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.

Validity of IL-6 and Arthrocentesis in the Cause and Management of Internal Derangement of TMJ.

Purpose: The aim of this clinical study was to evaluate the level of Interleukine-6 (IL-6), pre and post arthrocentesis to validate it as a biomarker in the Internal Derangement (ID) of TMJ. Material and Methods: This study included 30 patients (20 females and 10 males) of Temporo-Mandibular Dysfunction (TMD) with Disc displacement without reduction (DDwoR) Wilkes stage III, who were refractory to conservative management. Arthrocentesis was performed as a therapeutic modality. Synovial fluid aspirates were obtained prior to arthrocentesis and post arthrocentesis with 300 ml of Ringer Lactate solution into the superior joint compartment for the assessment of level of IL-6. The clinical parameters used for correlating the level of IL-6 were degree of pain (VAS I), chewing ability (VAS II), Maximal Mouth Opening (MMO) in both pre and post op phase with the follow-up period of 01 day, 01 week, 01 month, 03 month and 06 month and the results were compared. ELISA was performed to analyze the levels of IL-6 in the aspirates. The clinical parameters and the level of IL-6 were recorded and analyzed statistically. Results: The study showed ID of TMJ (Wilkes stage III) s are more prevalent in females especially in the fourth decades of life with the mean age of 38.4 years. The post operative assessment in terms of pain, maximum mouth opening, lateral movements of the mandible and the levels of IL-6 were found to be statistically significant with a P value <0.01. Conclusion: This study validates the role of IL-6 as a definitive biomarker for the pathogenesis of ID of TMJ Wilkes stage III and arthrocentesis proved to be a minimally invasive therapeutic modality for its management.

Bony bridge resorption after secondary alveolar grafting and correlation with success of orthodontic treatment: A prospective volumetric cone beam computed tomography (CBCT) study.

BACKGROUND: Cleft lip/palate is the second most observed congenital defect which constitutes a serious dental-medical-social problem. Successful uptake and stability of alveolar graft is required to achieve closure of the oro-nasal fistula and continuity of the dental arches. Resorption of bone graft may compromise the results achieved. This study determined the bony bridge volume required for successful repair of alveolar cleft, evaluated the resorption after 3 months of grafting and correlated the success of orthodontic treatment. METHODS: 30 patients with unilateral cleft lip and palate requiring secondary alveolar bone grafting and orthodontic correction were included in the study. After arch expansion and before alveolar grafting using cone beam computed tomography (CBCT) of maxilla was recorded and was repeated after 3 months of alveolar bone grafting to estimate the volume of grafted bone in the cleft. RESULTS: The bridge bone volume resorption after 3 months post-operative ranged from 14% to 100% with a mean of 36.46%. The percentage of resorption of alveolar bone graft after 3 months of surgery was statistically significant. Success of orthodontic treatment was statistically significant when correlated with percentage of resorption. CONCLUSION: The accurate localization and estimation of the size and extent of alveolar cleft area is important for treatment planning. Post-operative it is important to analyze the outcome of transplanted bone as early as possible. Early evaluation can help to predict the outcome of transplanted bone and may guide to re-grafting of the site immediate or to restart any interrupted orthodontic procedure, if necessary.

Retromandibular transparotid approach compared with transmasseteric anterior parotid approach for the management of fractures of the mandibular condylar process: a prospective randomised study.

