Robotic Neck Dissection in Head and Neck Cancer via Modified BABA Technique.

INTRODUCTION: Neck dissection forms an important component in the surgical management of head and neck cancers. By using the conventional techniques of neck dissection, a conspicuous scar is inevitable for the patients. The development of robotic assisted neck dissection provides for a scar-free neck along with good oncological and functional outcomes. METHODS: A prospective observational study was conducted in our institute from 2020 March to 2022 March, where robotic-assisted neck dissections performed via the modified bilateral axillo-breast insufflation technique. RESULTS: Eighty-two patients underwent robotic neck dissections in our institute. Notably, 79 patients were treatment-naïve. The average docking time was 12 min and console time was 160 ± 15 min. The mean lymph node yield was 28.2. The average post-operative stay was 5.6 days. The average follow-up was noted to be 6.4 months. The mean cosmetic satisfaction score in our patients was 4.45. Only one patient presented with nodal recurrence, who was identified as a defaulter for adjuvant treatment. Robotic neck dissection gives similar functional and oncological outcomes as compared with conventional neck dissection. Patients had excellent cosmetic satisfaction following the procedure. The limitations of these techniques include high cost of procedure and longer operating time. This is a level IV evidence study. CONCLUSION: Although good oncological, functional, and cosmetic outcomes have been attained in robotic assisted neck dissection, further randomized controlled studies need to be conducted to justify the added costs, cosmetic advantage, and the time taken. LEVEL OF EVIDENCE: Level IV Laryngoscope, 2024.

A Rare Case Report of Osteosarcoma of Maxilla with Double Free-Flap Reconstruction.

Osteosarcomas are rare and highly malignant bone tumours which are composed of malignant mesenchymal cells producing osteoid or immature bone. Maxillary osteosarcomas are rare tumours accounting for less than 1% of head and neck malignancies. Aggressive surgical resection is the main modality of treatment with good reconstruction. Due to the complex anatomy and location of maxilla as well as its proximity to the skull, resection with negative margins is always a challenge and so is the reconstruction so as to reduce the morbidity of the patient and to also give a good functional and cosmetic outcome. Clinical outcomes can be improved with administration of neoadjuvant or adjuvant chemotherapy in selected cases and radiotherapy in case of positive margins. A 41-year-old male patient presented to the outpatient department with complaints of a bulge over the hard palate for the past 1 year. CT scan showed a 6 × 5 × 4 cm osseous expansile lesion arising from the maxillary bone. Biopsy of the tumour showed features of conventional high-grade osteosarcoma. Plate-preserving maxillectomy with tracheostomy was done followed by reconstruction with a double free flap. On post-operative day 1, the flap showed signs of venous congestion and a new free anterolateral thigh flap was done. Patient was discharged on day 7 with a Ryles tube and a tracheostomy tube in situ. Final histopathological examination showed that the tumour was a high-grade chondroblastic osteosarcoma. After regular post-operative visits in the outpatient department and evaluation with flexible laryngoscopy, patient was started on oral feed by day 10 and decannulated by day 15. He has been on regular follow-up for the past 1 year and shows no signs of recurrence or residual disease on clinical examination as well as imaging. Maxillary osteosarcoma is a rare bone tumour which requires accurate imaging and biopsy for accurate surgical planning. The ideal treatment modality is radical resection with negative margins and appropriate reconstruction. With the advent of microvascular surgery, free flaps form the backbone for reconstruction of such large defects.

Polyethylene Glycol-Based Polymer-Drug Conjugates: Novel Design and Synthesis Strategies for Enhanced Therapeutic Efficacy and Targeted Drug Delivery.

Due to their potential to enhance therapeutic results and enable targeted drug administration, polymer-drug conjugates that use polyethylene glycol (PEG) as both the polymer and the linker for drug conjugation have attracted much research. This study seeks to investigate recent developments in the design and synthesis of PEG-based polymer-drug conjugates, emphasizing fresh ideas that fill in existing knowledge gaps and satisfy the increasing need for more potent drug delivery methods. Through an extensive review of the existing literature, this study identifies key challenges and proposes innovative strategies for future investigations. The paper presents a comprehensive framework for designing and synthesizing PEG-based polymer-drug conjugates, including rational molecular design, linker selection, conjugation methods, and characterization techniques. To further emphasize the importance and adaptability of PEG-based polymer-drug conjugates, prospective applications are highlighted, including cancer treatment, infectious disorders, and chronic ailments.

