Comparative Evaluation of Relapse After LeFort 1 Osteotomy in Cleft Palate and Non-cleft Individuals: A Longitudinal Study.

PURPOSE: The aim of this study was to assess and compare the likelihood of relapse one year after LeFort I advancement surgery in patients with and without cleft lip and palate. METHODS: A retrospective observational study which included two groups of participants who underwent LeFort I maxillary advancement was performed. Group 1 included 10 non-cleft subjects and Group 2 included 21 subjects with cleft palate. These maxillary deficient patients were chosen and operated using a technique where only a sagittal displacement was intended. Patients who underwent additional mandibular surgery, significant vertical or transverse alterations, or both were excluded. Pre-operative (T1), immediately post-operative (T2), and minimum one-year follow-up (T3) lateral cephalograms were studied for each group. Skeletal stability and dental stability after LeFort I surgery at a minimum of one-year follow-up in cleft palate and non-cleft patients were evaluated. RESULTS: For the given sample size, relapse tendencies showed statistically significant differences between cleft palate patients and non-cleft palate patients after maxillary advancement. The sella nasion angle and horizontal overlap of the maxillary and mandibular incisors (overjet) decreased by 2 degrees and 0.9 mm respectively in the cleft palate group while decreasing by 1.10 degrees and 0.40 mm in the non-cleft group. CONCLUSIONS: After maxillary advancement with LeFort I osteotomy and miniplate fixation in patients with cleft palate and non-cleft patients, some degree of relapse was detected in both groups for the given sample size after one year post-operatively. The cleft palate group displayed additional relapse tendencies when compared to the non-cleft group.

Single perforator-based anterolateral thigh flap, the workhorse flap, in oral cancer reconstruction: A tertiary care institution experience.

Background: Ablative procedures of the oral cavity require composite removal of tissues, which results in compromise of both functional activities and esthetic mutilation and proves to be a reconstructive challenge. This paper focuses on the reliability and versatility of a single perforator-based anterolateral thigh (ALT) flap in oral cancer reconstruction. Materials and Methods: All patients who underwent reconstruction with a single perforator-based ALT for oral cancer defects at our center were included in the study. Results: Forty-seven patients who underwent reconstruction with a single perforator-based ALT flap were included in our study. The average flap size in our series was 111 cm2, with the largest measuring 375 cm2. They was a complete loss of flap in two patients; both of them underwent salvage procedure and were reconstructed with pectoralis major myocutaneous flap. One had a partial loss that underwent re-exploration. Conclusion: We conclude that a single perforator-based ALT is a very safe, reliable, and versatile flap for head and neck reconstruction. The microvascular anastomosis may be expensive and technically a limitation; however, it has found a permanent place in our head and neck reconstructive toolkit and is the workhorse flap for head and neck reconstruction.

Functional and Aesthetic Outcome of Macgregor and Z Plasty (Step Ladder) Approach for Lip Splitting in Oral Squamous Cell Carcinoma.

Purpose: The aim of the study is to compare the functional and esthetic results of two lip splitting approaches-McGregor incision and stepladder Z plasty for surgical resection of primary Oral Squamous cell carcinoma (OSCC). Method: Prospective study involved 24 patients who had modified radical neck dissection for OSCC between 2018 and 2020. Predictor variables were drawn from demographic characteristics (age and gender), primary site, extent of the primary lesion. Patients were divided into two groups randomly with group I McGregor lip splitting incision and group II step ladder Z plasty, with subjective and objective assessment. Results: In the overall comparison of the oral incontinence between the two groups, there was no statistically significant results. Z plasty group had better outcome with lesser degree of drooling and good cosmesis. There was no difference between the speech efficiency between the two groups. Subjective assessment of the appearance of lips and face was better in Z plasty group. Subjective assessment of inversion and eversion was better in McGregor group. Cosmesis was assessed objectively by Stony Brook Scar Evaluation Scale (SBSES). Group 1 had a mean score of 2.92 out of 5 and Group II mean score of 4.08 out of 5. Cosmesis was better in Z plasty group. Conclusion: Z plasty was found as a superior option when it comes to cosmesis due to its geometric nature which allows accurate approximation. McGregor offers better functional outcome in terms of lip movement and oral incontinence.

A Rare Case of Glial Choristoma Arising from the Vomer in Association with Cleft Palate.

