 349 � Clinical Case Presentation 362 � Some More Cases 364 � Cases 1 365

29. Fibro-osseous Lesions of Jaws 370 � Classification 370 � Fibrous Dysplasia 370 � Osseous Dysplasias (OD) 374 � Ossifying Fibroma 376 � Juvenile Ossifying Fibroma 378 � Case Number 1 380 � Case Number 2 383

30. Vascular Anomalies 385 � Hemangiomas of the Maxillofacial Region 385 � Hemangioma 386 � Role of b-Blockers in Management of Hemangiomas 389 � Vascular Malformations 391 � Venous Malformations 394 � Arterial and Arteriovenous Malformations 396 � Case Number 1 397 � Case Number 2 402 � Some more cases 404

Section 6: Examination of Temporomandibular Joint Disorders31. Temporomandibular Joint Ankylosis 409

� Classification 409

32. Temporomandibular Joint Dislocation, Subluxation, and Hypermobility 422 � Etiology 422 � Diagnosis 423 � Treatment 424 � Surgery for Subluxation and Dislocation 426

33. Internal Derangements of Temporomandibular Joint and Myofascial Pain Dysfunction Syndrome 429

� Derangements of the Condyle-Disk Complex 429 � Structural Incompatibility of the Articular Surfaces 435 � Inflammatory Disorders of the TMJ 437 � Myofascial Pain Dysfunction Syndrome 438

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34. Clinical Cases of Temporomandibular Joint Pathology 441 � Case Number 1 441 � Case Number 2 443 � Case Number 3 444 � Osteochondroma of the Coronoid Process 448

Section 7: Maxillofacial Infections35. Fascial Spaces and Odontogenic Infections 451

� Infections of the Orofacial Region 452 � Types of Infection 454 � Fascial Space Infections 457 � Case of a Submandibular Space Infection 469 � Case Reports 471

36. Osteomyelitis and Osteonecrosis 474 � Classification 474 � Etiology 476 � Clinical Features 478 � Investigations Prior to Management 482 � Goals of Management 482 � Osteonecrosis and Hyperbaric Oxygen Therapy 486 � Definition 486 � Etiology 486 � Incidence 486 � Pathogenesis 486 � Histologic Features 487 � Clinical Classification of ORN 487 � Classification of ORN 487 � Differential Diagnosis 488 � Case Presentation 1 488 � Hyperbaric Oxygen Therapy 491 � Case Presentation 2 493 � Case Presentation 3 495 � Case 4 497

Section 8: Examination of Jaw Deformities37. Diagnosis and Evaluation of Jaw Deformity 501

� Dentofacial Deformity 501 � Esthetic Surgical Procedures 507 � Case Number 1 508 � Case Number 2 512

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38. Principles and Protocols of Bimaxillary Surgery 515 � Case Series 515 � Cephalometric Tracing and Osteotomy Lines 517 � Planning 520

39. Maxillary Orthognathic Procedures 522 � Anterior Maxillary Osteotomy 522 � LeFort I Osteotomy 526 � Case Series 528

40. Mandibular Orthognathic Procedures 535 � Classification of Osteotomies of the Mandible 535 � Technique 537 � Cases 541

Section 9: Miscellaneous41. Imaging in Maxillofacial Pathology 553

� Diagnostic Importance 553 � Imaging Modalities 553

42. Management of Soft Tissue Facial Wound 566 � Healing 566 � Case Series 573

43. Surgical Anatomy of Incisions in Maxillofacial Surgery 576 � General Guidelines for Incision Placement 576 � Incisions for Mandibular Area 577 � Incisions Around the Temporomandibular Joint 582 � Incisions for the Zygoma 584 � Incisions Around the Orbit 586 � Incisions Around the Nasal Complex 587 � Summary and Conclusion 589

44. Fluid, Electrolyte, and Acid–Base Balance 590 � Sodium 592 � Potassium 593 � Magnesium 594 � Calcium 595

45. Surgical Nutrition 600 � Nutrition and Maxillofacial Cancer 603 � Feeding Methods Enteral Nutrition 604 � Postoperative Nutrition Requirements 608

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46. Power-driven Instruments Useful in Maxillofacial Surgery 610 � Electrosurgery 610 � Basics of Lasers and its Effects on Tissues 615 � Laser Types 618 � Laser–Tissue Interaction 620 � Laser Hazards and Laser Safety 621 � Harmonic Scalpel 622

47. Instruments and Postexposure Prophylaxis 623 � Instruments to Transfer Sterile Instruments 624 � Instruments for Preparing Surgical Field 624 � Instruments to Hold Towels and Drapes in Position 625 � Instruments to Incise Tissue 625 � Instruments for Elevating Mucoperiosteum 627 � Instruments for Controlling Hemorrhage 628 � Procedure Specific Instruments of Oral and Oral and Maxillofacial Surgery 641 � Diagnostic Instruments 641 � For Opening the Mouth/Keeping the Mouth open 642 � Soft Tissue Retractors 642 � Instruments for Exodontia 644 � Instruments for Trauma and Orthognathic Surgery 651 � Instruments for Cleft Surgery 658 � Use of Drains in Oral and Maxillofacial Surgery 660 � Types of Drains 662 � Postexposure Prophylaxis (PEP) Following Needle Stick Injury 667

Questions and Answers 671

Index 697

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