Nitin Mokal - Academia.edu (original) (raw)

Papers by Nitin Mokal

Journal of Craniofacial Surgery, Sep 1, 2014

Despite advances in the acute management of craniofacial fractures, some patients will present wi... more Despite advances in the acute management of craniofacial fractures, some patients will present with secondary deformities. In an attempt to formulate treatment guidelines, we present a review of 152 cases of posttraumatic craniofacial deformities treated by us using different surgical techniques. Analysis of the underlying bony and soft tissue deficits was followed by stepwise reassembly of the skeletal fragments and re-establishment of facial contour and symmetry. The postoperative outcomes were evaluated in terms of aesthetic and functional parameters. Though all patients had considerable improvement after secondary correction of these deformities, soft tissue deficits and time elapsed till secondary reconstruction remain the major factors in achieving an ideal aesthetic outcome.

Indian Journal of Plastic Surgery, 2014

Aim: The purpose of this article is to review modification and outcome of secondary rhinoplasty a... more Aim: The purpose of this article is to review modification and outcome of secondary rhinoplasty along with Abbé flap for correction of secondary bilateral cleft lip deformity. Materials and Methods: A total of thirteen patients of secondary bilateral cleft lip-nose deformity having tight upper lip, lack of acceptable philtral column, Cupid's bow definition, irregular lip scars, and associated nasal deformity were selected. All the patients received Abbé flap and simultaneous nasal correction. All cases were treated during a period of three years. Mean patient age at the time of the operation was 21 years, and ranged from 16 to 27 years. The average follow-up period was three years. Results: Assessment of results was based on comparing preoperative and postoperative clinical photographs done by surgeon and patient relatives and patient satisfaction questionnaires. The columellar lengthening and upper lip vermillion correction achieved was satisfactory. There were no perioperative complications such as airway obstruction, bleeding, infection, wound disruption, or flap necrosis.

Indian Journal of Plastic Surgery, Jul 1, 2007

Injury to the parotid duct is commonly missed which may lead to a Þ stula subsequently. An extern... more Injury to the parotid duct is commonly missed which may lead to a Þ stula subsequently. An external duct Þ stula is distressing to the patient because of continuous dribble of saliva during mastication. Management of established duct Þ stula is controversial with a variety of methods both conservative and operative being reported in the literature, each having varying degrees of success. Reconstruction of the duct is not a good option because of its modest results. Internal diversion of the opening is an innovative, simple method to correct this problem. We report the successful use of this technique in a case of distal parotid duct Þ stula associated with apical root abscess of maxillary molars with cutaneous sinus-an unusual presentation, with a brief review of the literature on the management of parotid Þ stula.

British Journal of Plastic Surgery, May 1, 1990

Indian Journal of Plastic Surgery, 2009

Background: Managing the cleft lip nasal deformity has always been a challenge. Even now, there i... more Background: Managing the cleft lip nasal deformity has always been a challenge. Even now, there is no single established universally accepted method of correction. The open alveolar gap and the ipsilateral hypoplastic maxilla are two major problems in achieving consistently good results in a cleft lip nasal deformity. In our study, after Þ rst assuring the orthodontic realignment of maxillary arches, we combined bone grafting in the alveolar gap and along the pyriform margin, with a formal open rhinoplasty approach. Methods: All the patients underwent orthodontic treatment for preparation of the alveolar bone grafting. During the process of alveolar bone graft, a strip of septal cartilage graft was harvested from the lower border of the septum which also helps to correct the septal deviation. The cancellous bone graft harvested from the iliac crest was used to Þ ll the alveolar gap and placed along the pyriform margin to gain symmetry. Through open rhinoplasty along the alar rim and additionally using Potter's incision extending to the lateral vestibule, the lateral crura of the alar cartilage on the cleft side was released from its lateral attachment and advanced medially as a chondromucosal ß ap in a V-Y fashion, in order to bring the cleft-side alar cartilage into a normal symmetric position. The harvested septal cartilage graft was used as a columellar strut. The cleft nostril sill was narrowed by a Y-V advancement at the alar base and any overhanging alar rim skin was carefully excised to achieve symmetry. Results: The results of this composite approach were encouraging in our series of 15 patients with no additional morbidity and a better symmetry of the nose and airway especially in the adolescent age group. Conclusion: This concept of simultaneous approach when appropriate for nasal correction at the time of alveolar bone grafting showed an encouraging aesthetic and functional outcome.