Fractures of the mandibular condyle lead to displacement of the condyle and loss of the height of the ramus. A retromandibular approach is the most commonly used for open reduction and internal fixation (ORIF) of such fractures. We aimed to compare the complications associated with a retromandibular transparotid approach with a retromandibular transmasseteric anterior parotid (TMAP) approach for their management. Thirty patients were randomly selected into two groups (15 in each): Group A comprised the retromandibular transparotid approach and Group B the retromandibular TMAP. The variables evaluated were: operating time, facial nerve injury, occurrence of Frey syndrome, and sialocoele at one week, four weeks, three months, and six months. The mean (SD) age in group A and B was 33.93 (17.97) years and 33.53 (16.15) years, respectively, and there were 28 men and two women. Mean (SD) exposure time in the transparotid approach was 26.93 (5.19) minutes and 25.4 (8.35) minutes in the TMAP approach. The incidence of facial nerve injury was 2/15 patients in the transparotid group and 3/15 in the TMAP group, all of which resolved within six months. The incidence of sialocoele was 2/15 in the transparotid group. The results did not show any significant difference in complications between the two approaches, but the retromandibular transparotid approach provided straight-line access in fractures of the condylar neck, with fewer incidences of nerve injury. The anterior parotid approach, on the other hand, provided easier access for fractures that were medially dislocated or of the condylar base but had an increased incidence of facial nerve injuries.

Does methylprednisolone improve postoperative outcomes after mandibular third molar surgery? A systematic review and meta-analysis.

This systematic review and meta-analysis was performed to investigate whether methylprednisolone (MP) administered via any route improves postoperative outcomes (pain, trismus, and oedema) following mandibular third molar surgery. An electronic search of the PubMed, Scopus, Cochrane CENTRAL, and Google Scholar databases was performed to identify studies published in English up until January 2018. A total of 28 studies were included in the review: 25 randomized clinical trials (RCTs) and three controlled clinical trials. Studies were grouped according to the route of administration of MP for qualitative and quantitative analysis. Three studies were of 'high' quality and 22 were of 'medium' quality; three studies had a high risk of bias. Within the purview of the limitations of this review, the results showed that MP administered via any route significantly improves oedema in the early postoperative period, but has no effect on late postoperative oedema. Oral and intra-masseteric MP also seems to reduce pain and trismus in the early postoperative period. The results also indicate that oral MP may reduce late postoperative pain, while intra-masseteric MP may improve the late trismus outcome. More high quality RCTs are required to provide stronger evidence on the use of MP in third molar surgery.

A new multi-line cusp magnetic field plasma device (MPD) with variable magnetic field.

A new multi-line cusp magnetic field plasma device consisting of electromagnets with core material has been constructed with a capability to experimentally control the relative volume fractions of magnetized to unmagnetized plasma volume as well as accurate control on the gradient length scales of mean density and temperature profiles. Argon plasma has been produced using a hot tungsten cathode over a wide range of pressures 5 × 10-5 -1 × 10-3 mbar, achieving plasma densities ranging from 109 to 1011 cm-3 and the electron temperature in the range 1-8 eV. The radial profiles of plasma parameters measured along the non-cusp region (in between two consecutive magnets) show a finite region with uniform and quiescent plasma, where the magnetic field is very low such that the ions are unmagnetized. Beyond that region, both plasma species are magnetized and the profiles show gradients both in temperature and density. The electrostatic fluctuation measured using a Langmuir probe radially along the non-cusp region shows less than 1% (δIisat/Iisat < 1%). The plasma thus produced will be used to study new and hitherto unexplored physics parameter space relevant to both laboratory multi-scale plasmas and astrophysical plasmas.

Custom-made mouth prop for TMJ arthrocentesis: a technical note.

INTRODUCTION: TMJ arthrocentesis involves lavage of the upper joint space which forces the disc apart from the fossa and washes away the inflammatory components of the joint. To increase the joint space during arthrocentesis, the patient is usually asked to open the mouth and deviate it to the opposite side so as to distract the condyle from the glenoid fossa thereby increasing joint space. METHOD: The authors describe a simple and rapid technique of preparing a custom-made mouth prop to hold the mandible in eccentric position during arthrocentesis. FINDINGS: The custom-made mouth prop is an effective tool to help relax the patient in an eccentric position during the duration of arthrocentesis procedure.

The impact of HLA class I and EBV latency-II antigen-specific CD8(+) T cells on the pathogenesis of EBV(+) Hodgkin lymphoma.

