Management of Sialoceles Using an Indigenous Salivary Stent.

Background: A Sialocele is a subcutaneous extravasation of saliva from the salivary gland secondary to traumatic disruption of its duct or parenchyma. It is observed after ablative head and neck surgery or due to trauma. Though there are several techniques described, there is no universal consensus on how to treat postoperative sialoceles. Purpose: This paper describes a simple technique which was used to successfully treat 11 patients with postoperative sialoceles. Methods: In this paper we have described the use of an indigenously designed tapered stent used to decompress the sialocele. The decompression allows natural healing and fibrosis to occur over 4-6 days thereby resolving the sialocele. Results: 11 patients with postoperative sialoceles were successfully treated using our technique. Conclusion: The technique described by the authors is a simple, easy to perform procedure that can be managed in the outpatient office under local anesthesia with minimal equipment.

Cleft Maxillary Hypoplasia: Comparison of Techniques and Proposal of a Novel Treatment Protocol for Management.

This study was designed to compare different techniques of managing cleft maxillary hypoplasia and to propose a treatment protocol taking patient's age of presentation, amount of maxillary hypoplasia, and presence/absence of velopharyngeal insufficiency (VPI) into consideration. Five treatment modalities, viz. facemask therapy (Group I), anterior maxillary distraction (Group II), total maxillary distraction osteogenesis using rigid external distraction devices (Group III) and internal distraction devices (Group IV), and conventional orthognathic surgery (Group V), were assessed retrospectively using lateral cephalograms (taken at 3 intervals) and speech records (studied pre- and post-operatively). The results were subjected to statistical analysis. A P value of less than 0.05 was considered statistically significant. The mean advancement achieved in groups I, II, III, IV, and V was 4.2±1.54, 9.03±2.62, 11.82±1.18, 10.41±1.42, and 7.24±2.44 mm, respectively. The mean horizontal relapse noted in Groups I, II, III, IV, and V was 2.3 mm (n=8), 2.1 mm (n=14), 3.4 mm (n=10), 1.4 mm (n=5), and 2.4 mm (n=24), respectively. Compared to other groups, group II had fewer patients exhibiting relapse, a statistically significant observation. Similarly, statistically significant improvement in speech outcomes was found only in group II compared to other groups. Based on the results, a treatment protocol was proposed. The authors conclude that the proposed protocol would enable surgeons to decide the most appropriate treatment modality paying attention to not only the age of presentation and amount of advancement but also presence/absence of VPI which is instrumental in deciding upon the most appropriate treatment.

COVID-associated rhinocerebral mucormycosis: a retrospective analysis of presentation and outcomes.

OBJECTIVES: To comprehensively analyse the disease presentation and mortality of COVID-associated rhino-orbito-cerebral mucormycosis. METHODS: A retrospective analysis of the demographics, clinical and radiographic findings was performed. A binary logistic regression analysis was performed to examine the survival of patients with mucormycosis from hypothesised predictors. RESULTS: A total of 202 patients were included in this study. Statistical significance was demonstrated in the predilection to the male gender, recent history of SARS-COV-2, history of use of corticosteroid and hyperglycemia in this cohort of CAM. The mortality rate was 18.31%. Advanced age, raised HbA1c and intra-orbital extension were found to be predictors adversely affecting survival. CONCLUSION: Early diagnosis, aggressive surgical therapy, early and appropriate medical therapy can help improve outcomes. LEVEL OF EVIDENCE: Level 4.

Prevalence, severity, and risk factor of breakthrough infection after vaccination with either the Covaxin or the Covishield among healthcare workers: A nationwide cross-sectional study.

Background and Aims: The coronavirus disease-2019 (COVID-19) pandemic has grappled the entire globe since the beginning of 2020. In India, two vaccines were released in January 2021, the Covaxin® and the Covishield™. However, despite vaccination, many breakthrough infections were reported during the second wave in India. The present cross-sectional study aimed to find out prevalence, severity, and associated risk factors of breakthrough infection among healthcare workers (HCWs) vaccinated against COVID-19. Material and Methods: After ethical approval and CTRI registration, a validated questionnaire was circulated as Google form-based survey to HCWs across the nation through e-mail over 3 weeks. Biweekly reminders were sent to nonresponders till the desired sample size was attained, after which the survey was closed, and responses were charted. Data obtained from the responses were collated and analyzed. Results: A total of 1096 HCWs responded to the survey (54.8% response rate) and 23.36% had breakthrough infection. The severity of infection was more in the 30-50 years age group (P = 0.0170) and doctors belonging to clinical branches (P = 0.0005). The point estimate for effectiveness in preventing infection was significantly better with Covishield™ (78.5% vs. 72.4%) (P = 0.0260). Nearly all those who were infected after vaccination thought that vaccination decreased disease severity. Conclusion: Breakthrough COVID-19 infection still occurred after vaccination though the prevalence of severe infection was low. Covishield™ performed significantly better than Covaxin® in terms of preventing the disease. Clinical branches of medicine were found at a higher risk and younger HCWs or those with comorbidities had a higher severity of the disease.