Craniomaxillofacial Trauma and Reconstruction, Mar 1, 2012

Orbital roof fractures are rare. Traumatic encephaloceles in the orbital cavity are even rarer, w... more Orbital roof fractures are rare. Traumatic encephaloceles in the orbital cavity are even rarer, with only 21 cases published to date. Orbital roof fractures are generally encountered in males between 20 and 40 years of age following automobile collision. We report a case of an orbital roof fracture with traumatic encephalocele into the left orbit. Early diagnosis and treatment are very important because the raised intraorbital pressure may irreversibly damage the optic nerve. Computed tomography with 3-D reconstruction, the imaging modality of choice, showed the displaced fracture fragment deep into the orbit. Reconstruction of the orbital roof should be performed in every case. We used an extracranial approach to elevate the fracture with titanium mesh to stabilize the fragment. The cosmetic results were excellent but delay in treatment was responsible for delayed recovery of vision. The case report is followed by a brief overview of orbital roof fractures including pertinent review of literature.

Indian Journal of Plastic Surgery, Sep 1, 2017

Context: The bilateral cleft lip and nose deformity frequently requires lip revision surgery at t... more Context: The bilateral cleft lip and nose deformity frequently requires lip revision surgery at the time of secondary rhinoplasty. The goal is to achieve an adequate philtrum with a well-shaped Cupid's bow, white roll alignment and a central vermilion tubercle. Aims: We have devised a new technique of using prolabial tissue tailored as an island of skin based on a subcutaneous pedicle for the secondary reconstruction of the philtral aesthetic unit in patients with bilateral cleft lip nasal deformity. Settings and Design: This technique was used in 21 patients from March 2012 to August 2015. All patients had undergone primary lip repair at other institutions and required lip revision with simultaneous rhinoplasty. Subjects and Methods: The objective criteria considered in the post-operative evaluation by the authors included improvement of philtral ridge projection, symmetry of philtral column and nasal sill and white roll continuity. The ten individual parameters were given a score from 1 to 4 (with 1 = lowest and 4 = highest for each individual parameter) and the total score was rated as 31-40 = excellent, 21-30 = good, 11-20 = fair and 0-10 = Poor. The patients' overall satisfaction was assessed at 6 months postoperatively to record their impression of the aesthetic improvement after our procedure. Results: The follow-up period ranged from 6 months to 3 years. The prolabial flap had no post-operative complications. The authors' assessment judged 15 (71.4%) patients as having an excellent outcome and 6 (28.5%) patients as having a good outcome. All patients expressed subjective satisfaction with the post-operative appearance of their upper lip and rated their results as improved and overall satisfaction scoring was high. Conclusions: This technique is a new addition to the repertoire of procedures which already exist for the correction of bilateral cleft lip nose deformity. It is safe, reliable and has a good aesthetic outcome with no significant morbidity.

Annals of Plastic Surgery, Sep 1, 1990

A short forehead or a low hairline sometimes precludes the use of a median forehead flap for reco... more A short forehead or a low hairline sometimes precludes the use of a median forehead flap for reconstruction of defects of the lower nose when both lining and cover are needed. Two flag flaps based on the supratrochlear vessels were used in a patient with a full-thickness alar defect and a narrow, short forehead.