Heterotopic neuroglial tissue represents normal glial tissue in an abnormal location distant from the central nervous system. It is a rare congenital condition and the majority of these lesions are diagnosed at birth or early childhood. We report a rare case scenario of a growth arising from the vomer associated with cleft palate. The origin of a glial choristoma from the midline of the nasal cavity in association with a cleft palate has not been reported in the literature. Complete surgical excision was performed prior to palatoplasty with no postoperative complications or evidence of recurrence.

Modification of LeFort I Osteotomy for Correction of Severe Maxillary Cant Associated With Fibrous Dysplasia.

Differential superior reposition of maxilla following LeFort I osteotomy in the correction of maxillary cant poses a greater challenge especially when associated with the pathology like fibrous dysplasia which completely obliterates the antrum. Purpose of this paper is to highlight the modification of LeFort I osteotomy and hypothesis is to assess its difficulty index in modifying the standard steps, in executing the maxillary separation at various to correct the gross facial asymmetry to achieve a favorable outcome. Multiphased management involved scrupulous clinical planning, advanced imaging by computed tomgraphy scans, stereolithographic models to debulk the lesion. The second phase included pre surgical orthodontic evaluation along with correction of severe maxillary cant adopting a modified LeFort 1 osteotomy technique and standard bilateral sagittal split osteotomy, thereby simultaneously attaining functional stability and esthetic harmony.

Xanthogranulomatous Cholecystitis Mimicking Gall Bladder Cancer: a Diagnostic Dilemma and Review of Literature.

Xanthogranulomatous cholecystitis (XGC) is one of the rare variants of chronic cholecystitis which is characterized by inflammation of gall bladder along with infiltration by acute and chronic inflammatory cells. Intramural accumulation of lipid laden macrophages in GB wall is the hallmark of the disease. XGC results in dense adhesion of gall bladder (GB) to surrounding structures, like duodenum, colon, and stomach. The intense GB inflammation results in gall bladder perforation and development of fistulous communication between gall bladder and surrounding structures. This may also lead to formation of inflammatory mass which closely mimic gall bladder malignancy. Often differentiation from carcinoma of GB (Ca GB) on the basis of clinical presentation and even on intra-operative and radiological findings is difficult, and the issue could only be resolved on final Histopathology (HPE). We review presentation and investigation of a patient, discuss our approach in managing dilemma in treating such cases of XGC, and review the literature.

Does Pectoralis Major Myocutaneous Flap Cause the Shoulder Morbidity: A Clinical Comparative Study.

The aim was to compare the morbidity of shoulder function following modified radical neck dissection with and without Pectoralis Major Myocutaneous muscle flap (PMMC) harvest in head and neck cancer patient to determine the effect of PMMC flap harvest on shoulder function and also to determine the effect of physiotherapy. Materials and methods: Prospective study involving two groups study group of 20 patients with MRND, with PMMC flap reconstruction as part of head and neck cancer surgery and control group of 20 patients who had undergone MRND(IJV & SAN sparing) without PMMC flap in same period were included. All patients were assessed at 3rd and 6th month following completion of surgery using subjective (Shoulder Disability Questionnaire) and objective (goniometer and manual muscle testing) parameters. 40 patients were included in the study, 33 (82.5%) male and 7 (17.5%) female with a mean age of 49 years with stage III/IV carcinoma In Group-1 and Group-2 the shoulder disability decreased significantly after physiotherapy intervention and also at 6thmonth postoperatively both groups showed improvements in shoulder range of motion and muscle strength. Harvesting of PMMC flap does not intensify the morbidity of shoulder which is common in RND and during MRND. A regimen of home-based exercises and patient education are effective tools to reduce shoulder disability and improving shoulder function.

Acantholytic variant of squamous cell carcinoma in the mandible: A rare entity and a brief review.

Acantholytic Squamous Cell Carcinoma (ASCC) is an uncommon histopathologic variant of Squamous Cell Carcinoma which occurs in the sun-exposed skin and rarely in the oral cavity. Although the World Health Organization (WHO) has defined ASCC as a unique entity, its occurrence in the oral cavity has been just about 60 cases in the literature. There have been cases reported in the lips, tongue, gingiva and maxillary alveolus but rarely in the mandible. Definitive diagnosis and treatment of such a rare condition is challenging as there are not much available data in the literature. We report a rare case of Acantholytic Squamous cell carcinoma with pathologic fracture of the mandible which was managed aptly considering its hostile clinical, radiological and histological presentation. The reconstruction was done using a vascularised free fibula graft which helped in achieving a functional and aesthetic rehabilitation for the patient thereby improving his quality of life.

