Novel Role of CD34+ Stromal Cells/Telocytes in Oral Submucous Fibrosis Development and its Malignant Transformation.

BACKGROUND: Telocytes are interstitial cells widely distributed in the extracellular matrix of numerous tissues distinguished by their long, thin, and moniliform projections. Telocytes have a role in the stimulation of angiogenesis and contribute to the development and progression of fibrosis. AIM: The current study aimed to assess and compare the telocyte distribution in normal mucosa, oral submucous fibrosis (OSF), and OSCC associated with OSF (OSCC-OSF). MATERIALS AND METHODS: Formalin-fixed and paraffin-embedded tissue blocks of 30 OSF cases, 15 OSCC-OSF cases, and 15 normal oral mucosae were obtained. Immunohistochemical staining was done with antibodies to CD34 to assess the vasculature and telocytes. The mean vascular density (MVD) and mean telocyte density were compared between the groups using the Kruskal-Walli test. RESULTS: A statistically significant high MVD (3.4 ± 1.22) and mean telocyte density (3.8 ± 1.35) was observed in OSCC-OSF cases while it was lowest in advanced OSF cases. MVD was higher in early OSF cases than in normal mucosa. CONCLUSION: This study showed a decrease in CD34-positive telocytes in OSF, indicating that telocyte loss promotes the development of fibrosis.Increased angiogenesis coexisted with an increase in telocytes in OSCC-OSF.

Diaphragmatic and Pulmonary Functions Following an Ultrasound-Guided Supraclavicular Approach Versus a Costoclavicular Approach of a Brachial Plexus Block: A Randomized Study.

INTRODUCTION: A costoclavicular brachial plexus block is an emerging infraclavicular approach that targets the cords lateral to the axillary artery, providing rapid onset of sensory-motor blockade. However, the incidence of hemi-diaphragmatic paralysis (HDP), a potential complication, remains unclear compared to the widely used supraclavicular (SC) approach. This study aimed to compare the incidence of HDP between ultrasound-guided costoclavicular and SC brachial plexus blocks. OBJECTIVES: To compare the influence of ultrasound-guided SC and costoclavicular brachial plexus blocks on diaphragmatic excursion, thickness, and contractility along with pulmonary function. MATERIALS AND METHODS:  This prospective, randomized, observer-blinded controlled trial included 60 patients undergoing below-shoulder surgeries. Patients were randomized to receive either ultrasound-guided SC (Group S) or costoclavicular (Group C) brachial plexus block with 0.5% levobupivacaine. The diaphragmatic function was assessed using ultrasonographic evaluation of diaphragm thickness and diaphragmatic thickness fraction (DTF) pre- and postblock. Pulmonary function tests (PFTs) (forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and peak expiratory flow rate (PEFR)) were performed preblock and two hours postblock. Block characteristics were compared. RESULTS: The SC group exhibited a significantly larger reduction in DTF from preblock to postblock compared to the costoclavicular group (mean ΔDTF: 34.38% vs. 14.01%, p<0.01). Both groups showed significant declines in FVC, FEV1, and PEFR postblock, but the magnitude of deterioration was significantly greater in the SC group, displaying no significant difference in block characteristics. CONCLUSION: The costoclavicular brachial plexus block demonstrated superior preservation of diaphragmatic contractility and lesser deterioration of PFTs compared to the SC approach while being equally effective. These findings highlight the potential benefits of the costoclavicular technique in minimizing diaphragmatic dysfunction and respiratory impairment, particularly in patients at risk for respiratory complications.

Incidence of Facial Nerve Injury and Sialocele Formation Following Mandibular Condylar and Sub-condylar Fracture Fixation.