CRC Press eBooks, May 10, 2002

Indian Journal of Plastic Surgery, 2011

Aims: Cranial vault reconstruction can be performed with a variety of autologous or alloplastic m... more Aims: Cranial vault reconstruction can be performed with a variety of autologous or alloplastic materials. We describe our experience using high-density porous polyethylene (HDPE) cranial hemisphere for cosmetic and functional restoration of skull defects. The porous nature of the implant allows soft tissue ingrowth, which decreases the incidence of infection. Hence, it can be used in proximity to paranasal sinuses and where previous alloplastic cranioplasties have failed due to implant infection. Materials and Methods: We used the HDPE implant in seven patients over a three-year period for reconstruction of moderate to large cranial defects. Two patients had composite defects, which required additional soft tissue in the form of free flap and tissue expansion. Results: In our series, decompressive craniectomy following trauma was the commonest aetiology and all defects were located in the fronto-parieto-temporal region. The defect size was 10 cm on average in the largest diameter. All patients had good post-operative cranial contour and we encountered no infections, implant exposure or implant migration. Conclusions: Our results indicate that the biocompatibility and flexibility of the HDPE cranial hemisphere implant make it an excellent alternative to existing methods of calvarial reconstruction.

Indian Journal of Plastic Surgery, 2008

Maintenance of ear projection and post auricular sulcus in staged ear reconstruction in microtia ... more Maintenance of ear projection and post auricular sulcus in staged ear reconstruction in microtia is a trying problem. So also is the maintenance of the patency of the external auditory meatus following recanalization and meatoplasty. Numerous splints and dressing techniques have been described for the above situations. Some of the problems encountered include the availability of the materials, cost, expertise in fabrication and compliance. Aims: To devise a simple, reliable, inexpensive and readily available splint for the maintenance of post auricular sulcus and external auditory meatus opening. Settings and Design: A silicone catheter is made out of a soft and inert material that doesn't cause tissue necrosis or any loss of skin graft. The basic design is that of a simple, selfretaining type of splint that doesn't dislodge and can be prepared within minutes on the operating table. Materials and Methods: This splint has been used in four cases of microtia reconstruction and one case of congenital external auditory meatus stenosis between June 2006 and August 2007. A 14 or 16 Fr silicone Foley's catheter was used. The proximal end of a catheter of required length was retained and the distal part was cut off. The catheter was looped into a circle around the base of the reconstructed ear and secured in position with a suture. A similar construct was used in cases of external auditory meatus reconstruction or recanalization. The funnel-shaped distal drainage end was sutured to the circular frame near the region of the tragus. This funnel was inserted into the external auditory canal. Results: The catheter was found to sit snugly in the newly created sulcus, thereby maintaining the sulcus and ear projection. It aided in maintaining the meatal opening of a satisfactory diameter in the case of external auditory canal recanalization. It was never found to slip or get dislodged in any of the cases. There was no skin graft loss or tissue necrosis due to the use of the splint. Conclusions: The silicone Foley's catheter is found to be a simple, readily available, inexpensive and reliable self-retaining splint following ear elevation in microtia and external auditory meatus recanalization. The catheter is easily constructed and applied intraoperatively. The results following its usage have been uniformly good in all cases without causing any adverse events at the operated site or discomfort to the patient ensuring good compliance.

Journal of Cleft Lip Palate and Craniofacial Anomalies, 2014

The Abbe flap is commonly used for the correction of secondary deformities of cleft lip. The midl... more The Abbe flap is commonly used for the correction of secondary deformities of cleft lip. The midline lower lip scar of the donor site can lead to a bridging contracture when it crosses the labiomental crease. By addition of a small Z-plasty we can ensure that the concavity of the crease is maintained with a superior aesthetic result.

Indian Journal of Plastic Surgery

SummaryAn inexpensive device for continuous passive mobilization of the hand has been fabricated ... more SummaryAn inexpensive device for continuous passive mobilization of the hand has been fabricated for usage in hand physiotherapy units. It is simple to use, effective and can be fabricated easily. 25 digits in 22 patients who suffered from a variety of hand injuries and consequent restricted joint motion were treated with this device. A high patient compliance, decreased pain and significant improvement in the range of motion were observed. The device is suitable for use in a hospital department. The concept and evolution of continuous pasive motion is also discussed.

Annals of the Academy of Medicine, Singapore, 1997

Three cases are presented to stress important points in the diagnosis and management of concomita... more Three cases are presented to stress important points in the diagnosis and management of concomitant maxillofacial, cervical spine and laryngeal trauma. Emergency tracheostomy to control airway, immediate rigid fixation of maxillofacial fractures, early computed tomographic (CT) scans to evaluate the extent of laryngeal and cervical spine injury and the early repair of laryngeal injury will provide better aesthetic and functional results.

