BSc, BDS, MDS (UK), FRACDS (Australia), FDSRCS (Edinburgh),
Diplomate American Board of Oral and Maxillofacial Surgery.

Orbital Trauma:  Current Management Options Using Virtual Computer Assisted Reconstruction

Orbital trauma is involved in 47% of severely injured patients. Isolated orbital fractures account for 4% to 16% of all fractures. It is usually a result of blunt trauma due to motor vehicle accidents, interpersonal assaults, sports injuries, industrial accidents and fire arm injuries. Orbital anatomy is complex with seven bones contributing to the formation of the orbit like zygomatic, maxilla, lacrimal, sphenoid, ethmoid, frontal and palatine bone along with highly specialized nerves and structures bundled in the orbital cavity. The volume of the orbit is 30 ml with the globe averages 7 ml.  The orbital growth is 85% complete by the age of 5 and the remaining between 7 years and puberty.  Orbital floor in children and adults is a commonly occurring fracture and the most encountered combination is the floor and medial wall fracture.  Fractures of the orbit could also be a part of zygomatico-maxillary complex , naso-orbito-ethmoidal and frontal sinus fractures. These fractures are classified into pure/impure and open and trap door fractures. Hence, adequate and optimal management of orbital injuries possess great challenges to Oral and Maxillofacial Surgeons.

This paper would discuss the soft tissue injuries of the periorbital area, the mechanism involved in  orbital fractures, diagnostic imaging and its role in ensuring adequate restoration of orbital volume, indications and timing of repair, surgical access and choice of autogenous and alloplastic materials for  the orbit using computer assisted reconstruction. Brief summary of complications will also be presented. The paper would also highlight the use of 3-D Modelling in the assessment and reconstruction of orbital fractures with selective indications of intraoperative navigation. The author will discuss his own observations and experience in treating orbital fractures including pearls and pitfalls.

Temporomandibular Joint Disorders: Treatment Approaches to Management based on Diagnosis

There are many myths and fallacies regarding the management of TMD Disorders both non-surgical(conservative) and surgical. Therefore, treatments delivered to the patients should be evidence based with reproducible results keeping in view the best practices and in the best interest of patients. Temporomandibular disorders are a very common problem in 4% of general population seeking treatment at some point in time. A higher percentage like 40% will show signs and 25% symptoms of this disorder. These disorders can be divided into common disorders, uncommon disorders and rare conditions. Aetiology of TMD is multifactorial, biopsychosocial with predisposing and precipitating factors. This talk would highlight clinical sign and symptoms, diagnostic imaging in evolving a diagnosis with stepwise treatment algorithm reversible/conservative in a clinical setting of Myofascial pain, Internal disc derangement and TMJ arthritides. Irreversible options with caution will also be discussed including total joint replacements. An update on the use of Botox in TMD will also be presented.