Extraskeletal Myxoid Chondrosarcoma of Floor of Mouth-A Rare Case Report and Review of Literature.

Introduction: Chondrosarcomas are rare malignancies of the cartilage and myxoid chondrosarcoma is its variant which commonly occurs in soft tissue of extremities. Extraskeletal chondrosarcoma is a rare malignant neoplasm of bone or soft tissue origin and is characterized by the presence of spindle cells admixed with well differentiated cartilage or chondroid stroma. They are mostly radioresistant tumours and surgical resections with adequate margins is considered as the ideal treatment modality with adjuvant radiotherapy in high grade tumours and add on chemotherapy, in case of presence of poor prognostic factors. Case Report: A 51-year-old diabetic, hypertensive female patient presented to our outpatient department with difficulty in chewing food for a duration of 6 months. On clinical examination, she had an ulceroproliferative growth involving right lower alveolus and floor of mouth. MRI face and neck with contrast showed a 4.1 × 2.9 × 4.5 cm lesion involving right lower alveolus extending to floor of mouth. Biopsy showed features of extraskeletal myxoid chondrosarcoma. She was planned for upfront surgery (Right composite resection with modified radical neck dissection with free fibula flap). Patient was stable post-surgery and was discharged in stable condition. Final histopathology report was high grade myxoid chondrosarcoma. The case was presented in tumour board and the patient was planned for adjuvant radiotherapy. She has been on regular follow up for the past 2 years and shows no signs of recurrence. Conclusion: Extraskeletal myxoid chondrosarcoma of oral cavity is a rare entity and very few cases are reported. It is a malignant neoplasm which is diagnosed with the help of immunohistochemistry. Surgery is the ideal modality of treatment accompanied by adjuvant radiotherapy in cases of high-grade tumours.

Tellurium Containing Long Lived Emissive Fluorophore for Selective and Visual Detection of Picric Acid through Photo-Induced Electron Transfer.

A novel tellurium (Te) containing fluorophore, 1 and its nickel (2) and copper (3) containing metal organic complex (MOC) have been synthesized to exploit their structural and optical properties and to deploy these molecules as fluorescent probes for the selective and sensitive detection of picric acid (PA) over other commonly available nitro-explosives. Furthermore, density functional theory (DFT) and single crystal X-ray diffraction (SCXRD) techniques revealed the inclusion of "soft" Tellurium (Te) and "hard" Nitrogen (N), Oxygen (O) atoms in the molecular frameworks. Owing to the presence of electron rich "N" and "O" atoms along with "Te" in the molecular framework, 1 could efficiently and selectively sense PA with more than 80 % fluorescence quenching efficiency in organic medium and having detection limit of 4.60 µM. The selective detection of PA compared to other nitro-explosives follows a multi-mechanism based "turn-off" sensing which includes photo-induced electron transfer (PET), electrostatic (π-π stacking and π-anion/cation) interaction, intermolecular hydrogen bonding and inner filter effect (IFE). The test strip study also establishes the sensitivity of 1 for detection of PA.

Intraoral anastomosis for primary microsurgical reconstruction in patients of oral cavity malignancies: Retrospective analysis of 30 cases from a tertiary care center in India.

INTRODUCTION: In patients undergoing either robotic neck dissection or no neck dissection, the neck recipient vessels for the free flaps remain unexposed. Intraoral vessels have been successfully used as microvascular recipients but their use in intraoral malignancies is uncommon. We describe our initial experience of using intraoral recipients in 30 patients with oral cavity malignancies. METHODS: For this retrospective observational study, the hospital records of all patients who underwent microvascular reconstruction using intraoral recipient vessels over a 14-month period at a tertiary care hospital in India were studied. Patient demographics, disease profile, details of oncosurgical resection, reconstructive procedure details, and postoperative recovery data were analyzed. RESULTS: Intraoral anastomosis was successfully performed in 30 patients. The average patient was middle-aged (mean age 54 years) and male (26/30). Location of the postexcision defect was the buccal mucosa in 16/30 and the tongue in 12/30 patients. Anterolateral thigh flap (ALT) was used in 28/30 patients. Recipient vessels were facial vessels in 24/30 patients and lingual vessels in 6/30 patients. Venous anastomotic coupler was used in 27/30 patients. Three patients underwent re-exploration for flap congestion with loss of flap in 2/30 patients. CONCLUSION: The intraoral approach offers consistent vascular anatomy and can be performed without any external incision and oro-cervical tunneling. Being technically challenging, it has an initial learning phase. Adequate mouth opening and preservation of recipient vessels during excision and neck dissection are important prerequisites. This approach can offer a scarless reconstruction, which can improve the psycho-social rehabilitation of the patients.