In 40% of cases of classical Hodgkin lymphoma (cHL), Epstein-Barr virus (EBV) latency-II antigens [EBV nuclear antigen 1 (EBNA1)/latent membrane protein (LMP)1/LMP2A] are present (EBV(+) cHL) in the malignant cells and antigen presentation is intact. Previous studies have shown consistently that HLA-A*02 is protective in EBV(+) cHL, yet its role in disease pathogenesis is unknown. To explore the basis for this observation, gene expression was assessed in 33 cHL nodes. Interestingly, CD8 and LMP2A expression were correlated strongly and, for a given LMP2A level, CD8 was elevated markedly in HLA-A*02(-) versus HLA-A*02(+) EBV(+) cHL patients, suggesting that LMP2A-specific CD8(+) T cell anti-tumoral immunity may be relatively ineffective in HLA-A*02(-) EBV(+) cHL. To ascertain the impact of HLA class I on EBV latency antigen-specific immunodominance, we used a stepwise functional T cell approach. In newly diagnosed EBV(+) cHL, the magnitude of ex-vivo LMP1/2A-specific CD8(+) T cell responses was elevated in HLA-A*02(+) patients. Furthermore, in a controlled in-vitro assay, LMP2A-specific CD8(+) T cells from healthy HLA-A*02 heterozygotes expanded to a greater extent with HLA-A*02-restricted compared to non-HLA-A*02-restricted cell lines. In an extensive analysis of HLA class I-restricted immunity, immunodominant EBNA3A/3B/3C-specific CD8(+) T cell responses were stimulated by numerous HLA class I molecules, whereas the subdominant LMP1/2A-specific responses were confined largely to HLA-A*02. Our results demonstrate that HLA-A*02 mediates a modest, but none the less stronger, EBV-specific CD8(+) T cell response than non-HLA-A*02 alleles, an effect confined to EBV latency-II antigens. Thus, the protective effect of HLA-A*02 against EBV(+) cHL is not a surrogate association, but reflects the impact of HLA class I on EBV latency-II antigen-specific CD8(+) T cell hierarchies.

Efficacy of Autogenous Split Thickness Calvarial Graft in the Management of Residual Cranial Defect.

INTRODUCTION: The patients with cranial deformity suffer from headache, dizziness, irritability, loss of concentration, depression, anxiety, intolerance to noise and vibration and neuromotor weakness. It is therefore essential to restore the calvarium. MATERIAL AND METHOD: This study was conducted in the Department of Oral and Maxillofacial Surgery, Armed Forces Medical College, Pune between Oct 2010 and Mar 2012. The study population was selected from the outpatient department and from the referred cases. The aim was to study the uptake of split thickness calvarial graft in the management of residual cranial defect. After applying the inclusion and exclusion criterions, ten cases were selected with residual cranial deformity, operated for cranioplasty using split thickness calvarial graft and evaluated. CONCLUSION: It was concluded that cranioplasty using autogenous split thickness calvarial graft for restoring cranial defects is a useful technique and this procedure allows the surgeon to reconstruct a moderate-to-large cranial defect, without breaching the inner cortical plate.

Comparative evaluation of the mandibular distraction zone using ultrasonography and conventional radiography.

The purpose of this study was to determine the efficacy of ultrasonography (USG) for the evaluation of bone formation in the mandibular distraction wound and to compare this with radiographic evaluation, which is currently the standard modality. Twenty-two patients underwent mandibular distraction (30 sides) with a variety of distraction devices. The wounds were assessed with plain radiographs and USG at established time intervals. Estimates of bone formation using a semiquantitative bone fill score were made for radiographs and USG. USG bone fill scores were correlated with radiography scores. At week 4 the difference between the scores was statistically significant (P=0.01); at all other time points, USG and radiography scores were comparable. At week 4, USG scores were significantly higher than the corresponding radiography scores, indicating that USG is an earlier indicator of calcification in the distraction zone as compared to radiography. USG evaluation of the distraction osteogenesis (DO) zone has many inherent advantages over conventional methods. The results of this study indicate that USG is an accurate non-invasive technique that may prove to be useful in assessing the mandibular DO regenerate in patients.

