Osteomyelitis and Pathologic Fracture of Mandible in Undiagnosed Osteopetrosis.

Osteopetrosis (OP) is a heterogeneous group of rare, heredity bone disorders with variable clinical features involving the bones of the body. OP is characterized by increased bone density, which is caused by aberrant osteoclast-mediated bone resorption. This syndromic disorder comes with a series of problems and, unless recognized and treated early, can lead to a multitude of further grave complications. We report a rare case of a female patient who reported chronic unhealed extraoral draining sinus present over the left submandibular region with pathologic fracture of the left mandibular angle, which, if, was diagnosed early with the identification of the osteopetrosis syndrome, could have been managed more conservatively.

Efficacy of platelet-rich fibrin in maxillary sinus augmentation and simultaneous implant placement in deficient maxillary ridges: A pilot comparative study.

Background: Rehabilitation with dental implants has become the most widely accepted treatment protocol for rehabilitation of lost natural teeth. Direct sinus lift is one of the most predictable procedures for augmenting the deficient posterior maxillary ridges. Methods: The study was designed in patients with insufficient bone for implants in the maxillary posterior ridges. The test group received platelet-rich fibrin alone as filler, and the control group received a bone allograft. The residual bone height (RBH), implant mobility, and soft tissue characteristics between and within the groups were compared and analyzed. Results: Both the groups had considerable gain in RBH, and the intragroup analysis revealed clinical gain in bone height in both the groups, with the test group exhibiting statistically significant gain which kept on improving from 6 months with z= -3.477 and a p value of 0.001 to 9 months with z=-3.531 and a p value of 0.027. Conclusion: The results suggest that the use of platelet-rich fibrin alone improves the bone regeneration, thereby achieving predictable and stable augmentation of the sinus floor required for the success of implant therapy.

Rehabilitation of acquired mandibular defect with two-piece, magnet-retained salivary reservoir.

Resection of large tumors involving mandible is the most common reason for mandibulectomy in patients. Adjunct therapies complicate the clinical situation and advocates innovations in conventional design concepts and treatment protocols. Xerostomia is one of the most common complications arising post-radiotherapy. Incorporation of a salivary reservoir in the design has been frequently used in xerostomia patients using acrylic dentures. The purpose of the article is to highlight a technique and steps in rehabilitation of a large acquired mandibular defect using a two-piece, magnet-retained acrylic removable partial denture with salivary reservoir.

Insight into growth of Au-Pt bimetallic nanoparticles: an in situ XAS study.

Au-Pt bimetallic nanoparticles have been synthesized through a one-pot synthesis route from their respective chloride precursors using block copolymer as a stabilizer. Growth of the nanoparticles has been studied by simultaneous in situ measurement of X-ray absorption spectroscopy (XAS) and UV-Vis spectroscopy at the energy-dispersive EXAFS beamline (BL-08) at Indus-2 SRS at RRCAT, Indore, India. In situ XAS spectra, comprising both X-ray near-edge structure (XANES) and extended X-ray absorption fine-structure (EXAFS) parts, have been measured simultaneously at the Au and Pt L3-edges. While the XANES spectra of the precursors provide real-time information on the reduction process, the EXAFS spectra reveal the structure of the clusters formed in the intermediate stages of growth. This insight into the formation process throws light on how the difference in the reduction potential of the two precursors could be used to obtain the core-shell-type configuration of a bimetallic alloy in a one-pot synthesis method. The core-shell-type structure of the nanoparticles has also been confirmed by ex situ energy-dispersive spectroscopy line-scan and X-ray photoelectron spectroscopy measurements with in situ ion etching on fully formed nanoparticles.

Effect of oxygen partial pressure in deposition ambient on the properties of RF magnetron sputter deposited Gd2O3 thin films.

Gadolinium oxide is an excellent optical material that offers high transmission in a wide wavelength range of 200-1600 nm and exhibits a high bulk refractive index of ∼1.80 at 550 nm. In the present study, a set of Gd2O3 thin films has been deposited on fused silica substrates by RF sputtering of a Gd2O3 target under various O2 to Ar flow ratios. The samples have been characterized by grazing incidence x-ray diffraction (GIXRD) to study the long range structural behavior, by GIXR to study density and surface roughness of the films, by atomic force microscopy measurements to study morphological properties, by Rutherford backscattering measurements for compositional studies, and by transmission spectrophotometry and spectroscopic ellipsometry techniques to study their optical properties. It has been observed that the films deposited with 10% oxygen partial pressure have low density, high surface roughness, and high void content, which results in a low value of refractive index of this film, and film quality improves as oxygen partial pressure is further increased. Extended x-ray absorption fine structure measurement with synchrotron radiation has also been employed to extract local structural information around Gd sites, which has in turn been used to explain some of the observed macroscopic properties of the films.