Studying the efficacy of isolation as a control strategy and elimination of tuberculosis in India: A mathematical model.

India has the highest burden of both tuberculosis (TB) and multidrug-resistant TB (MDR-TB) based on the WHO Global TB Report 2019. Although the available data suggest that the total TB incidence has declined, the absolute number of new cases is still increasing. The number of reported TB cases in India in 2018 was 2.2 million, which was 1.5 million in 2009. About 47% increment in TB case notification in India within a decade shows a persistent public health problem. India contributes about 22% of the World's TB burden. Indian National Strategic Plan 2017-2025, sets out the government plans to eliminate TB by 2025. However, the milestone seems unrealistic to achieve the TB eradication goal by 2025. We developed a five-dimensional mathematical model to understand the TB dynamics in India and investigate the possibility of the earliest TB eradication time frame. The model stratifies the entire TB class into three different classes as drug-sensitive (DS), MDR, and isolated classes. The effective reproduction number, equilibrium points, and stability analysis of the model were carried out. This model predicts the total estimated cases of DS-TB and MDR-TB from 2018 to 2035 through numerical simulation and suggests that TB may be eliminated by 2035 in India if the treatment success rate could be achieved to 95%, by contact tracing and isolating at least 50% of MDR-TB.

Thyroid hormone dynamics of Tharparkar and Sahiwal cattle during induced heat stress.

Thyroid hormones and Cortisol level are the essential biomarkers in the assessment of stress condition. This study was done to estimate the metabolic hormonal profile of Tharparkar and Sahiwal during heat stress condition. The experiment was conducted on two groups consisting of Tharparkar and Sahiwal animals (5 in each group) and the experimental period comprised a 7-day acclimatization period, a heat exposure period of 21 days at control (25 °C), moderate (35 °C) and severe (42 °C) heat stress within a 9-10-day recovery period between each exposure. The hormonal concentrations of T3, T4 and cortisol were determined in serum. The serum concentration of Thyroxine (T4) and tri-iodothyronine (T3) decreases whereas cortisol level increases in both the breeds when subjected to heat stress. However, the serum level of T4 was significantly (p < 0.05) more declined in Sahiwal as compared to Tharparkar but there was no significant difference found between the two breeds in serum T3 levels. The cortisol levels were elevated in both breeds during heat stress but significantly (p < 0.05) more elevated in the Sahiwal. Hence, observations of these hormonal profiles suggest a better thermo-adaptability in Tharparkar as compared to Sahiwal.

Impacts of lockdown on the dynamics of forestry biomass, wildlife species and control of atmospheric pollution.

In this paper, we have formulated and analysed a mathematical model to investigate the impacts of lockdown on the dynamics of forestry biomass, wildlife species and pollution. For this purpose, we have considered a nonlinear system of four ordinary differential equations representing rates of change of the density of forestry biomass, the density of wildlife species, the concentration of pollutants and lockdown. Conditions for the existence, uniqueness and local stability of all equilibria along with the global stability of the interior equilibrium point are derived. Furthermore, conditions that influence the persistence of the system are obtained. By formulating an optimal control problem, the optimal strategies for minimizing the cost of implementation of lockdown as well as the concentration of pollutants are also studied. Numerical simulations are carried out to verify and validate our analytical findings. By this study, we have observed that implementation of lockdown for a sufficient period of time minimizes excessive harvesting of both forestry biomass and wildlife species and the concentration of pollutants in the environment. It is also found that lockdown policy is effective in the optimal control of atmospheric pollution. Therefore, lockdown plays a significant role in the dynamics of forestry biomass, wildlife species and control of pollution in the environment.

Assessment of Kidney Involvement in COVID-19 Patient.

