Background: The aim of this study was to evaluate the efficacy of heat cured 'poly methyl methacrylate resin prosthesis and to assess the acceptability of the indigenously manufactured titanium mini bone plate and screws in patients treated for repair of cranial defects. Methods: 17 patients with cranial defect were treated for reconstruction of the skull defect with two types of implants i.e. Acrylic resin plate prosthesis and titanium minibone plates, either in combination or singularly. In these cases, the skull defects resulted from trauma (88.23%) or due to ablative tumour surgery (11.96%). Acrylic implant was used in 12 cases (70.85%), titanium plates and screws in 2 cases (11.76%) and a combination of both of the above in 3 cases (17.64). Results: The primary reconstruction was carried out in 2 cases (11.96%) and secondary reconstruction was done in 15 cases (88.23%). Majority of the cases underwent secondary reconstruction because of the initial surgical emergency requiring quick debulking and closure. In 2 cases where primary reconstruction was done, the second surgery could be avoided with gratifying results. Conclusion: 70.85% underwent reconstruction with polymethyl methacrylate resin prosthesis and in the rest either titanium plates were used singly or in combination. Only in one patient, there was rejection of the implant due to infection. In 94% cases the graft was well taken up with excellent results. MJAFI 2005; 61 : 36-40

On extra-oral examination, an obvious facial asymmetry of the mandibular third with deviation of chin to right with a convex profile and excessive exposure of lower lip was noticeable. Bilateral temporomandibular joint and condylar movements were within normal limits without any clicking or grating noise. The mentolabial sulcus and the nasolabial sulcus were flattened. Intra-oral examination revealed an adequate inter-incisal mouth opening of 35mm. There was an anterior open-bite deformity of 4mm, with deviation of mandibular midline to the right by 7mm. There was a Angle's class I relation of molars on the right with a class III relation on the left and cross bite of right maxillary premolars and anterior teeth. Cephalometric analysis was done in both lateral and postero-anterior views, which revealed SNA: 84º,SNB : 82º,ANB:2º and there was asymmetry in the lower third of the face. Study models were obtained from impressions and articulated after rotating the mandibular cast arbitrarily in a transverse plane to achieve maximum intercuspation, thereby correcting the deviated midline and the left side class III relation to Class I. Surgical splint was fabricated over the occlusal surfaces of maxillary and mandibular teeth in the new corrected occlusal relation. The patient was operated under general anaesthesia with intra oral bilateral sagittal split osteotomy, transverse rotation and reposition. Rigid internal fixation was done using titanium plates and screws. Haemostasis was achieved and wound was sutured with absorbable vicryl after placing an extra-oral drain bilaterally.Extra oral pressure dressing was kept for 72 hours and maxillo-mandibular fixation with eyelet wires was maintained for a period of 4 weeks. Post-operative recovery and healing period was uneventful and satisfactory. There was no neurological deficit but the anterior open-bite was not corrected completely. Post-operative occlusion was stable and satisfactory and cephalometric analysis after 4 months revealed marked improvement in midline shift and chin deviation.