Hemimasticatory spasm: a case report with a new management strategy.

Hemimasticatory spasm is a rare neuromuscular disorder where the patient experiences involuntary, painful spasm of muscles of mastication. Only 15 cases have been reported in literature. We present a case which was treated unconventionally with satisfactory outcome.

Low-grade osteosarcoma of the mandible.

Osteosarcoma (OS), a rare malignant bone tumour arising from primitive bone forming mesenchyme, most often arises in the metaphyses of long bones of the extremities. Bone or osteoid formation within the tumour is characteristic of an osteosarcoma. Craniofacial osteosarcoma (CFOS), most often located in the mandible or maxilla, accounts for only 5-13% of all osteosarcomas. In general, OS of the jaw is a high-grade lesion. Low-grade lesions are rare and represent less than 2% of all osteosarcomas reported in the literature. Because of its rarity and well differentiation, Low-grade OS is usually misdiagnosed as a benign lesion. The clinical and radiographic presentation does not correlate well with the subtle histology picture of a low-grade osteosarcoma which makes the diagnosis difficult.

Ameloblastic Carcinoma of the mandible.

Odontogenic carcinomas are rare lesions arising from dental embryogenic residues and have been designated by a variety of terms like malignant ameloblastoma, ameloblastic carcinoma, metastatic ameloblastoma or primary intra-alveolar epidermoid carcinoma. Ameloblastic carcinoma combines the histological features of ameloblastoma with cytological atypia, even in the absence of metastasis. The lesion has been reported to arise either from the odontogenic cyst or the ameloblastoma. Majority originate de novo and the remaining are malignant transformation of an ameloblastoma.

Mandibular third molars as a risk factor for angle fractures: a retrospective study.

INTRODUCTION: Anecdotal reports suggest that the presence of mandibular third molars predispose the mandible to angle fractures. The purpose of this study was to evaluate the presence of mandibular third molars as a risk factor for angle fractures in patients with fractured mandibles. MATERIALS AND METHOD: A retrospective study was designed comprising of patients admitted for treatment of mandibular fractures between January 2006 and January 2009. Data sources were the patients' medical records and radiographs. The predictor variables were the presence and position of third molar. Third molar position was grouped into 9 categories based on the Winter's and Pell & Gregory classification. The outcome variable was the presence of an angle fracture. Other study variables included age, sex, race and mechanism of injury, associated fractures and fracture location. RESULTS: Of the 136 patients with mandibular third molars, 49 cases had angle fractures. Of the 18 patients without mandibular third molars, 03 had angle fractures. CONCLUSION: The results of this study demonstrate that patients with fractured mandibles and mandibular third molars are nearly 2.2 times more likely to have an angle fracture than patients without mandibular third molars.

Distribution of the F374 allele of the SLC45A2 (MATP) gene and founder-haplotype analysis.

The membrane-associated transporter protein (MATP) plays an important role in melanin synthesis. The L374F mutation in the SLC45A2 gene encoding MATP has been suggested to be associated with skin colour in major human populations. In this study more detailed distribution of the F374 allele was investigated in 1649 unrelated subjects from 13 Eurasian populations and one African population. The highest allele frequency was observed in Germans (0.965); French and Italians showed somewhat lower frequencies; and Turks had an intermediate value (0.615). Indians and Bangladeshis from South Asia were characterized by low frequencies (0.147 and 0.059, respectively). We also found the F374 allele in some East and Southeast Asian populations, and explained this by admixture. Haplotype analysis revealed that the haplotype diversity was much lower in Germans than in Japanese, and suggest that the L374F mutation occurred only once in the ancestry of Caucasians. The large differences in distribution of the F374 allele and its haplotypes suggest that this allele may be an important factor in hypopigmentation in Caucasian populations.