Growth of block copolymer stabilized metal nanoparticles probed simultaneously by in situ XAS and UV-Vis spectroscopy.

The growth of Au and Pt nanoparticles from their respective chloride precursors using block copolymer-based reducers has been studied by simultaneous in situ measurement of XAS and UV-Vis spectroscopy at the energy-dispersive EXAFS beamline (BL-08) at INDUS-2 SRS at RRCAT, Indore, India. While the XANES spectra of the precursor give real-time information on the reduction process, the EXAFS spectra reveal the structure of the clusters formed at the intermediate stages of growth. The growth kinetics of both types of nanoparticles are found to be almost similar and are found to follow three stages, though the first stage of nucleation takes place earlier in the case of Au than in the case of Pt nanoparticles due to the difference in the reduction potential of the respective precursors. The first two stages of the growth of Au and Pt nanoparticles as obtained by in situ XAS measurements could be corroborated by simultaneous in situ measurement of UV-Vis spectroscopy also.

Analysis of argentinated peptide complexes using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry: Peptide = oxytocin, arg(8) -vasopressin, bradykinin, bombesin, somatostatin, neurotensin.

RATIONALE: The increased use of silver nanoparticles (AgNPs) for various biological applications, and over-expression of various peptide receptors in different tumors/cancer cells, necessitate the need for dedicated investigations on the intrinsic binding ability of Ag with various biologically important peptides for better understanding of AgNPs-peptide interactions and for the future development of contrasting agents as well as drugs for imaging/biomedical applications. METHODS: The [M+(Ag)n ](+) complexes are prepared and characterized using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOFMS). RESULTS: Silver complexes of the peptides [M+(Ag)n ](+) , where M = oxytocin, arg(8) -vasopressin, bradykinin, bombesin, somatostatin, and neurotensin, have been investigated for their intrinsic Ag(+) -binding ability. Unusual binding of up to seven Ag(+) with these small peptides is observed. The mass spectra show n = 1-5 for bombesin and somatostatin, n = 1-6 for bradykinin and arg(8) -vasopressin, and n = 1-7 for oxytocin and neurotensin. In addition, oxytocin and arg(8) -vasopressin show the formation of dimers and their complexes [M2 +(Ag)n ](+) with n = 1-8 and n = 1-5, respectively. The possible amino acid residues responsible for Ag(+) binding in each peptide have been identified on the basis of density functional theory (DFT)-calculated binding energy values of Ag(+) towards individual amino acids. CONCLUSIONS: Mass spectrometric evidence indicates that the peptides, viz., oxytocin, arg(8) -vasopressin, bradykinin, bombesin, somatostatin, and neurotensin, show greater affinity for Ag(+) . Hence, they may be used as carriers for AgNPs in targeted drug delivery as well as an alternative for iodinated contrasting agents in dual energy X-ray imaging techniques. Radio-labeled Ag with these peptides can also be used in radio-pharmaceuticals for diagnostic and therapeutic applications. Copyright © 2016 John Wiley & Sons, Ltd.

Extended x-ray absorption fine structure measurements on radio frequency magnetron sputtered HfO2 thin films deposited with different oxygen partial pressures.

Two sets of HfO2 thin film have been deposited by the radio frequency magnetron sputtering technique at various oxygen partial pressures, one set without any substrate bias and another set with a 50 W pulsed dc substrate bias. The films have been characterized by extended x-ray absorption fine structure (EXAFS) measurements at the Hf L3 edge, and the structural information obtained from analysis of the EXAFS data has been used to explain the macroscopic behavior of the refractive index obtained from spectroscopic ellipsometry measurements. It has been observed that the variation of refractive index with oxygen partial pressure depends on the Hf-Hf bond length for the set of films deposited without substrate bias, while for the other set of films deposited with pulsed dc substrate bias, it depends on the oxygen coordination of the nearest neighbor shell surrounding Hf sites.

EXAFS studies on Gd-doped ZrO2 thin films deposited by RF magnetron sputtering.