Indian Journal of Plastic Surgery, 2005

Three cases of single stage, bi-lamellar reconstruction of full-thickness, horizontal, lateral th... more Three cases of single stage, bi-lamellar reconstruction of full-thickness, horizontal, lateral three quarter lower eyelid defects using pedicled island flaps of adjacent vascular territories and hard palate muco-periosteal graft are being presented. All cases were done for Basal Cell Carcinoma of the region. While the island flaps allowed for a simple, single stage reconstruction of the external lamella, the hard palate muco-periosteal graft, by virtue of its inherent resilience and a rich glandular component, took well and provided for a good functional and aesthetic result. The follow-up ranged from 6 to 40 months and the final result has been oncologically, functionally and aesthetically satisfactory.

Indian Journal of Plastic Surgery, 2005

One hundred normal individuals of different age groups from Mumbai (India) were included in this ... more One hundred normal individuals of different age groups from Mumbai (India) were included in this study. Various dimensions of lip-nose complex were measured. The results were compared with the available data for blacks, Caucasians and Chinese. In the population under study lip-nose complex measurements differ in all dimensions with blacks and Caucasians and show resemblance to the Chinese. The analysis of the data does not simply indicate the differences in the measurements but also points out change in growth patterns which will have a clinical significance.

Indian Journal of Plastic Surgery, 2010

The aim is to discuss a new method of muscle repair in midline cleft lip. Three patients with mid... more The aim is to discuss a new method of muscle repair in midline cleft lip. Three patients with midline cleft lip were repaired with our technique of muscle repair and the results evaluated. Our new method of muscle repair in the form of 'Z' helps in forming the philtral dimple.

International journal of scientific research, 2021

In children, nasal reconstruction with the forehead ap has not been studied thoroughly and even ... more In children, nasal reconstruction with the forehead ap has not been studied thoroughly and even less mentioned is the expanded forehead ap.

Journal of Craniofacial Surgery, Sep 1, 2014

Despite advances in the acute management of craniofacial fractures, some patients will present wi... more Despite advances in the acute management of craniofacial fractures, some patients will present with secondary deformities. In an attempt to formulate treatment guidelines, we present a review of 152 cases of posttraumatic craniofacial deformities treated by us using different surgical techniques. Analysis of the underlying bony and soft tissue deficits was followed by stepwise reassembly of the skeletal fragments and re-establishment of facial contour and symmetry. The postoperative outcomes were evaluated in terms of aesthetic and functional parameters. Though all patients had considerable improvement after secondary correction of these deformities, soft tissue deficits and time elapsed till secondary reconstruction remain the major factors in achieving an ideal aesthetic outcome.

Indian Journal of Plastic Surgery, 2014

Aim: The purpose of this article is to review modification and outcome of secondary rhinoplasty a... more Aim: The purpose of this article is to review modification and outcome of secondary rhinoplasty along with Abbé flap for correction of secondary bilateral cleft lip deformity. Materials and Methods: A total of thirteen patients of secondary bilateral cleft lip-nose deformity having tight upper lip, lack of acceptable philtral column, Cupid's bow definition, irregular lip scars, and associated nasal deformity were selected. All the patients received Abbé flap and simultaneous nasal correction. All cases were treated during a period of three years. Mean patient age at the time of the operation was 21 years, and ranged from 16 to 27 years. The average follow-up period was three years. Results: Assessment of results was based on comparing preoperative and postoperative clinical photographs done by surgeon and patient relatives and patient satisfaction questionnaires. The columellar lengthening and upper lip vermillion correction achieved was satisfactory. There were no perioperative complications such as airway obstruction, bleeding, infection, wound disruption, or flap necrosis.