Immunoexpression of claudin-4 and correlation with estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2-neu in breast cancer.

Background: Claudins are important transmembrane proteins in tight junction. The role of intercellular tight junctions in breast epithelial cells is traditionally thought to be in maintaining polarity and barrier function. However, claudin-4, a tight junction protein, is overexpressed in breast tumor cells compared to normal epithelial cells, which generally corresponds to loss in polarity and can provide valuable information about biology of the tumor. A prospective clinical study was conducted to assess the expression claudin-4 in patients with breast cancer and its correlation with hormone receptors - estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2)-neu. Materials and Methods: The study included 102 biopsy-proven breast carcinoma patients. The biopsy samples were evaluated immunohistochemistry for expression of ER, PR, HER2-neu, and claudin-4. The expression of claudin-4 was correlated with ER, PR, and HER2-neu. Results: In the study, we found that out of 26 cases of high claudin-4, 25 cases (96.15%) were ER negative and P < 0.001, which was significant. Similar results were found with PR-negative cases. Whereas, out of 76 cases with low claudin-4, 54 cases (71.05%) were HER2-neu negative and P = 0.022, which was significant. Conclusions: Claqudin-4 expression has a negative correlation with ER and PR and has a positive correlation with HER2-neu. Hence, it can be effectively utilized as a prognostic and therapeutic marker in breast cancer in the future.

Comparison of arterial to end-tidal carbon dioxide gradient P (a-ET)CO2 in volume versus pressure controlled ventilation in patients undergoing robotic abdominal surgery in the Trendelenburg position. A randomised controlled study.

Background and Aims: Robotic surgery is increasingly prevalent as an advancement in care. Steep head-down positions in pelvic surgery can increase the ventilation-perfusion mismatch and increase ventilatory requirements to offset carbon dioxide (CO2) increases consequent to pneumoperitoneum. The primary objective was to assess the impact of two ventilatory strategies, volume versus pressure-controlled ventilation on the arterial to end-tidal carbon dioxide gradient P (a-ET)CO2 in patients undergoing robotic surgery in the Trendelenburg position. The effects on alveolar to arterial oxygen gradient P (A-a)O2, peak airway pressure (Paw), dynamic compliance (Cdyn) and haemodynamics were also assessed. Methods: Fifty-one patients, 18-75 y, American Society of Anesthesiologists I-III undergoing robotic surgery in Trendelenburg position were randomised to volume-controlled ventilation (Group VCV) or pressure-controlled ventilation (Group PCV). The P (a-ET)CO2 was measured at baseline T0, 10 min after Trendelenburg position T1, 2 h of surgery T2, 4 h T3 and at Te, 10 min after deflation. The P (A-a) O2, Paw, Cdyn, heart rate and blood pressure were also measured at the same time. Results: The P (a-ET)CO2 at T1, T2, T3 and at Te was lower in Group PCV versus Group VCV. The Paw was lower at T1, T2, and T3 and Cdyn higher at T3 and Te in Group PCV at comparable minute ventilation. Haemodynamics and P (A-a)O2 were comparable between the groups. Conclusion: Pressure-controlled ventilation reduces P (a-ET)CO2 gradient, Paw and improves Cdyn but does not affect P (A-a) O2 or haemodynamics in comparison to volume-controlled ventilation in robotic surgeries in the Trendelenburg position.

Grossly Depressed Frontal Bone Fracture in a Paediatric Patient: A Case Report.

This study highlights the management of a grossly depressed frontal bone fracture with obvious deformity in a paediatric patient as facial fracture management is frequently intricate and challenging, particularly within the paediatric population as compared to adult. Paediatric fractures have a greater capacity to remodel, but the paediatric brain and craniofacial skeleton are still developing which puts the children at risk for unique complications, such as growing skull fractures.

Phosphaturic Mesenchymal Tumor in the Maxillofacial Region: A Diagnostic Dilemma.