ZrO2 thin films with 0%, 7%, 9%, 11%, and 13% Gd doping have been prepared by RF magnetron sputtering and have been characterized by grazing incidence x-ray diffraction, spectroscopic ellipsometry, and optical transmission measurements to probe their structural and optical properties. Extended x-ray absorption fine structure (EXAFS) measurements have also been carried out on the samples at the Zr K- and Gd L3-edges. It has been observed that Gd goes to Zr sites up to 9%-11% doping concentration, and for Gd doping concentrations beyond 11%, Gd precipitates out as a separate Gd2O3 phase. The local structure information surrounding the Zr and Gd sites obtained from the analysis of the EXAFS studies have also been used to explain the macroscopic optical properties of the samples.

Extended x-ray absorption fine structure measurements on asymmetric bipolar pulse direct current magnetron sputtered Ta(2)O(5) thin films.

Tantalum pentoxide (Ta2O5) thin films have been deposited on fused silica substrates using a novel asymmetric bipolar DC magnetron sputtering technique under a mixed ambient of oxygen and argon. Films have been prepared at different oxygen-to-argon ratios, and the sputtering ambient and optical properties of the films have been investigated by spectroscopic ellipsometry, while the structural analysis of the films has been carried out by grazing incidence x-ray diffraction and extended x-ray absorption fine structure (EXAFS) measurements. The concentration of oxygen and tantalum in the Ta2O5 films has been estimated by Rutherford backscattering spectrometry (RBS). The variation of the optical constants of the films with changes in deposition parameters has been explained in the light of the change in average Ta-O bond lengths and oxygen coordination around Ta sites as obtained from EXAFS measurements. The trend in variation of the oxygen-to-tantalum ratio in the films obtained from RBS measurement, as a function of oxygen partial pressure used during sputtering, is found to follow the trend in variation of the oxygen coordination number around Ta sites obtained from EXAFS measurement.

Evaluation of the hard and soft tissue changes after maxillary advancement with rigid external distractor in unilateral cleft lip and palate induced maxillary hypoplasia.

BACKGROUND: Midfacial growth retardation in cleft lip and palate (CLP) cases, is seen in all the three dimensions. Conventionally these cases are managed by orthographic surgery which has a high rate of relapse. The application of the distraction osteogenesis (DO) has revolutionized the management protocol. The aim of the study was to evaluate the efficacy of rigid external distractor (RED) in management of cleft induced maxillary hypoplasia. METHODS: Ten cases of unilateral CLP between 11 and 20 years of age having gross midfacial deficiency and those who have undergone presurgical orthodontic treatment were included in the study. The cases were operated for Le Fort 1 osteotomy and application of RED. DO was carried out through transnasal traction wires. Clinico-radiological evaluation of presurgical and 1, 6 and 12 months post distraction parameters were statistically analysed by application of paired 't'-test. RESULT: There were 4 males and 6 females with a mean age of 15.1 years. The mean distraction carried out was 14.95 mm. There was a significant improvement in all the hard and soft tissue parameters except SNB. Facial profile improvement and stable occlusion was achieved in all the cases. CONCLUSION: Midfacial DO using RED is a versatile procedure where the maxilla can be moved in multiple planes to achieve a functional, aesthetic and occlusal balance. Keeping in view of the significant relapse rate the clinicians are required to plan 15-20% excess amount of distraction.

Dermoid cysts of maxillofacial region.

The dermoid cyst is an uncommon clinicopathological lesion of developmental origin. The term dermoid cyst is used to describe 3 cysts that are closely related histologically: dermoid cyst, epidermoid cyst, and teratoma. Epidermoid and dermoid cysts are benign nature, which may occur anywhere in the body, but most predominantly in the ovary and scrotal regions. Only about 7% are found in the head and neck. The occurrence of such cysts in the oral cavity is extremely rare, with approximately 1.6% located in this area. The floor of the mouth is one of the most commonly affected area, however, these cysts can also be found in the tongue, lips, buccal mucosa and jaw bones. There is always a difficulty of making a correct diagnosis of these lesions with clinical examinations and conventional radiography. To achieve a diagnosis and to develop correct surgical strategy specialized imaging examinations such as ultrasonography (US), computed tomography (CT), Magnetic Resonance Imaging (MRI) and histopathological examination should be carried out. Treatment comprises total surgical excision the approach remains dictated logically by the cyst's location. Ample understanding and vigilance about this slow growing painless mass is essential not only because of the symptoms it produces but also due to its malignant potential. When dermoid cysts occur on the floor of the mouth, they may enlarge to such an extent that they can interfere with deglutition and produce respiratory obstruction. Early diagnosis and treatment are essential for these cystic entities.