Purpose: To study the incidence of sialocele formation in the parotid gland and to study the incidence of facial nerve affliction following treatment of mandibular condylar and sub-condylar fractures. Materials and methods: The present study is a retrospective study conducted on a total of 82 patients with 107 sub-condylar and condylar fractures treated in this centre from August 2008 to August 2020. The surgical approaches used to treat the fractures were considered, and the occurrence of sialocele, salivary fistula and facial nerve paralysis was noted. The facial nerve function was analysed using House-Brackmann system of classification. Results: The incidence of sialocele formation was seen in 15.87% of cases, and the incidence was seen more commonly during a preauricular approach (52.94%) followed by retromandibular (41.17%) followed by anterior parotid transmassetric approach (11.76%). The incidence of facial nerve affliction was seen in 17.57% of cases with majority of them showing temporal branch involvement in 21.05% of cases. Conclusion: During the treatment of condylar and sub-condylar fractures, the facial nerve is at considerable risk of damage; however, understanding the anatomy of the nerve is of importance to avoid such complications. Sialocele formation is also an undesirable complication of such surgeries, a prompt diagnosis and early treatment is mandatory to overcome further unwanted sequel.

Clinical and CT Scan Evaluation of Outcomes of Modified SARPE Using a Bone-Borne Hyrax Appliance in Unilateral Posterior Crossbite.

Objective: The objective of this study was to evaluate, using clinical and computed tomography, outcomes of unilateral SARPE with a bone-borne hyrax appliance in case of unilateral crossbite and to assess the correlations between hyrax appliance opening and post-SARPE skeletal changes. Materials and Methods: Two patients of unilateral crossbite underwent Unilateral SARPE and post-surgical expansion of maxilla using a bone-borne hyrax appliance. Computed tomography was used to make comparative linear and angular measurements of the anterior, intermediate, and posterior portions of the maxilla. The correlation between maxillary expansion and appliance opening was also investigated. Results: Significant overall expansion was observed with maximum expansion in the anterior and inferior portions of the maxilla. The degree of appliance opening was significantly greater than that of the skeletal expansion. Comparative CAD measurements showed maximum increase in interdental width at the second premolar level. Conclusion: The transverse expansion of the maxilla obtained with a bone-borne hyrax is less than uniform. The lack of linear correlation between appliance opening and skeletal expansion is attributable to multiple factors, including those related to the device, the surgical technique, and the craniofacial deformity itself.

Technique for Foot Reconstruction with Custom-made Calcaneal Prosthesis in Primary Malignancy - A Case Report.

The foot is an uncommon location for osseous tumors, comprising ∼ 3% of all skeletal tumors, which occur particularly around the calcaneum. Radical surgery creates a void in the foot which adversely affects the ability to salvage it. Calcaneal replacement surgeries are not commonly performed due to factors involving instability of the prosthesis, soft-tissue defects, and resultant failure, which can occur in the postoperative period. Thus, we herein report a rare case of synovial sarcoma arising from the sheath of the tibialis posterior tendon, with secondary involvement of the calcaneus bone. Considering the previous experiences of different surgeons, a custom-made prosthesis was designed with relevant modifications.

Technique for Foot Reconstruction with Custom-made Calcaneal Prosthesis in Primary Malignancy - A Case Report / Técnica de reconstrução do pé com prótese de calcâneo feita sob medida em câncer primário - Relato de caso

Abstract The foot is an uncommon location for osseous tumors, comprising ~ 3% of all skeletal tumors, which occur particularly around the calcaneum. Radical surgery creates a void in the foot which adversely affects the ability to salvage it. Calcaneal replacement surgeries are not commonly performed due to factors involving instability of the prosthesis, soft-tissue defects, and resultant failure, which can occur in the postoperative period. Thus, we herein report a rare case of synovial sarcoma arising from the sheath of the tibialis posterior tendon, with secondary involvement of the calcaneus bone. Considering the previous experiences of different surgeons, a custom-made prosthesis was designed with relevant modifications.