Lifestyle and Prevalence of Menstrual Disorders among Undergraduate Medical and Nursing Students: Can We Bring a Change?

Objectives: Menstruation is a normal physiological phenomenon, but sometimes the abnormalities and pain associated with it can severely affect the daily routine of women and may create a stressful environment for them. The objective of this study was to conduct a comparative evaluation of the pattern of menstruation, lifestyle and the outlook toward menstruation among undergraduate female medical and nursing students. Methods: It was a descriptive cross-sectional study conducted among the undergraduate medical and nursing students of a tertiary care Institute. A semi-structured questionnaire was used to collect the data. Of the 400 students approached, 188 completed the questionnaire. Results: The mean age of the participants was 21.23 ± 1.47 years. The mean age of menarche was 12.65 ± 1.24 years among the medical students and 13.69 ± 1.38 years among the nursing students (P < 0.05). Overall, the common menstrual abnormalities observed were dysmenorrhea (71.2%) and premenstrual syndrome (70.2%) followed by menstrual irregularity (14.8%). On correlating lifestyle with menstrual abnormalities, no significant association was found. However, the most common reason for college absenteeism in both groups was dysmenorrhea and fear of unexpected heavy bleeding. Conclusion: Despite having a medical background and knowledge about the physiology of menstruation, medical and nursing students do carry certain myths regarding menstruation which are being carried forward in society. Small roleplays in the OPD (Outpatient Department) area and public awareness lectures should be planned. They will not only develop confidence and better understanding among the students but also create social awareness.

SARS-CoV-2, Uncontrolled Diabetes and Corticosteroids-An Unholy Trinity in Invasive Fungal Infections of the Maxillofacial Region? A Retrospective, Multi-centric Analysis.

OBJECTIVES: Collate and analyse data of maxillofacial/rhino-cerebro-orbital fungal infections reported during the era of the Covid-19 pandemic, with the aim of investigating the common contributing factors leading to such infections and of highlighting the significance of this surge seen in patients infected with SARS-CoV-2. METHOD: This retrospective observational multi-centric study analysed patient data collected from clinicians belonging to different specialties in Bangalore, India. The data included the presentation and management of patients presenting with aggressive maxillofacial and rhino-cerebro-orbital fungal infections and explored the relationship between SARS-CoV-2, corticosteroid administration and uncontrolled diabetes mellitus. RESULTS: All 18 patients were Covid positive. Sixteen of the 18 patients received steroids for Covid treatment and 16 patients were diabetic (of whom 15 patients who were diabetics received steroids for Covid-19 treatment). Loss of vision was noted in 12 of the 18 patients and 7 of them underwent orbital exenteration. The fungi noted was mucormycosis in 16 patients, aspergillosis in 1 patient and a mixed fungal infection in 1 patient. Eleven of the patients survived, 6 died and 1 was lost to follow-up. There was a significantly higher incidence of diabetes (p = 0.03) amongst these cohort of patients who were Covid-19 positive with mucormycosis. A significantly higher number (p = 0.0013) of patients were administered steroids at some point during the treatment. CONCLUSION: Despite the limited sample size, it is evident that there is a significant increase in the incidence of angioinvasive maxillofacial fungal infections in diabetic patients treated for SARS-CoV-2 with a strong association with corticosteroid administration.

Sialendoscopic Management of Obstructive Salivary Gland Pathology: A Retrospective Analysis of 236 Cases.

PURPOSE: To analyze and assess the results of treating obstructive salivary gland pathology by sialendoscopy or sialendoscopic-assisted surgery and analyze the difference in submandibular and parotid gland pathology. PATIENTS AND METHODS: Between December 2012 and March 2020, 211 patients (236 procedures) underwent sialendoscopy/sialendoscopic-assisted surgery for treatment of obstructive salivary gland pathology. The cases were retrospectively analyzed for type of pathology, symptomatic relief, type of intervention (endoscopy alone or combined with open surgery), recurrence of symptoms, number of gland excisions, and complications encountered. Sialolith cases (n = 117) were treated by sialendoscopic/sialendoscopy-assisted surgical sialolithotomy using basket or graspers. Strictures (n = 69) were treated by serial dilatation or balloon dilatation with or without intraductal steroid. Mucous plugs (n = 26) were managed by sialendoscopic lavage and occasional retrieval using wire baskets. RESULTS: There were 123 submandibular sialendoscopies in 118 patients and 113 parotid sialendoscopies in 95 patients. Of the 123 submandibular sialendoscopies, 99 were treated for sialolithiasis, 14 for strictures, 3 for mucous plugs, and 2 for foreign bodies. Of the 95 parotid sialendoscopies, 18 were treated for sialolithiasis, 55 for strictures, 23 for mucous plugs, and 1 for foreign body. The success rate was 85.3% for submandibular gland treatment and 92% for parotid gland treatment. About 62.7% of cases were treated by combined method (sialendoscopy with open approach) in submandibular gland and 50% in parotid gland. The number of gland excisions performed was 5 (2.1%). CONCLUSIONS: Sialendoscopy although associated with a gradual learning curve can be used for all cases of obstructive salivary gland pathology with excellent success rate and minimum morbidity. Parotid gland obstructive pathology is distinct from that seen in the submandibular gland, with strictures and mucous plugs contributing to most cases. Diagnosing and treatment planning for strictures and mucous plugs should therefore be as seamless as that for sialoliths.

