EphB3 as a Potential Mediator of Developmental and Reparative Osteogenesis.

The ephrin-B family of membrane-bound ligands is involved in skeletal patterning, osteogenesis, and bone homeostasis. Yet, despite the increasing collection of data affirming their importance in bone, the Eph tyrosine kinases that serve as the receptors for these ephrins in osteoblast stem cell niches remain unidentified. Here we report the expression of EphB3 at sites of bone growth in the embryo, especially at the calvaria suture fronts, periosteum, chondrocytes, and trabeculae of developing long bones. Strong EphB3 expression persisted in the adult calvarial sutures and in the proliferative chondrocytes of long bones, both of which are documented niches for osteoblastic stem cells. We observed EphB3-positive cells in the tissue filling a created calvarial injury, further implying EphB3 involvement in bone healing. Genetic knockout of EphB3 caused an increase in the bone tissue volume as a fraction of total volume in 6-week-old calvaria and in femoral trabecular density, compared to wild type controls. This difference resolved by 12 weeks of age, when we instead observed an increase in the bone volume of femoral trabeculae and in trabecular thickness. Our data identify EphB3 as a candidate regulator of osteogenesis either alone or in combination with other bone-expressed Ephs, and indicate that it appears to function as a limiter of bone growth.

Frey's Syndrome Consequent to an Unusual Pattern of Temporomandibular Joint Dislocation: Case Report with Review of Its Incidence and Etiology.

Frey's syndrome was first described in the 18(th) century. Recognizing it as a nonspecific condition, the symptom of gustatory sweating in patients with parotid gland inflammation was described by Duphenix and Baillarger. However, as a specific diagnostic entity, gustatory sweating, following trauma to parotid glands, was first described by Polish neurologist Lucie Frey, in 1923, and hence he proposed the term auriculotemporal syndrome. The condition is characterized by sweating, flushing, a sense of warmth, and occasional pain in the preauricular and temporal areas, following the production of a strong salivary stimulus. Several etiologies of Frey's syndrome have been mentioned in the literature; however, none attribute dislocation of the "intact" mandibular condyle as a cause of the syndrome. Reviewing its pathophysiology, etiology, and incidence in detail, we describe a case of Frey's syndrome subsequent to superolateral dislocation of the intact mandibular condyle following fracture of the anterior mandible. Its management and prevention are also discussed in brief.

Maxillofacial trauma in central karnataka, India: an outcome of 95 cases in a regional trauma care centre.

Materials and Methods A 6-year retrospective analysis of 111 patients treated for maxillofacial fractures in Davangere, Karnataka from January 2004 to December 2009 was performed. Variables like age, gender, occupation, type of fracture and mechanism of injury, concomitant injury, mode of treatment, and complications were recorded and assessed. Results Men between 21 and 30 years were mostly affected (male-to-female ratio = 10:1; age range = 17.60 years; mean 31.7 ± 9.8 [standard deviation]). Most fractures were caused by road traffic accidents (RTAs; 74.7%), followed by interpersonal violence (IPV; 15.8%), falls (4.2%), industrial hazards and animal attacks (2.1% each), and self-inflicted injury (1.1%). Forty-two cases were isolated zygomaticomaxillary complex (ZMC) fractures. The total number of facial fractures documented was 316, of which 222 were purely related to the ZMC; however, 11 were confined only to the midface. Fifty-three cases had concomitant lower jaw fractures, totaling 83. Ophthalmic injuries occurred in 30.52% of cases. Ninety-two cases were treated with open reduction and internal fixation (ORIF), and three cases were managed conservatively. The complication rate observed was 25.26%. Conclusion RTA continues to be the chief etiological factor in maxillofacial injury with males being affected predominantly. IPV and falls next contribute significantly to the incidence of such injuries. Concomitant injuries, however, require prompt recognition and appropriate management. ORIF still remains the mainstay of treatment; however, fixation devices are constantly being improved upon in an attempt to reduce immobilization time thereby facilitating early return to function with minimal morbidity. Nevertheless, future advances in maxillofacial trauma diagnosis and management are likely to reduce associated morbidity.

Tramadol versus ketorolac in the treatment of postoperative pain following maxillofacial surgery.

Pain plagues daily activity and hence its management would require alleviation at both the mental and physical planes, thus, bringing about comfort. It includes delivering analgesics in parenteral or oral form, or patches depending on the intensity and availability. Best analgesic regimens are ones that offer broad coverage, easy to administer, safe and economical. A drug seemingly appropriate to treat moderate to severe pain would be Tramadol hydrochloride, a centrally acting synthetic opioid analgesic with lower opiate-like dependence than Morphine. Ketorolac, a pyrrolo-pyrrole derivative, possesses analgesic, anti-inflammatory and anti-pyretic activity would also appear equally suitable. Fifty adult ASA grade I and II patients undergoing surgery under GA in the Department of Oral & Maxillofacial Surgery, College of Dental Sciences, Davangere, were included. Ketorolac (30 mg IM) for 25 patients and Tramadol (100 mg IM) for 25 patients were administered at the time of skin closure and repeated after 8 and 16 h from the conclusion of surgery. Pain, using the VAS at the 2nd, 4th, 6th, 12th and 24th post-operative hour, was assessed and compared using χ(2)-test. Vitals were monitored and adverse events were looked for. Though both the drugs resulted in significant decrease in pain intensity from the 2nd to 24th post-operative hour, Tramadol always resulted in better pain control than Ketorolac at every post-operative hour (P < 0.050). To conclude, intramuscular Tramadol seemed useful in controlling pain following surgery, with better levels of tolerance than intramuscular Ketorolac. However, both the drugs produced mild side effects but did not appear to influence the outcome.