Nasopalatine canal cyst, a diagnostic twist.

We present a case of nasopalatine duct cyst in a 35-yearold female. The cyst was diagnosed based on the presence of only one clinical symptom and no obvious clinical signs, which is a relatively rare occurrence. However, the radiographic and histological presentation of this lesion was typical of a nasopalatine duct cyst. Therefore, this case report aims to highlight the variable presentations of the nasopalatine cyst, which is often misdiagnosed and treated as an endodontic infection.

Unraveling the challenges in the diagnosis and management of desmoplastic fibroma of the mandible-a case report.

Desmoplastic fibroma (DF) is an uncommon bone tumor that originates from the mesenchymal tissue and despite being benign, exhibits aggressive behavior locally. The following report describes the case of a 7-year-old boy with a rapidly enlarging swelling on the right side of the mandible. After a thorough clinical examination, radiographic imaging, and histopathological analysis, the diagnosis of DF was confirmed. Treatment planning was formulated considering both the tumor's tendency for local recurrence and the patient's well-being. Due to the patient's young age, segmental resection was not deemed appropriate, and an aggressive curettage and enucleation of the lesion followed by the bone graft was performed instead. The patient was kept under close follow-up for the first month of post-surgery and later reviewed after 3, 6, 9, and 12 months, respectively. Good bone healing was observed on radiographs. The patient did not show any signs of recurrence based on clinical or radiographic assessments and did not exhibit any neurosensory deficits as well.

Flexible Bronchoscopy Combined With Videolaryngoscope For Tracheal Intubation In A Child With Hunter Syndrome: A Case Report.

Hunter syndrome (mucopolysaccharidosis type II) has the highest reported prevalence of difficult tracheal intubation among the seven known types of mucopolysaccharidoses. Despite improved difficult airway guidelines and equipment, conventional approaches may fail in some cases. A 10-year-old child with Hunter syndrome, was scheduled for multiple dental extractions. On the first visit, failed intubation was declared as per Difficult Airway Society guidelines in the surgical day-care suite of our institute and the procedure was postponed. The case was then planned to be handled in the main operating room with additional preparation and input from the paediatric otolaryngologist for possible tracheostomy, paediatric intensive care for postoperative need for ventilation, and difficult airway resource faculty for an unconventional approach-videolaryngoscope combined with fibreoptic bronchoscope-which resulted in safe administration of anaesthesia. This case illustrates the importance of meticulous planning in the management of previously failed airway.

Is There A Difference Between Disease-Free Survival Of Oral Squamous Cell Carcinoma Referred By Dentists Versus Other Physicians? A Systematic Review.

Objective: To compare disease-free survival rates in oral squamous cell carcinoma patients initially attended and referred by dentists versus other physicians. METHODS: The systematic review was conducted after registration with the International prospective register of systematic reviews at the University of York, the United Kingdom, and comprised search on Medline, PubMed, Cochrane and CINAHAL Plus databases for studies published up to December 2021. The Population-Intervention-Comparison- Outcomes-Study criteria was used to search for studies involving patients diagnosed with oral squamous cell carcinoma receiving referrals by dentist or by other healthcare providers. Disease-free survival of patients was taken as the main outcome. Customized data collection proforma was used to record data in line with the Preferred Reporting Items in Systematic Reviews and Meta- Analysis guidelines. Data was subjected to systematic, qualitative review. RESULTS: Of the 344 studies found, 8(2.3%) were analysed in detail. Patients referred by dentists ranged from 22.6% to 54%. Males comprised 53% to 70.3% of the sample. The highest number of referrals was made by primary physicians, ranging from 27.4% to 71.6%. Upto 67.6% cases were diagnosed with stage 1 and 2 oral cancer. The highest 5-year survival rate was 75% in a study where 59% patients were diagnosed at an early stage of disease. Conclusion: The relative scarcity of studies makes it impossible to draw an association between oral cancer survival rate and type of referral.

Relationship of maxillary third molar root to the maxillary sinus wall: A cone-beam computed tomography (CBCT) based study.

Background: The relationship of the root of the maxillary third molars and the maxillary sinus (MS) is an important predictor of the anticipated difficulty in extraction. The aim of this study was to assess the location of maxillary third molars to the inferior wall of the MS in a sample of Pakistani population evaluated using cone-beam computed tomography (CBCT) imaging and to assess if age or gender has any influence on third molar to MS distance. Methods: The CBCT scans of adult patients, carried out keeping image volume at 8 cm×8 cm, and the voxel size 0.2 and 0.1 mm. Images retrieved from the hospital database were included in the study. The relationship of root apices of maxillary third molar with the MS was assessed according to the vertical, horizontal and Winter's classification. Descriptive statistics, t test and chi-square test of association were applied. Results: CBCT scans of 93 patients, 56 males and 37 females were evaluated. The mean age was 41.12±17.13 years. The mean distance of third molar roots to the MS wall was 2.38±1.54 mm for males and 1.86±1.04 mm for females, on the left and 2.67±1.81 mm for males and 2.58±1.54 mm in females, on the right side. Independent sample t test showed that there was no significant difference for third molar to sinus wall distance in the two genders. No significant difference was found between the two sides. Conclusion: In a sub-population of Pakistani adults, the mean distance between the roots of the upper third molar and MS wall is around 2 mm. Only 5% males and 8% females had their upper third molars roots protruding into the MS.

Prosthetic complications with dental implants: a bibliometric analysis of 20 topcited articles.