Incidence of Mortality and Its Relation to Comorbidity in Ludwig's Angina: A Retrospective Study.

Introduction: Ludwig's angina is a serious life-threatening infective condition of maxillofacial region due to odontogenic origin which is clinically diagnosed by its clinical signs and symptoms. Airway management and early surgical decompression is the main stay of management. The mortality rates in Ludwig's angina remains multivariate. There is a paucity in literature regarding the mortality rates of this disease. Aim and Objectives: Aim of this retrospective study is to describes the characteristics, probable cause of death and mortality rates of patients with co-morbidities presenting to the emergency department (ED) who were subsequently admitted with a primary diagnosis of Ludwig's angina. Materials and Method: Study was conducted in the department of maxillofacial surgery in a tertiary care teaching hospital from Jan 2011 to Dec 2022. Data of 17 patients who were clinically diagnosed as Ludwig's angina were included in the study. The comorbidity, source of odontongenic cause, mode of intubation and the outcome of the disease were evaluated. Result: Comparison of categorical variables was done using Fishers exact test. A p-value of <0.7 was considered statistically significant. The results suggested that Out of 17 patients 12 patients (70.5%), 7 male and 5 females had comorbidities and four cases (23.5%) had complication of death, all having co-morbidities. Summary: It concludes that associated comorbidity has a significant role in progress and outcome of the disease and incidence of death is more common in cases having associated comorbidity.

"Bridging the Breach": Cranioplasties Using Different Reconstruction Materials-An Institutional Experience.

Introduction: Cranioplasty is a time tested surgical procedure to restore the form and function of either congenital or acquired calvarial defects. Both autologous bone flaps and alloplastic substitutes have been surgically explored over time to achieve the pre-morbid contour and eliminate the existing and anticipated complications like the "Sinking flap Syndrome". Though autologous bone flap, if preserved, is generally considered the first choice for reconstruction, however its absence/large defect reconstruction calls for alternative options. The selection of the reconstructive material is governed by various patient factors and material-related issues. The current study is an institutional experience of calvarial reconstruction with different materials. Though the aim of the surgery is always maximum patient comfort and satisfaction, post-operative outcome may vary from case to case. Materials and Method: Patients with calvarial defects post decompressive craniectomy, referred to the Department of OMFS from the Department of Neurosurgery/Neurology at our tertiary care centre, were successfully managed for the same using autologous Bone flap, customized Titanium and PEEK patient specific implant (PSI). Post-op evaluation for aesthetics, ease of adjustment/workability, thermal conductivity and infection/exposure was done at 01 and 06 months. Results: Fifteen patients of cranial defects post decompressive craniectomy were taken up of calvarial reconstruction using autologous Bone flap (n = 5), Titanium (n = 5) and PEEK (n = 5) patient specific implant (PSI). Satisfactory restoration of cranial contour was seen in all cases immediately after surgery. One patient underwent flap necrosis in bone flap group, while thermal conductivity was reported in 2 out of 5 cases of titanium PSI. Ease of workability was relatively low in all cases of PEEK group while increased overall surgical duration was encountered in bone flap group owing to second surgical site in abdomen. Conclusion: A variety of reconstruction materials may be used for cranial contouring depending on the defect and surgeon's experience, however the results may vary from case to case thus mandating tailor-made treatment for each patient.

Histopathological Interpretation of TMJ Osteophyte: Report and Review.

Introduction: Osteophytes are osseocartilaginous structures which are commonly found in common degenerative joint diseases. It can be free or attached to nature. There is a paucity of information in the literature regarding the histopathological interpretation of osteophytes in Temporomandibular Joint (TMJ). Purpose: To report the incidental finding of osteophytes in cases of chronic protracted TMJ dislocation. Material and Method: To present case of an elderly 72-year-old female and a 35-year-old male with chronic protracted TMJ dislocation who were treated surgically for their condition with an incidental finding of an osteophyte in TMJ intraoperatively. Result: The histopathological examination revealed fibrocartilaginous core tissue surrounded by bone formation due to dystrophic calcification. Conclusion: The microscopic examination is mandatory in order to study and understand the pathophysiology of an osteophyte. This study presents rare histopathological evidence of an osteophyte. It reflects the process of its formation and the possibilities of fate of an osteophyte in TMJ.

Correlating Nasal Patency with Obstructive Sleep Apnea in Obese Versus Non-Obese Patients: An Acoustic Rhinometry Study.