Indian Journal of Plastic Surgery, Jul 1, 2007

Injury to the parotid duct is commonly missed which may lead to a Þ stula subsequently. An extern... more Injury to the parotid duct is commonly missed which may lead to a Þ stula subsequently. An external duct Þ stula is distressing to the patient because of continuous dribble of saliva during mastication. Management of established duct Þ stula is controversial with a variety of methods both conservative and operative being reported in the literature, each having varying degrees of success. Reconstruction of the duct is not a good option because of its modest results. Internal diversion of the opening is an innovative, simple method to correct this problem. We report the successful use of this technique in a case of distal parotid duct Þ stula associated with apical root abscess of maxillary molars with cutaneous sinus-an unusual presentation, with a brief review of the literature on the management of parotid Þ stula.

British Journal of Plastic Surgery, May 1, 1990

Indian Journal of Plastic Surgery, 2009

Background: Managing the cleft lip nasal deformity has always been a challenge. Even now, there i... more Background: Managing the cleft lip nasal deformity has always been a challenge. Even now, there is no single established universally accepted method of correction. The open alveolar gap and the ipsilateral hypoplastic maxilla are two major problems in achieving consistently good results in a cleft lip nasal deformity. In our study, after Þ rst assuring the orthodontic realignment of maxillary arches, we combined bone grafting in the alveolar gap and along the pyriform margin, with a formal open rhinoplasty approach. Methods: All the patients underwent orthodontic treatment for preparation of the alveolar bone grafting. During the process of alveolar bone graft, a strip of septal cartilage graft was harvested from the lower border of the septum which also helps to correct the septal deviation. The cancellous bone graft harvested from the iliac crest was used to Þ ll the alveolar gap and placed along the pyriform margin to gain symmetry. Through open rhinoplasty along the alar rim and additionally using Potter's incision extending to the lateral vestibule, the lateral crura of the alar cartilage on the cleft side was released from its lateral attachment and advanced medially as a chondromucosal ß ap in a V-Y fashion, in order to bring the cleft-side alar cartilage into a normal symmetric position. The harvested septal cartilage graft was used as a columellar strut. The cleft nostril sill was narrowed by a Y-V advancement at the alar base and any overhanging alar rim skin was carefully excised to achieve symmetry. Results: The results of this composite approach were encouraging in our series of 15 patients with no additional morbidity and a better symmetry of the nose and airway especially in the adolescent age group. Conclusion: This concept of simultaneous approach when appropriate for nasal correction at the time of alveolar bone grafting showed an encouraging aesthetic and functional outcome.

Craniomaxillofacial Trauma and Reconstruction, Mar 1, 2012

Orbital roof fractures are rare. Traumatic encephaloceles in the orbital cavity are even rarer, w... more Orbital roof fractures are rare. Traumatic encephaloceles in the orbital cavity are even rarer, with only 21 cases published to date. Orbital roof fractures are generally encountered in males between 20 and 40 years of age following automobile collision. We report a case of an orbital roof fracture with traumatic encephalocele into the left orbit. Early diagnosis and treatment are very important because the raised intraorbital pressure may irreversibly damage the optic nerve. Computed tomography with 3-D reconstruction, the imaging modality of choice, showed the displaced fracture fragment deep into the orbit. Reconstruction of the orbital roof should be performed in every case. We used an extracranial approach to elevate the fracture with titanium mesh to stabilize the fragment. The cosmetic results were excellent but delay in treatment was responsible for delayed recovery of vision. The case report is followed by a brief overview of orbital roof fractures including pertinent review of literature.