A comprehensive management protocol to treat cleft maxillary hypoplasia.

AIM: To describe a comprehensive management protocol to treat cleft maxillary hypoplasia specific to the patient's age, degree of hypoplasia and presence or absence of velopharyngeal incompetence (VPI). MATERIALS AND METHODS: A total of 359 patients suffering from cleft maxillary hypoplasia were retrospectively studied from January 2004 till June 2015. Lateral cephalograms were taken to assess the degree of deformity and advancement achieved at three intervals. Patients were treated by four treatment modalities: Facemask therapy, Anterior maxillary advancement, Total maxillary osteogenesis and LeFort I advancement. RESULTS: 359 patients of cleft maxillary hypoplasia were treated and followed up for a mean of 25 ± 3.6 months. Group I had 20 patients, all in the pre-pubertal age group with less than 11 mm discrepancy. 25% of patients in this group had relapse; Group II: 196 patients who were all above 11 years of age and included all grades of hypoplasia, only 6.25% patients had relapse; Group III had 36 patients all with severe form of hypoplasia and were above 5 years of age. Relapse in this group was 16.6%; Group IV had 102 patients who were above 16 years of age and had mildmoderate severity of hypoplasia. Relapse rate was 18.75%. CONCLUSION: Extensive literature search and our institutional study has helped us formulate a protocol that delineates the most appropriate treatment modality for a specific age group and degree of hypoplasia also considering the effect of treatment on velopharyngeal incompetence.

Single Injection Technique Prolotherapy for Hypermobility Disorders of TMJ Using 25 % Dextrose: A Clinical Study.

INTRODUCTION: Hypermobility disorders of the Temporomandibular joint (TMJ) can be treated by both conservative and surgical approaches. Conservative approaches should be considered as first line treatment for such disorders. Prolotherapy with 25 % dextrose being injected into the posterior pericapsular tissues is one such treatment modality with favorable outcomes. AIM: To study the efficacy of single injection of 25 % dextrose in pericapsular tissues in the management of hypermobility joint disorders of TMJ as first line treatment. PATIENTS AND METHODS: We have studied a total of 23 patients suffering from either chronic recurrent dislocation or subluxation of the TMJ who were treated with the single injection technique prolotherapy with 25 % dextrose into the pericapsular tissues along with auriculotemporal nerve block and found encouraging results. RESULTS: Overall success rate in our study was 91.3 % (21/23) with a minimum follow up period of 13.9 months. Number of successfully treated patients requiring one injection was 7 (30.4 %), two injections was 8 (34.7 %) and requiring three injections was 6 (26.1 %). There were no permanent complications. CONCLUSION: Hence the use of 25 % dextrose as a proliferant to treat hypermobilty disorders of the TMJ is recommended by us as a first line treatment option as it is safe, economical and an easy procedure associated with minimal morbidity.

Use of repeat anterior maxillary distraction to correct residual midface hypoplasia in cleft patients.

OBJECTIVES: The study was designed to evaluate the efficacy of performing a second, repeat anterior maxillary distraction (AMD) to treat residual cleft maxillary hypoplasia. MATERIALS AND METHODS: Five patients between the ages of 12 to 15 years with a history of AMD and with residual cleft maxillary hypoplasia were included in the study. Inclusion was irrespective of gender, type of cleft lip and palate, and the amount of advancement needed. Repeat AMD was executed in these patients 4 to 5 years after the primary AMD procedure to correct the cleft maxillary hypoplasia that had developed since the initial procedure. Orthopantomogram (OPG) and lateral cephalograms were taken for evaluation preoperatively, immediately after distraction, after consolidation, and one year postoperatively. The data obtained was tabulated and a Mann Whitney U-test was used for statistical comparisons. RESULTS: At the time of presentation, a residual maxillary hypoplasia was observed with a well maintained distraction gap on the OPG which ruled out the occurrence of a relapse. Favorable movement of the segments without any resistance was seen in all patients. Mean maxillary advancement of 10.56 mm was achieved at repeat AMD. Statistically significant increases in midfacial length, SNA angle, and nasion perpendicular to point A distance was achieved (P=0.012, P=0.011, and P=0.012, respectively). Good profile was achieved for all patients. Minimal transient complications, for example anterior open bite and bleeding episodes, were managed. CONCLUSION: Addressing the problem of cleft maxillary hypoplasia at an early age (12-15 years) is beneficial for the child. Residual hypoplasia may develop in some patients, which may require additional corrective procedures. The results of our study show that AMD can be repeated when residual deformity develops with the previous procedure having no negative impact on the results of the repeat procedure.