Resumo O pé é um local incomum para tumores ósseos, e compreende cerca de 3% de todos os tumores esqueléticos, em especial ao redor do calcâneo. A cirurgia radical cria um vazio no pé, o que afeta de forma negativa a capacidade de resgate do membro. As cirurgias de reconstrução do calcâneo não são comumente realizadas por causa da instabilidade da prótese, defeito de partes moles, e consequente possibilidade de insucesso pósoperatório. Assim, apresentamos aqui um caso raro de sarcoma sinovial originário da bainha do tendão tibial posterior com acometimento secundário do osso calcâneo. Considerando as experiências prévias de diferentes cirurgiões, projetamos uma prótese sob medida com modificações relevantes.

Micro-Raman spectroscopy analysis of dentin remineralization using eggshell derived nanohydroxyapatite combined with phytosphingosine.

The aim of this study was to assess the remineralization efficacy of chicken eggshell-derived nano-hydroxyapatite (CEnHAp) combined with phytosphingosine (PHS) on artificially induced dentinal lesions. PHS was commercially procured whereas CEnHAp was synthesized using microwave-irradiation method and characterized using X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FT-IR), high-resolution scanning electron microscopy-energy-dispersive X-ray spectroscopy (HRSEM-EDX), and transmission electron microscopy (TEM). A total of 75 pre-demineralized coronal dentin specimens were randomly treated with one of the following test agents (n = 15 each): artificial saliva (AS), casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), CEnHAp, PHS, and CEnHAp-PHS under pH cycling for 7, 14, and 28 days. Vickers microhardness indenter, HRSEM-EDX, and micro-Raman spectroscopy methods were used to assess the mineral changes in the treated dentin samples. Data were submitted to Kruskal-Wallis and Friedman's two-way analyses of variance (p < 0.05). HRSEM and TEM analysis depicted irregular spherical structure of the prepared CEnHAp with a particle size of 20-50 nm. The EDX analysis confirmed the presence of Ca, P, Na and Mg ions. The XRD pattern showed the characteristic crystalline peaks for hydroxyapatite and calcium carbonate that are present in the prepared CEnHAp. Dentin treated with CEnHAp-PHS revealed highest microhardness values along with complete tubular occlusion compared to other groups at all test time intervals (p < 0.05). Specimens treated with CEnHAp showed increased remineralization than those treated with CPP-ACP followed by PHS and AS groups. The intensity of mineral peaks, as observed in the EDX and micro-Raman spectra, confirmed these findings. Further, the molecular conformation of the collagen's polypeptide chains, and amide-I and CH2 peaks attained peak intensities in dentin treated with CEnHAp-PHS and PHS whereas other groups revealed poor stability of collagen bands. Microhardness, surface topography, and micro-Raman spectroscopy analyses revealed that dentin treated with CEnHAp-PHS have an improved collagen structure and stability as well as highest mineralization and crystallinity.

Radioactive Iodine Uptake in Postoperative Seroma: A Cause for False Positivity.

Besides the known physiologic uptake of 131I, the literature describes various false-positive findings on 131I scans in benign lesions, inflammation, traumatic sites, and postsurgical sites, to name a few. However, to the best of our knowledge, no study has shown false-positive uptake of 131I in a postoperative seroma at the postsurgical site. We describe such a case here.

Bisphosphonate Osteonecrosis in a Case of Langerhans Cell Histiocytosis: Report of a Case and Review of Literature.

Langerhans Cell histiocytosis is a rare multisystem disease originating from dendritic cell lines primarily characterized by osteolytic lesion of the skeleton. Chemotherapy along with bisphosphonates have been used to control the progression of the disease and prevent the osteolysis associated with the disease. Bisphosphonate osteonecrosis of the jaws is a common finding following treatment with bisphosphonates for osteoporosis, metastatic tumors to the bone or the osteolytic lesions of multiple myeloma. The article highlights a rare case of bisphosphonate osteonecrosis of the mandible in a case of long-standing Langerhans cell histiocytosis.