Oncogenic osteomalacia is a rare paraneoplastic syndrome and is associated with the presence of phosphaturic mesenchymal tumor (PMT) which results in renal phosphate wasting with hypophosphatemia. In total, 95% of cases reported in upper and lower extremities and in head and neck are a rare site for these tumors. Besides osteomalacia, the clinical presentation includes bone pain and multiple bone fractures. Only fewer cases of PMT are reported in the oral cavity. The presentation of this rare case in a young patient was palatal swelling mimicking like an abscess which was clinically and by advanced imaging evaluated and histopathological findings confirmed the rare presentation. Following the surgical excision, the serum level of FGF23 rapidly decreased, hypophosphatemia improved, and the clinical symptoms greatly improved. The result suggests that the overexpressed FGF23 primary tumor in the palate was the cause of osteomalacia which is a rare entity.

Correction to: Phosphaturic Mesenchymal Tumor in the Maxillofacial Region: A Diagnostic Dilemma.

[This corrects the article DOI: 10.1007/s12663-020-01496-8.].

Small secretory proteins of immune cells can modulate gynecological cancers.

Small secretory proteins of immune cells are mostly Cytokines, which include chemokines, interleukins, interferons, lymphokines and tumor necrosis factors but not hormones or growth factors. These secretory proteins are the molecular messengers and primarily involved in autocrine, paracrine and endocrine signaling as immunomodulating agents. Hence, these proteins actually regulate the cells of immune system to communicate with one another to produce a synchronized, robust, still self-regulated response to a specific antigen. Chemokines are smaller secreted proteins that control overall immune cell movement and location; these chemokines are divided into 4 subgroups, namely, CXC, CC, CX3C and C according to the position of 4 conserved cysteine residues. Complete characterization of cytokines and chemokines can exploit their vast signaling networks to develop cancer treatments. These secretory proteins like IL-6, IL-10, IL-12, TNFα, CCL2, CXCL4 & CXCL8 are predominantly expressed in most of the gynecological cancers, which directly stimulate immune effector cells and stromal cells at the tumor site and augment tumor cell recognition by cytotoxic T-cells. Hence; these secretory proteins are the major regulators, which can actually modulate all kinds of gynecological cancers. Furthermore, advancements in adoptive T-cell treatment have relied on the use of multiple cytokines/chemokines to establish a highly regulated environment for anti-tumor T cell growth. A number of in vitro studies as well as animal models and clinical subjects have also shown that cytokines/chemokines have broad antitumor activity, which has been translated into a number of cancer therapy approaches. This review will focus on the foremost cytokines & chemokines involved in the majority of the gynecological malignancies and discuss their basic biology as well as clinical applications.

Unusual Gigantiform Angiomatosis of Jawbone.

ABSTRACT: The purpose of this paper is to highlight rare highly infiltrative massive Angiomatosis and depict surgical outcome of a rare case series of gigantic lesions in the maxillofacial region. Data were recorded from the medical records of patients. Predictor variables were drawn from demographics, age, gender, site, evaluation of surgical treatment. The outcome variables were the challenges encountered and related complications. Out of 6 patients, the youngest was 10 and the oldest was 26 years old. Soft tissue and jawbone involvement were seen in 3 patients each with a single massive lesion involving both maxilla and mandible. All 6 patients had wide excision of the lesion with one patient having 2 stage procedures. No complications or recurrence was seen at 1-year follow-up. Angiomatosis is a rare and benign lesion in the head and neck region. its diffuse infiltrating nature may give a false malignant picture. it clinically mimics Hemangioma or Arteriovenous (AV) malformation thus requires thorough evaluation and its surgical intervention is challenging as described in this case series because of its magnitude and infiltrative nature.

Phase analysis of tungsten and phonon behavior of beryllium layers in W/Be periodic multilayers.

In periodic W/Be multilayers, thickness-dependent microstructural and phase modifications were investigated in W and Be layers. In X-ray diffraction, α-W was predominant for the ultrathin layer of W, while ß-W evolved along with the α-W phase for higher film thickness. For the thicker layers, the thermodynamically metastable ß-W vanished and a single well-defined preferably oriented stable α-W phase was observed. The lattice spacing revealed that these phases exist in the tensile stressed condition. With the increase in thickness of Be layers, the blueshift and narrow linewidth of the transverse optical (TO) phonon mode was observed in Raman scattering studies. However, the TO mode was redshifted and the linewidth was further narrowed consistently with an increase in the thermal annealing temperature of the multilayers. The investigation has quantified an increase in compressive strain and reduction of defects with an increase in thickness of the Be layers. However, for thermally annealed samples, the compressive strain in the Be layers was relaxed and crystalline quality was improved.