Median cleft of lower lip and mandible is a rare anomaly. This Cleft has also been described as Cleft No. 30 of Tessier′s classification. In minor forms only lower lip is cleft. Frequently, the cleft extends into the mandibular symphysis and the tongue is attached to the cleft alveolar margin. At times the tongue may be bifid or absent, hyoid absent, thyroid cartilage underdeveloped, strap muscles atrophic, manubrium sterni absent, clavicles widely spaced etc. The earliest report of this anomaly was by Couronne′ in 1819. Since then very few cases have been reported in literature with variations. We describe a male child who presented at the age of 6 months with an ectopic salivary gland on the dorsum of the tongue in addition to median cleft of lower lip, ankyloglossia and notching of the mandible. Excision of mass on dorsum of tongue, release of ankyloglossia and lip from the alveolus followed by repair was done. No bony work was done since the mandible was only notched. On post-operative follow-up at 18 months, dentition was delayed in both maxillary as well as mandibular teeth and there was a gap between the lower central incisors. At the age of 2 years 4 months, the dentition is still not complete and the gap between the lower central incisors is very apparent. There is a supernumerary upper central incisor on right side. There is no mobility between the two segments of mandible. Speech is normal. A regular follow-up will be done to study the eruption of permanent central incisors at the age of 7 years and till eruption of all permanent teeth to assess the occlusion and to decide whether any bony work is needed or not.

Implant-supported overdentures provide a good opportunity for dentists to improve oral health and quality-of-life of patients. Atrophic mandible poses a significant challenge to successful oral rehabilitation with dental implants. In this article, the fabrication of lower overdenture by two narrow platform implants is described with dual retentive, resilient, self-locating locator attachment system. The locator attachment system has the lowest profile in comparison with the ball and bar attachments and is versatile up to 40° of divergence between two implants. By using locators as attachments, we can meet functional, economic and social expectation of patients with ease and satisfaction.

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Post-traumatic external carotid artery pseudoaneurysms are very uncommonly encountered in clinical practice. We present the case of a young man who developed pseudoaneurysm 5 weeks after a maxillofacial injury treated elsewhere. Case PresentationA 23-year-old male presented with a history of swelling over the left side of face since 1 week. He had a history of road traffic accident 5 weeks ago. He was treated elsewhere after the injury by tracheostomy, open reduction and internal fixation of his mandibular symphysis fracture with closed approach for his condylar head fractures. On examination, the patient had left sided facial palsy, tender diffuse swelling over left side of face and neck, trismus and dental malocclusion. A computed tomography (CT) scan with angiography was performed which revealed a pseudoaneurysm of the terminal branch of external carotid artery about 6.6 9 4.9 9 8.9 cm in diameter AP/RL/CC (Fig. 1). Bilateral sagitally fractured condylar heads and left coronoid process fractures were noted with lateral flaring of the left mandible. Symphysis was fixed using plates and screws (Fig. 2). The radiologist interpreted on CT scan that the origin of the pseudoaneurysm was most likely to be the superficial temporal artery.The treatment plan was surgical repair of the superficial temporal artery pseudoaneurysm and correction of the malocclusion by mandibular repositioning. A preauricular incision was made, the pseudoaneurysm identified and the superficial temporal artery was doubly ligated. On opening the pseudoaneurysm wall, to our surprise, there was a torrential bleed from within, thus raising the possibility of another source of the pseudoaneurysm origin. With pressure applied locally, an extension of the incision in the neck to a parotidectomy type was made. The external carotid artery (ECA) was identified and a vascular control sought. ECA control was then tightened to minimize the bleeding and 5-0 polypropylene (Prolene, Ethicon) was used to suture repair the rent in distal part of internal maxillary artery from within the pseudoaneurysm cavity. Hemostasis was confirmed after releasing the ECA. The symphyseal fracture was re-osteotomized using an existing chin scar, and the entire left mandible mobilized medially at the ramal angle to correct the flaring, two 2.5 mm miniplates were secured with eight screws at the symphysis. A satisfactory neoocclusion was achieved. A suction drain was applied and closure was done in layers. The post-operative course was uneventful (Fig. 3). DiscussionIn the head and neck, blunt, penetrating or surgical trauma can infrequently lead to damage of vessels resulting in pseudoaneurysms. The diagnosis of these vascular complications is made easy with the availability of CT angiography [1,2]. A CT scan also is advantageous in assessing the artery of origin and relation of the pseudoaneurysm with the bony fractures and planning the treatment strategy. In our patient depending on the CT angiography, we however misinterpreted the pseudoaneurysm in the pre-auricul...

The platysmal myocutaneous flap has shown promising results for the reconstruction of defects in the head and neck region. It has been successfully used for the reconstruction of the defects over the cheek, floor of the mouth, buccal mucosa, tongue, lower lip, mandibular alveolus, hypopharnx and supraglotic larynx. The posteriorly and the superiorly based platysmal flaps have a wide range of applicability in the reconstruction of intraoral defects. In the present series we have used a posterosuperiorly based platysmal flap which has shown encouraging results. It was also found that leaving the base of the mandible intact helps in maintaining the periosteal blood supply which further contributes to the survival of the flap. The thinness, arc of rotation, pliability and ease of availability of the platysmal myocutaneous flap gives the reconstructive surgeon an additional option, especially when a microvascular flap is not feasible.