The purpose of this review was to explore the 20 most cited articles on prosthetic complications with dental implants. Identification of such articles could be helpful in prosthodontics residency programmes in devising the curriculum of essential reading material in implantology. The Institute for Scientific Information, Web of Science Database, and Google Scholar were used to identify the 20 top-cited articles published in journals from 1980 till June 2021. These articles were then evaluated according to the number of citations, authors, study design, publication year, and publishing journal. Descriptive statistics were computed for bibliometrics. It was observed that the citation count ranged from 6,391 to 315 (in descending order). The Toronto study is the most cited study on dental implant prosthetic complications. Prospective studies and systematic and narrative reviews were the predominant study designs used in the articles; however, alarmingly no randomised controlled trials were included in the list.

Migratory dental implant in the maxillary antrum: a case report.

Dental implants offer a predictable solution for the replacement of missing dentition. This report describes the case of a patient who underwent dental implant surgery several years ago but due to negligence on the part of previous dentist, her implant pushed into the maxillary sinus. The patient presented with vague pain and swelling in the right maxillary region. Orthopantomogram (OPG) showed that the implant was lying in the right maxillary sinus which the patient had no clue of. It was decided to retrieve the implant and later restore the missing teeth for definitive function and aesthetics. However, at the time of surgery, the implant in question was missing from the anticipated position as it had migrated to the most posterior-superior compartment of the antrum making its retrieval difficult in the first attempt. Later, a maxillofacial surgeon carried out the retrieval. Fortunately, the implant moved back to a more favourable position at the time of second surgery.

Knowledge, attitudes and practices of physicians and dentists on medication-related osteonecrosis of the jaw: a cross-sectional survey.

Background Bisphosphonate medication can cause osteonecrosis of the jaw, which is an uncommon but serious complication. This survey explores the knowledge, attitudes and practices of dentists and physicians regarding medication-related osteonecrosis of the jaw (MRONJ).Methods A cross-sectional study was conducted among physicians and dentists of Pakistan's secondary and tertiary care hospitals between March and June 2021. Data were collected through a web-based questionnaire distributed among the eligible clinicians involved in prescribing bisphosphonates to patients or management of osteonecrosis. SPSS Statistics 23.0 was used for the data analysis. The frequencies and proportions of the descriptive variables were reported.Results A response rate of 29% was achieved. Only six dentists (n = 6/61; 9.8%) were aware that mammalian target of rapamycin inhibitors could lead to osteonecrosis. Only one-third (n = 9/26; 34.6%) of physicians informed their patients about the possible side effects of bisphosphonates. The most commonly identified risk factor among them was the duration of the drug (n = 77/87; 88.5%) and the least identified was gender (n = 34/87; 39.0%).Conclusions Our study revealed insufficient knowledge among the respondents about the recently updated established guidelines available on MRONJ. The majority of physicians don't refer patients to dentists before prescribing bisphosphonates and other associated medications.

A Wide-Base Population Pyramid And Other Factors Explain Low Mortality In Pakistan During Covid-19 Pandemic.

World is experiencing an unprecedented pandemic of COVID-19 for over a year. This viral infection outbreak originated in December 2019 at Wuhan, China and within three months became a global pandemic. The outbreak has affected over 200 countries and territories of the world. Despite of having well-established health care system, countries such as China, Italy, Iran, Spain, France, Germany and USA have experienced a high death toll in this pandemic. Pakistan although being geographic neighbour of China and Iran, is somehow protected from the otherwise expected high case-fatality of COVID-19. This paper explains what factors have protected Pakistan from a high mortality in this pandemic.

Oral maxillofacial surgical residency and its impact on the academic and research productivity at different levels in Pakistan.

Oral and maxillofacial (OMF) surgery is a unique speciality. In many countries, OMFS is a dental speciality but the scope of its practice significantly overlaps with other specialities, including otolaryngology, head and neck surgery, plastic surgery, and orthopaedics. Thus, OMF surgery represents a true amalgamation of medical and dental specialities. There are different requirements of OMF residency training, which include a dental undergraduate training, medical training, or both. The training pathways for this speciality have evolved much in the last three decades and there is still no consensus over a single uniform path of becoming an OMF surgeon. An OMF surgeon deals with trauma, cysts, tumours and other pathologies of the maxilla, mandible, and zygomatic complex that need surgical correction. In addition to being a diverse speciality, the academic and research domains of residency have also changed. In Pakistan, residency training in OMF surgery started in 1994 and since then a lot of growth has taken place. This paper summarises the evolution and scope of OMF surgery and the contribution of this speciality in the overall academia and research in Pakistan's national dental scenario.

Association between type of fixation and a length of stay amongst maxillofacial fracture patients: A retrospective charts review.

We aimed to explore the predictors of hospital length of stay for patients admitted and with maxillofacial injuries. Patients presenting with maxillofacial trauma were included. Poly-trauma involving neurosurgery and/ or needing orthopaedics intervention were excluded. Logistic regression was applied to explore the predictors associated with the hospital stay of > 4 days. There were 241 patients with mean age 29.35 ± 12.5 years (age range 12-80 years). Mandibular fracture was the commonest observation 121(50.2%), followed by maxillary 48(19.9%), and zygomatic bone fracture 9 (3.7%). Road traffic accident 196 (81.3%) appears to be the most common etiology of maxillofacial injuries in the studied sample. The mean length of hospital stay among bone plating patients was 5.96 ±6.8 days compared to 4.15±6.2 days for ones treated without bone plating; p-value 0.05. It was concluded that longer length of stay is required in patients with more complex management including bone plates.

Dental care of patients scheduled for cardiovascular surgery: Which protocols should be followed?

Dental extraction of abscessed or infected teeth before cardiac operation is frequently advocated to lower the risk of infections, especially infective endocarditis. The scientific evidence that supports dental procedures before cardio-valvular surgery is, however, limited. The aim of the present paper was to explore whether there are any protocols for patients needing dental treatment before cardiac surgery. Moreover, we have discussed the real life challenges encountered in the management of such patients.