Indian Journal of Plastic Surgery, Sep 1, 2017

Context: The bilateral cleft lip and nose deformity frequently requires lip revision surgery at t... more Context: The bilateral cleft lip and nose deformity frequently requires lip revision surgery at the time of secondary rhinoplasty. The goal is to achieve an adequate philtrum with a well-shaped Cupid's bow, white roll alignment and a central vermilion tubercle. Aims: We have devised a new technique of using prolabial tissue tailored as an island of skin based on a subcutaneous pedicle for the secondary reconstruction of the philtral aesthetic unit in patients with bilateral cleft lip nasal deformity. Settings and Design: This technique was used in 21 patients from March 2012 to August 2015. All patients had undergone primary lip repair at other institutions and required lip revision with simultaneous rhinoplasty. Subjects and Methods: The objective criteria considered in the post-operative evaluation by the authors included improvement of philtral ridge projection, symmetry of philtral column and nasal sill and white roll continuity. The ten individual parameters were given a score from 1 to 4 (with 1 = lowest and 4 = highest for each individual parameter) and the total score was rated as 31-40 = excellent, 21-30 = good, 11-20 = fair and 0-10 = Poor. The patients' overall satisfaction was assessed at 6 months postoperatively to record their impression of the aesthetic improvement after our procedure. Results: The follow-up period ranged from 6 months to 3 years. The prolabial flap had no post-operative complications. The authors' assessment judged 15 (71.4%) patients as having an excellent outcome and 6 (28.5%) patients as having a good outcome. All patients expressed subjective satisfaction with the post-operative appearance of their upper lip and rated their results as improved and overall satisfaction scoring was high. Conclusions: This technique is a new addition to the repertoire of procedures which already exist for the correction of bilateral cleft lip nose deformity. It is safe, reliable and has a good aesthetic outcome with no significant morbidity.

Annals of Plastic Surgery, Sep 1, 1990

A short forehead or a low hairline sometimes precludes the use of a median forehead flap for reco... more A short forehead or a low hairline sometimes precludes the use of a median forehead flap for reconstruction of defects of the lower nose when both lining and cover are needed. Two flag flaps based on the supratrochlear vessels were used in a patient with a full-thickness alar defect and a narrow, short forehead.

CRC Press eBooks, May 10, 2002

Indian Journal of Plastic Surgery, 2011

Aims: Cranial vault reconstruction can be performed with a variety of autologous or alloplastic m... more Aims: Cranial vault reconstruction can be performed with a variety of autologous or alloplastic materials. We describe our experience using high-density porous polyethylene (HDPE) cranial hemisphere for cosmetic and functional restoration of skull defects. The porous nature of the implant allows soft tissue ingrowth, which decreases the incidence of infection. Hence, it can be used in proximity to paranasal sinuses and where previous alloplastic cranioplasties have failed due to implant infection. Materials and Methods: We used the HDPE implant in seven patients over a three-year period for reconstruction of moderate to large cranial defects. Two patients had composite defects, which required additional soft tissue in the form of free flap and tissue expansion. Results: In our series, decompressive craniectomy following trauma was the commonest aetiology and all defects were located in the fronto-parieto-temporal region. The defect size was 10 cm on average in the largest diameter. All patients had good post-operative cranial contour and we encountered no infections, implant exposure or implant migration. Conclusions: Our results indicate that the biocompatibility and flexibility of the HDPE cranial hemisphere implant make it an excellent alternative to existing methods of calvarial reconstruction.

Indian Journal of Plastic Surgery, 2008

Maintenance of ear projection and post auricular sulcus in staged ear reconstruction in microtia ... more Maintenance of ear projection and post auricular sulcus in staged ear reconstruction in microtia is a trying problem. So also is the maintenance of the patency of the external auditory meatus following recanalization and meatoplasty. Numerous splints and dressing techniques have been described for the above situations. Some of the problems encountered include the availability of the materials, cost, expertise in fabrication and compliance. Aims: To devise a simple, reliable, inexpensive and readily available splint for the maintenance of post auricular sulcus and external auditory meatus opening. Settings and Design: A silicone catheter is made out of a soft and inert material that doesn't cause tissue necrosis or any loss of skin graft. The basic design is that of a simple, selfretaining type of splint that doesn't dislodge and can be prepared within minutes on the operating table. Materials and Methods: This splint has been used in four cases of microtia reconstruction and one case of congenital external auditory meatus stenosis between June 2006 and August 2007. A 14 or 16 Fr silicone Foley's catheter was used. The proximal end of a catheter of required length was retained and the distal part was cut off. The catheter was looped into a circle around the base of the reconstructed ear and secured in position with a suture. A similar construct was used in cases of external auditory meatus reconstruction or recanalization. The funnel-shaped distal drainage end was sutured to the circular frame near the region of the tragus. This funnel was inserted into the external auditory canal. Results: The catheter was found to sit snugly in the newly created sulcus, thereby maintaining the sulcus and ear projection. It aided in maintaining the meatal opening of a satisfactory diameter in the case of external auditory canal recanalization. It was never found to slip or get dislodged in any of the cases. There was no skin graft loss or tissue necrosis due to the use of the splint. Conclusions: The silicone Foley's catheter is found to be a simple, readily available, inexpensive and reliable self-retaining splint following ear elevation in microtia and external auditory meatus recanalization. The catheter is easily constructed and applied intraoperatively. The results following its usage have been uniformly good in all cases without causing any adverse events at the operated site or discomfort to the patient ensuring good compliance.