The aim of this study was to correlate nasal patency with Obstructive Sleep Apnea (OSA) in obese versus non-obese patients using Acoustic Rhinometry (AR). Eccovision® Acoustic Rhinometer equipment was used to compare nasal cross-sectional areas (CSA1,2 & 3 corresponding to nasal valve region, anterior portion of middle & inferior turbinate and posterior portion of middle & inferior turbinate respectively) and volume in age and gender matched sample divided into three groups: Group 1: Non-obese patients without OSA (25 patients, 13 males and 12 females); Group 2: Non-obese patients with OSA (25 patients, 14 males and 11 females); Group 3: Obese patients with OSA (25 patients, 13 males and 12 females). The mean nasal cross-sectional areas and volume were lower in Group 2 compared to Group 1 but statistically non-significant (P value > 0.05 for all). The mean nasal cross-sectional areas and volume were significantly lower in Group 3 as compared to Groups 1 and 2 (P value < 0.05 for all). BMI showed a statistically significant positive (direct) correlation with AHI in Groups 2 and 3 (P value < 0.05 for both). The nasal cross-sectional areas and volume showed a statistically significant negative (inverse) correlation with AHI in Groups 2 and 3 (P value < 0.05 for both). OSA diagnosed cases with high BMI may not present with an obvious nasal obstruction; the nasal patency may still be compromised due to reduced nasal lumen secondary to obesity. AR, being cost-effective and non-invasive modality; is advocated to evaluate pre-treatment nasal patency, as well as follow up evaluation to ascertain improvement after the intervention.

Long-Term Study of Relapse After Mandibular Orthognathic Surgery: Advancement Versus Setback.

Background: Relapse is a continuing process and should be evaluated on a long rather than short term. Materials and Methods: Treatment records of 46 patients who underwent mandibular orthognathic surgery were divided into two groups, i.e. Group 1: Mandibular Advancement (MA) surgery (n = 26) and Group 2: Mandibular Setback (MS) surgery (n = 20). Lateral cephalograms were traced at T0 (01 week before surgery), T1 (01 week after surgery), T2 (01 year after surgery) and T3 (minimum 05 years after surgery) to study short- and long-term skeletal and dental relapse in horizontal, vertical and angular parameters selected for the study. Relapse was correlated with gender, age, amount of surgical movement and intra-operative change in mandibular plane angle to study effect of these factors on relapse. Results: All horizontal, vertical and angular parameters studied showed significant relapse at short term (from T1 to T2) which continued significantly till long-term evaluation (T2 to T3) in both groups (P value < 0.001). Horizontal relapse in all parameters, vertical relapse in all parameters (except Pog and overbite at T1-T2) and angular relapse in all parameters (except Ramus inclination at T1-T2) was significantly higher in Group 2 compared to Group 1 (P value < 0.001 for all). Relapse showed significant and positive correlation with amount of surgical movement and intra-operative change in mandibular plane angle in both groups (P value < 0.05 for all). Conclusion: Both MA and MS surgeries show significant relapse on both short- and long-term evaluation which it is higher in MS as compared to MA surgeries.

Comparative evaluation of vertical body osteotomy and sagittal split osteotomy for mandibular corpus distraction.

PURPOSE: Mandibular corpus distraction is conventionally carried out by fixing miniaturized intraoral distractors to the body of the mandible after vertical osteotomy posterior to the last tooth. This procedure is not only technically difficult but also has high chances of damaging the inferior alveolar neurovascular bundle. The third molars are also required to be extracted. To overcome these problems, bilateral sagittal split ramus osteotomy was used and the distractor was fixed. The study was carried out to compare the results of the 2 osteotomies for mandibular corpus distraction. PATIENTS AND METHODS: Twenty patients with nonsyndromic mandibular hypoplasia requiring corpus distraction were divided into 2 groups of 10 each. In group 1 osteotomy was carried out by conventional vertical body osteotomy and in group 2 by bilateral sagittal split osteotomy, and distractors were fixed. All cases were evaluated for 24 months. The results were compared clinically and radiologically. RESULTS: The average amount of bone lengthening achieved was 12 mm. Two patients in group 1 had paresthesia of the left lip throughout the follow-up period. One patient in group 2 had uncontrolled flair of the proximal segment, leading to a skeletal relapse of 5 mm. There were no other complications. Improvements in facial profile and occlusion were well maintained during follow-up. CONCLUSION: Mandibular corpus distraction with bilateral sagittal split osteotomy is a better option than distraction with conventional vertical osteotomy.