Rapid economical acetic acid Papanicolaou staining procedure versus conventional staining procedure in normal oral mucosa.

Background: Papanicolaou (Pap) staining technique is a conventional technique used in cytology but it is time consuming. Aim: The aim of the study was to determine the efficacy of Rapid Economical Acetic acid Papanicolaou stain (REAP) over conventional staining technique in studying normal oral mucosa. Materials and Methods: Eighty patients were selected and were grouped based on their habits. Two smears were obtained from each patient and were subjected to both the staining techniques. A total of 160 slides were studied for features such as cellular outline, nuclear outline, nuclear details, cellular differentiation, micronuclei and cellular transparency. Results: The conventional staining procedure showed 79 cases of optimal cellular staining, 78 cases of optimal nuclear staining, 35 cases of optimal nuclear details, 57 cases of optimal differentiation and 27 cases of optimal transparency and 33 cases of optimal micronuclei. REAP staining showed 75 cases of optimal cellular staining, 64 cases of optimal nuclear staining, 20 cases of optimal nuclear details, 36 cases of optimal differentiation and 28 cases of optimal transparency and 25 cases of optimal micronuclei. Conclusion: REAP staining effectively reduces the time and the cost factor, but the cytological details are well observed under conventional staining technique in normal patients.

Performance and survival outcomes of defect-driven versus specimen-driven method of frozen section intraoperative margin assessment in oral cancers.

Margin status is one of the most important prognostic factors in oral cancers. Intraoperative frozen section (FS) can be performed to ensure a margin-negative resection, however the method of FS assessment is debatable. The aim of this study was to compare the defect-driven (DDA) versus specimen-driven (SDA) approach for intraoperative assessment of tumour margins in oral cancer resections and their impact on loco-regional recurrence and survival. The primary study endpoint was margin status determined from the final histopathological examination report. Secondary endpoints were disease recurrence and survival. This retrospective cohort study compared the two methods of FS in terms of their performance and survival outcomes. All oral squamous cell carcinoma patients who underwent surgery as the primary treatment from January 2018 to February 2019 were included. The involved margin rate was slightly lower with SDA than DDA (7.5% vs 11.8%), however the difference was not statistically significant. The recurrence rate was higher with DDA (19/51, 37.2%) than SDA (14/53, 26.4%), although this was not statistically significant. Local recurrence-free survival (DDA 62% vs SDA 75%; P = 0.653) and overall survival (DDA 76% vs SDA 78%; P = 0.300) at 18 months of follow-up were comparable. There was no significant difference in sensitivity or specificity of intraoperative FS for margin assessment between SDA and DDA. The type of intraoperative FS technique used did not affect loco-regional recurrence or overall survival.

Role of Acute Physiology, Age, and Chronic Health Evaluation (APACHE) II Score in Predicting Outcomes of Peritonitis Due to Hollow Viscous Perforation: A Prospective Observational Study.

Background The Acute Physiology and Chronic Health Evaluation II (APACHE II) is the most commonly used severity-of-disease scoring system in ICUs worldwide. There is a paucity of data describing the role of APACHE II score in predicting outcomes of peritonitis due to hollow viscous perforation. This study aims at identifying the importance of the APACHE II score in predicting outcomes of patients with peritonitis secondary to hollow viscus perforation. Methods The study is a prospective, observational study that included all the patients diagnosed with perforation peritonitis who underwent emergency laparotomy and were admitted to the Department of Surgery from May 2017 to May 2018. APACHE II scores were assigned to all patients in order to calculate their individual risk of mortality before undergoing emergency surgery. The accuracy in outcome prediction of the APACHE II system was assessed by means of receiver operating characteristic (ROC) curve and Pearson correlation coefficient and its significance test. Result A total of 50 patients with perforation peritonitis were included in this study. Peptic ulcer disease was the major etiology leading to perforation in 54% of patients, followed by gangrenous bowel. The mean APACHE II score was 9.54. Out of the 50 patients, seven patients succumbed to the illness. All the seven patients whose APACHE II score > 16 developed systemic complications, and three of them developed a local complication. Conclusion APACHE II score correlated well with the outcome in the current study, and APACHE II score also correlated well with the hospital and ICU stay.