BACKGROUND AND AIM: Physicians need to be aware of the difficulties that SARS-CoV-2 infection brings to other regions of the body, such as the kidneys, even though the key emphasis is on pulmonary characteristics. The most frequent kidney complication among COVID-19 hospitalized patients is considered acute kidney injury (AKI). This study aimed to describe overall different aspects of acute kidney injury (AKI) in COVID-19 patients admitted to JLNMCH during the COVID-19 pandemic and to determine the prevalence of AKI among COVID-19 hospitalized patients. METHODS AND MATERIALS: All adult patients (over the age of 18 years) who screened positive for COVID-19 in a swab specimen from areas of nasopharyngeal by reverse transcriptase polymerase chain reaction and then hospitalized were included in the study. Information was gathered on the patient's demographics, general medical history, and drugs prescribed. From past medical information, associated comorbidities and home pharmaceuticals were identified. We gathered hospitalization information, such as duration of stay in ICU, details about the application of mechanical ventilation, information regarding extracorporeal membrane aeration, details of the use of vasopressor administration, and baseline results of laboratory test along with baseline clinical information during 48 hours of hospitalization. RESULTS: The percentage of patients with no history of AKI requiring traumatic mechanical ventilation was 79.4%, while the percentage of patients with no history of AKI not requiring traumatic mechanical ventilation was 11.5%. The difference was relevant statistically (p<0.001). The percentage of patients with AKI of any stage requiring traumatic mechanical ventilation was 22.8%, while the percentage of patients with no history of AKI not requiring traumatic mechanical ventilation was 76.8%. The difference was relevant statistically (p<0.022). CONCLUSION: We discovered that AKI was a rather typical finding among hospitalized COVID-19 patients. Patients hospitalized for COVID-19 had a poor prognosis if they developed AKI.

Association of serum ferritin with COVID-19 in a cross-sectional study of 200 intensive care unit patients in a rural hospital: Is ferritin the forgotten biomarker of mortality in severe COVID-19?

Background: The COVID-19 disease caused by the SARS-CoV-2 virus, has toppled the world since first case noted in 2019, and the cases have been increasing there after. This grave effect is caused by the cytokine storm induced inflammation produced by the noxious virus. As it is an inflammatory state, various acute phase reactants are expected to raise; thus serum ferritin is contemplated to increase. Here we aim to anchor serum ferritin as a way marker for diagnosis and management of COVID-19 patients and study its role as a prognostic marker. Another aspect is the association of COVID-19 with the N: L ratio; observation has stated that higher N: L ratio results in more severe outcome. The study aimed to establish a correlation of COVID-19 severity with serum ferritin in the form of HRCT Score, N: L Ratio and Clinical Outcome in the patients admitted in Intensive Care Unit. Result: Out of 200 patients who were admitted in the intensive care unit with COVID-19, the association of serum ferritin with N: L Ratio and HRCT Score was significant, and the association of serum ferritin with clinical outcome in terms of discharged and expired was found to be statistically significant. Conclusion: Serum ferritin was found to be a potent marker for clinical outcome in intensive care unit patients in terms of death versus treated. HRCT Score and N:L ratio were found to be correlated with serum ferritin. Therefore, we conclude that serum ferritin may determine the severity of COVID-19 infection and it can be used as a marker for Clinical Outcome thereby making it an often neglected biomarker for predicting prognosis in COVID-19 with most of the physicians focusing mostly on interleukin 6, C Reactive protein and d dimer as a marker of severe COVID infection.

Rhinocerebral Mucormycosis With Brain Abscess Presenting as Status Epileptucus in a COVID-19-Infected Male: A Calamitous Complication.

With the evolution of COVID-19 disease, the emergence of more complications associated with COVID-19 is taking place. Mucormycosis is the most common opportunistic fungal infection encountered after COVID-19. In this case report, we describe a case of a 61-year-old male type 2 diabetic with sino-orbital-cerebral mucormycosis infection who was treated with conventional guidelines for a recent COVID-19 infection and further presented with generalized tonic-clonic status seizures. Neuroimaging revealed sino-orbital mucormycosis with right frontal lobe abscess. He was treated with anti-epileptics, steroids, amphotericin-B, and functional endoscopic sinus surgery (FESS).

Systems biology under heat stress in Indian cattle.

Transcriptome profiling of Vrindavani and Tharparkar cattle (n = 5 each) revealed that more numbers of genes were dysregulated in Vrindavani than in Tharparkar. A contrast in gene expression was observed with 18.9 % of upregulated genes in Vrindavani downregulated in Tharparkar and 17.8% upregulated genes in Tharparkar downregulated in Vrindavani. Functional annotation of genes differentially expressed in Tharparkar and Vrindavani revealed that the systems biology in Tharparkar is moving towards counteracting the effects due to heat stress. Unlike Vrindavani, Tharparkar is not only endowed with higher expression of the scavengers (UBE2G1, UBE2S, and UBE2H) of misfolded proteins but also with protectors (VCP, Serp1, and CALR) of naïve unfolded proteins. Further, higher expression of the antioxidants in Tharparkar enables it to cope up with higher levels of free radicals generated as a result of heat stress. In this study, we found relevant genes dysregulated in Tharparkar in the direction that can counter heat stress.