Enzyme content of hepatocellular lysosomes in the liver of the tumour-bearing mouse.

An increase in the number of hepatocellular lysosomes was not detected in mice bearing the solid or ascites forms of Sarcoma 180 or Ehrlich's tumour. Despite this, biochemical studies showed significant increases in acid phosphatase, cathepsin-D and beta-galactosidase. This difference between morphological and biochemical observations is explained by the fact that only gross increases in lysosome population are likely to be detected in the small samples examined with the electron microscope, but by biochemical methods whereby many grams of tissue are analysed finer changes may be detected. As far as is known at present there is an increase in hepatocellular lysosomes and/or lysosomal enzymes in tumour-bearing mice, rats and man and no exception to this exists.

Lysozyme production by a granuloma in vivo: output in blood and lymph in relation to ultrastructure and immunochemistry.

The output of lysozyme into the venous and lymphatic drainage of a B.C.G. experimental granuloma has been studied. There is a massive output of lysozyme by both routes maximal in the lymph at 28 days, and in the serum at 35 days after induction of the granuloma. There is no similar excretion of acid phosphatase. The lactic dehydrogenase level both in blood draining the granuloma and blood draining the normal limb is elevated but not in precise synchrony with lysozyme output. Macrophages in the granuloma show ultrastructural features suggestive of secretion of dense granules, by appearance of electron dense material in the Golgi zone, and condensation therefrom. Granules are discharged on to the surface of lipid droplets, presumably representing attempted phagocytosis, but are not discharged elsewhere on the cell surface. Granules are released by cell disintegration both of macrophages and polymorphs. Lysozyme was demonstrated immunocytochemically in macrophage granules. The macrophages in the granuloma are biosynthetically active as shown by uptake of tritiated tyrosine. The findings support the view that granulomas export lysozyme and that this is due partly to exocytosis of material by macrophages on to the surface of lipid globules and partly to cell disintegration.

Enzyme content of hepatocellular lysosomes in the tumour-bearing rat.

An increase in the number of hepatocellular lysosomes is detectable with the electron microscope in rats bearing a carcinogen-induced sarcoma but not in rats bearing a transplanted Walker tumour. Biochemical studies show an increase in lysosomal enzymes in the liver of both groups of rats, but the increase in the rats bearing a carcinogen-induced sarcoma was greater than that in rats bearing a Walker tumour. This difference is explained by the fact that only gross increases in lysosomal population are likely to be detected in the small samples examined with the electron microscope, but by biochemical methods whereby many grams of tissue are analysed, finer changes may be detected. The collective data to date indicate that an increase in hepatocellular lysosomes and/or lysosomal enzymes occurs in rats and man bearing a variety of tumours and to this there is, as yet, no known exception.

Biosynthesis of murein lipoprotein in Escherichia coli: effects of 3,4-dihydroxybutyl-1-phosphonate.

The effects of 3,4-dihydroxybutyl-1-phosphonate, a four-carbon analog of sn-glycerol 3-phosphate, on the biosynthesis of the glyceryl moiety in murein lipoprotein of Escherichia coli were studied. The compound at a concentration of 55 microM strong inhibits in the incorporation of [2-3H]glycerol radioactivity into lipoprotein by virtue of its inhibition of the synthesis of phosphatidylglycerol. On the other hand, the incorporation of prelabeled [2-3H]glycerol radioactivity into lipoprotein was only partially inhbited by 3,4-dihydroxybutyl-1-phosphonate even at a much higher concentration (1 mM). These data were consistent with the postulated pathway for the biosynthesis of the lipid moiety in lipoportein: cysteine-lipoprotein + phosphatidylglycerol leads to glycerylcystein-lipoprotein + phosphatidic acid.