Application of Navigation Surgery in Temporomandibular Joint Ankylosis Case and Review of Literature.

The aim of this article is to develop a navigation-guided oral and maxillofacial surgery including surgical planning, simulation and navigation in temporomandibular joint ankylosis case practiced in tertiary care hospital. After getting the computed tomographic angiography of head and neck, the special software of Brain lab® is used to mark the arteries and veins of the patient, which was in close approximation to the mandibular condyle. Brain lab® navigation system was used during the surgery to ascertain the middle meningeal artery location, and osteotomy cut was given. Navigation technology use in the neurosurgery is not new. But its use in the subcontinent in the field of maxillofacial surgery is quite rare. First time, it has been used scientifically in temporomandibular joint ankylosis case. Navigation technology use in the maxillofacial surgery requires a holistic imaginative/creative approach to make the surgeries more predictive and safe.

8-Isoprostane: A salivary oxidative stress biomarker for oral submucous fibrosis and oral squamous cell carcinoma.

BACKGROUND: 8-isoprostane is one of the stable oxidative stress marker formed by the lipid peroxidation of arachidonic acid. It is present in detectable quantities in all biological fluids. Elevation of 8-Isoprostane has been reported in various neurological, cardiological disorders, and periodontal diseases. AIM: The present study was conducted to estimate and compare the level of 8-isoprostane in plasma and saliva in patients with oral squamous cell carcinoma (OSCC), oral submucous fibrosis (OSMF), and in controls. The study also aimed to find out if 8-isoprostane can be used as an effective oxidative stress marker in evaluating the disease progression in OSCC. MATERIALS AND METHODS: Plasma and salivary samples were taken from 10 cases each of clinically diagnosed OSMF, clinically and hisotpathologically diagnosed cases of OSCC and controls. The samples were subjected to 8-Isoprostane ELISA procedure and analyzed. Statistical analysis was performed using the SPSS software. RESULTS: The levels of 8-isoprostane in plasma showed an average increase from normal to OSMF to OSCC but was not statistically significant. The variations in the level of salivary 8-isoprostane were found to be statistically significant (P = 0.037) suggesting that there is a gradual increase in levels of isoprostane from controls to OSMF to OSCC. CONCLUSION: The results showed that the concentration of isoprostane in saliva showed a progressive and steady increase from control through OSMF to OSCC indicating that saliva could be used as an effective diagnostic tool in estimating tumor markers. Large scale studies correlating with other potentially malignant oral disorders are required to ascertain the role of 8-Isoprostane as an ideal tumor marker.

Complications of Diagnostic TMJ Arthroscopy: An Institutional Study.

INTRODUCTION: The prevalence of using arthroscopy for the diagnosis of the TMJ disorders is increasing due to its superiority to conventional methods of imaging. Although considered to be safe, complications do occur. PATIENTS AND METHOD: A single operator single-institution retrospective study consisting of 50 patients taken up for diagnostic arthroscopy was analysed for complications. RESULTS: Lacerations of external acoustic meatus was found in 03 patients (6%); immediate partial hearing loss was seen in 01 patient (2%); transient facial nerve palsy was found in 05 patients (10%); sensory disturbances over the distribution of auriculotemporal nerve was evident in 01 patient (2%); haemorrhage as visualised by excessive bleeding through trocar skin puncture wound was seen in 05 patients (5%). Post-operative pain more than the pre-operative pain on assessment by visual analogue scale was noted in 05 patients (10%) on the immediate post-operative day. Reduction in spontaneous mouth opening was noted in 15 patients (30%). CONCLUSION: Though the complication rate was found to be higher than most of the other studies, they were minor which resolved without any intervention. The cases with complications were clustered at the beginning of the series which suggests the steep learning curve and the importance of surgeons' experience and skill involved in this procedure.