Investigating the Effect of Vibrotactile Feedback in Transfemoral Amputee With and Without Movable Ankle Joint.

The loss of somatosensory feedback after transfemoral amputation imposes a serious challenge in achieving postural stability. In the recent past, weight shifting exercises with fixed ankle joint have been reported useful in boosting the limit of stability (LOS) only in the sound limb; the LOS on the prosthetic limb did not improve. A fixed ankle joint restricts movement in the anterior-posterior direction at the ankle level. Thus, it may suppress the ability to move forward LOS despite awareness of center of pressure (COP) due to vibrotactile feedback. Therefore, it could have limited the improvement in the LOS of a prosthetic limb in previous studies. This article investigates this hypothesis by evaluating the effect of vibrotactile feedback in the LOS of transfemoral amputees with fixed as well as movable ankle joints. This evaluation is done during weight shifting exercises. Firstly, we developed an in-house COP guided vibrotactile sensory feedback system. Next, we recruited five transfemoral amputees to perform a weight-shifting exercise with a) fixed ankle joint (single-axis cushion heel (SACH) foot) and b) movable ankle joint (single-axis foot). Finally, we analyzed the recorded center of pressure trajectory signals for the limit of stability. The findings of repeated measures ANOVA showed a marginally significant interaction ( [Formula: see text], [Formula: see text], [Formula: see text]) between ankle joint and feedback conditions during backward shifting in weight shifting exercise. Further analysis showed that during the backward shifting fixed ankle joint did not improve in the presence of vibrotactile feedback, while a marginally significant ( [Formula: see text]) improved LOS was observed in the movable ankle joint with feedback. The findings conclude that the vibrotactile feedback is more effective in transfemoral amputees with movable ankle joint compared with fixed ankle joint.

Plumbagin ameliorates memory dysfunction in streptozotocin induced Alzheimer's disease via activation of Nrf2/ARE pathway and inhibition of ß-secretase.

Although plumbagin (5-hydroxy-2-methyl-1,4-naphthoquinone) protects against cerebral ischemia and spinal cord injury-induced oxidative stress and inflammation by activating the nuclear factor-erythroid 2-related factor-2 /antioxidant response element (Nrf2/ARE) pathway, its role in the amelioration of neurodegenerative diseases remains unexplored. In the present study, we investigated the effect of plumbagin on Alzheimer's disease (AD)-like condition in mice. The animals were treated intracerebroventricularly with streptozotocin (STZ; 3 mg/kg) twice, on day 1 and 3, to induce AD-like condition, and the symptoms were evaluated after 14 days. While the loss of learning and memory performance was evident in the mice subjected to Morris water maze (MWM), there was a striking increase in the population of astrocytes labelled with glial fibrillary acidic protein (GFAP) in the hippocampus. Daily intraperitoneal (i.p.) treatment with plumbagin (0.5 and 1 mg/kg), starting from 1 h prior to first dose of STZ, significantly prevented the cognitive deficits in MWM. On the other hand, administration of Nrf2/ARE pathway inhibitor, trigonelline (10 and 15 mg/kg, i.p.) enhanced the effects of STZ. Pre-treatment with subeffective dose of trigonelline (5 mg/kg) significantly attenuated the effects of plumbagin in MWM. While plumbagin prevented the STZ induced GFAP expression, this effect of plumbagin was attenuated by trigonelline. Moreover, the in silico docking study revealed potent inhibitory effect of plumbagin on ß-secretase enzyme. The results of the present study suggest that plumbagin improves cognitive function in STZ induced mouse model of AD possibly via Nrf2/ARE mediated suppression of astrogliosis and inhibition of ß-secretase enzyme.

Reconstruction with free flaps in robotic head-and-neck onco-surgeries.

AIMS AND OBJECTIVE: The aim of the present article is to highlight how reconstruction with free flaps is different and difficult in cases with robotic head-and-neck cancer surgery. It also highlights the technical guidelines on how to manage the difficulties. MATERIALS AND METHODS: Eleven patients with oropharyngeal cancer having undergone tumour excision followed by free-flap reconstruction been reviewed here. Nine patients had tumour excision done robotically through intraoral route while neck dissection done with transverse neck crease incision. There is a problem of difficult flap inset in this group of patient. Two patients had intraoral excision of tumour followed by robotic neck dissection via retroauricular incision. With no incision directly on the neck, microvascular anastomosis is challenging in this set of patients. Free flap was used in all the cases to reconstruct the defect. RESULTS: Successful reconstruction with free flap was done in all the cases with good outcome both functionally and aesthetically. CONCLUSION: Free-flap reconstruction is possible in robotic head-and-neck cancer surgery despite small and difficult access, but it does need practice and some technical modifications for good outcome.