Journal of Cleft Lip Palate and Craniofacial Anomalies, 2014

The Abbe flap is commonly used for the correction of secondary deformities of cleft lip. The midl... more The Abbe flap is commonly used for the correction of secondary deformities of cleft lip. The midline lower lip scar of the donor site can lead to a bridging contracture when it crosses the labiomental crease. By addition of a small Z-plasty we can ensure that the concavity of the crease is maintained with a superior aesthetic result.

Indian Journal of Plastic Surgery

SummaryAn inexpensive device for continuous passive mobilization of the hand has been fabricated ... more SummaryAn inexpensive device for continuous passive mobilization of the hand has been fabricated for usage in hand physiotherapy units. It is simple to use, effective and can be fabricated easily. 25 digits in 22 patients who suffered from a variety of hand injuries and consequent restricted joint motion were treated with this device. A high patient compliance, decreased pain and significant improvement in the range of motion were observed. The device is suitable for use in a hospital department. The concept and evolution of continuous pasive motion is also discussed.

Annals of the Academy of Medicine, Singapore, 1997

Three cases are presented to stress important points in the diagnosis and management of concomita... more Three cases are presented to stress important points in the diagnosis and management of concomitant maxillofacial, cervical spine and laryngeal trauma. Emergency tracheostomy to control airway, immediate rigid fixation of maxillofacial fractures, early computed tomographic (CT) scans to evaluate the extent of laryngeal and cervical spine injury and the early repair of laryngeal injury will provide better aesthetic and functional results.

Indian Journal of Plastic Surgery, 2005

Three cases of single stage, bi-lamellar reconstruction of full-thickness, horizontal, lateral th... more Three cases of single stage, bi-lamellar reconstruction of full-thickness, horizontal, lateral three quarter lower eyelid defects using pedicled island flaps of adjacent vascular territories and hard palate muco-periosteal graft are being presented. All cases were done for Basal Cell Carcinoma of the region. While the island flaps allowed for a simple, single stage reconstruction of the external lamella, the hard palate muco-periosteal graft, by virtue of its inherent resilience and a rich glandular component, took well and provided for a good functional and aesthetic result. The follow-up ranged from 6 to 40 months and the final result has been oncologically, functionally and aesthetically satisfactory.

Indian Journal of Plastic Surgery, 2005

One hundred normal individuals of different age groups from Mumbai (India) were included in this ... more One hundred normal individuals of different age groups from Mumbai (India) were included in this study. Various dimensions of lip-nose complex were measured. The results were compared with the available data for blacks, Caucasians and Chinese. In the population under study lip-nose complex measurements differ in all dimensions with blacks and Caucasians and show resemblance to the Chinese. The analysis of the data does not simply indicate the differences in the measurements but also points out change in growth patterns which will have a clinical significance.

Indian Journal of Plastic Surgery, 2010

The aim is to discuss a new method of muscle repair in midline cleft lip. Three patients with mid... more The aim is to discuss a new method of muscle repair in midline cleft lip. Three patients with midline cleft lip were repaired with our technique of muscle repair and the results evaluated. Our new method of muscle repair in the form of 'Z' helps in forming the philtral dimple.

International journal of scientific research, 2021

In children, nasal reconstruction with the forehead ap has not been studied thoroughly and even ... more In children, nasal reconstruction with the forehead ap has not been studied thoroughly and even less mentioned is the expanded forehead ap.