Detection of human papillomavirus 16 and 18 in patients with oral squamous cell carcinoma and potentially malignant oral disorders in South Indian population: A pilot study.

THE AIM OF THE STUDY: Human papillomavirus (HPV) is an oncogenic virus and the high-risk genotype HPV 16 and 18 are the most commonly associated with carcinoma. The aim of the study is to determine the prevalence of HPV 16 and 18 in normal oral mucosa, potentially malignant oral disorders (PMOD), and in oral squamous cell carcinoma (OSCC) in South Indian population and whether it can be used as a biological marker to identify the severity of the disease in patients. MATERIALS AND METHODS: Cytological samples from buccal mucosa were obtained from ten OSCC patients, ten patients with PMOD, and ten from control group. The samples were subjected to polymerase chain reaction. RESULTS: The prevalence of HPV 16 in control, PMOD, and OSCC was 80%, 50%, and 70%, respectively. The prevalence of HPV 18 in control, PMOD, and OSCC was 70%, 60%, and 50%, respectively. CONCLUSION: HPV 16 and 18 was noticed in normal oral mucosa, potentially malignant oral lesions, and SCC. The absence of sequential increase or decrease of HPV 16 and 18 in the three groups in this study prevents its use from being used as a marker to identify the progression of the disease.

Clinical and MRI Evaluation of Orthodontic Mini-Screws for Disc Repositioning in Internal Derangement of TMJ: A Prospective Study.

PURPOSE: The purpose of this study was to assess the efficacy of orthodontic mini-screws as a modified suture anchor for disc repositioning in cases of internal derangement of the temporomandibular joint. PATIENTS AND METHODS: A prospective evaluation of ten patients was undertaken for a period of 6 months using this modified approach from Jan 2014 to Jun 2016. Symptomatic patients with clinical and MRI features suggestive of internal derangement of TMJ and willing to undergo surgical repositioning of articular disc to alleviate symptoms of temporomandibular dysfunction were taken up for the study. Post-operatively, functional outcomes were assessed in terms of reduction in pain, joint movement and absence of joint noise and clicking sounds. Post-operative MRI was used to assess the disc position and morphological changes in the disc and arthritic changes in the condyle. RESULTS: All patients underwent a surgical repositioning of the anteriorly displaced disc by the modified orthodontic suture anchor. Patients were post-surgically followed up at intervals of 1, 3 and 6 months. Immediate complications in terms of pain, restriction of functional motion and transient facial nerve palsy were noted. Late complications include temporal nerve palsy in one case. All patients experienced significant improvement with good functional outcomes and stable repositioning of disc was noticed at the end of 6 months. CONCLUSION: The modified disc repositioning using an orthodontic screw via a mini preauricular approach provided a good functional outcome in all patients as assessed over a period of 6 months. However, the long-term functional sequel of the procedure and changes in the articular disc needs to be assessed.

Complications of Midface Swing for Management of Juvenile Nasopharyngeal Angiofibroma.

INTRODUCTION: Access osteotomies provide direct exposure to inaccessible areas of the deep part of craniofacial skeleton for treating pathologies involving vital structures. The use of maxillary swing approach for gaining wide access to the nasopharynx, infratemporal fossa, parapharyngeal space, middle fossa of skull base. Though the maxillary swing requires transfacial incision for wide exposure but with careful handling the scar is minimum and this approach can be used in young people. MATERIALS AND METHODS: Surgical resection is carried out following preoperative embolization of the involved feeder vessels. Total 16 cases were considered for this study. RESULTS: This article highlights cases successfully treated in our institution, the mention of complications associated with the cases along with management. CONCLUSION: Maxillary swing is a good approach for getting access to the deep pathologies like JNA.