Perception of pain due to various orthodontic procedures.

OBJECTIVE: To investigate five orthodontic procedures, namely separator placement, banding, initial arch wire ligation (0.016 NiTi), T-loop activation, and use of intermaxillary elastics with respect to intensity of peak pain, time of peak pain, need of medication for pain relief, and effect on routine life due to pain. METHOD AND MATERIALS: One hundred patients (52 males, 48 females) selected for comprehensive orthodontic therapy were included in the study. They were divided into five study groups, namely the separator group, banding group, initial NiTi group, T-loop activation group, and intermaxillary elastics group. Each patient was given a previously prepared questionnaire regarding the following: time of peak pain, intensity of peak pain, need for analgesic consumption, and effect on routine life. RESULTS: Consumption of medication for pain relief was found to be highest in the separator and the initial NiTi groups. Routine life was affected most in the intermaxillary elastics and the initial NiTi groups, but it was not statistically significant. Statistically significant differences were found between the T-loop activation and the banding groups and also between the banding and the intermaxillary elastic groups with respect to perception of intensity of peak pain. In the separator group, the time of peak pain was experienced at the 24th hour and in the rest of the groups it was at the 6th hour with most patients, although the values were not statistically significant. CONCLUSION: Peak pain intensity varies from one procedure to another. It was significantly more due to T-loop activation and wear of intermaxillary elastics than banding.

Isolation and immunohistochemical identification of Flavobacterium psychrophilum from the tissue of catfish, Clarias batrachus.

This study deals with the identification of bacteria in paraffin embedded tissue of Indian catfish, Clarias batrachus experimentally infected with F. psychrophilum to ascertain it's precise role in the occurrence and state of carrier stage of coldwater disease in asymptomatic fishes. Significant (P < 0.05) mortality was recorded in C. batrachus of this region due to persistent occurrence of creamish/yellowish with non smooth edged colonies of rod shaped flexible gram negative bacterium, F. psychrophillum. Serodiagnosis made through polyclonal antiserum dilutions (raised against H antigen of Aqb Fb-6 isolate in rabbit) revealed that staining intensity of this bacterium was dilution dependent as tissue and smears treated with 1:300 and 1:500 antiserum dilutions conferred close relationship at immunofluorescence level with F. psychrophilum and stained deeply in the tissues and smear prepared from liver, kidney and intestine of experimentally infected C. batrachus. Result of this study would be helpful in identifying the fish pathogenic bacteria in carrier fish where mortality occurs without explicit clinical signs of disease.

Congenital cheek teratoma with temporo-mandibular joint ankylosis managed with ultra-thin silicone sheet interpositional arthroplasty.

Primary cheek teratomas are rare with < 5 reported cases. None had associated temporo mandibular joint ankylosis (TMJA). The fundamental aim in the treatment of TMJA is the successful surgical resection of ankylotic bone, prevention of recurrence, and aesthetic improvement by ensuring functional occlusion. Early treatment is necessary to promote proper growth and function of mandible and to facilitate the positive psychological development of child. Inter-positional arthroplasty with ultra-thin silicone sheet was performed. Advantages include short operative time, less foreign material in the joint space leading to negligible foreign body reactions and least chances of implant extrusion. Instead of excising a large bony segment, a thin silicone sheet was interposed and then sutured ensuring preservation of mandibular height. Aggressive post-operative physiotherapy with custom made dynamic jaw exerciser was used to prevent recurrence.

Intraoral excision of large submental dermoid.

Sublingual dermoids are the rarest forms of craniofacial dermoids mostly seen in young individuals. Excision of large and deep submental dermoid is generally done via extraoral approach scarring the most prominent part of the face, which can lead to post operative scar hypertrophy and hyperpigmentation especially in non-Caucasian races. Presence of such scars leads to adverse psychological effects in young individuals. Excision via intraoral route, although technically demanding, can be simplified using basic principles of plastic surgery leading to optimal aesthetic outcome with least downtime. We excised a large sublingual dermoid extending deep to the mylohyoid muscle through intraoral approach with excellent cosmetic results. Clinicians dealing with such lesions should keep these principals in their armamentarium when dealing with this rare subset of cases.