Evaluate the Effectiveness of Toluidine Blue for Obtaining Safe Margins in Resection of Oral Squamous Cell Carcinoma.

Aims: To evaluate the effectiveness of toluidine blue for obtaining safe margins in oral squamous cell carcinoma. Materials and methods: Intra-operatively irrigation of the lesion and its surrounding areas was done with toluidine blue solution for 20 s. Followed by irrigation with 1% acetic acid to remove all the mechanically retained stain. The unstained margins were demarcated using incision placed by no 15 BP blade. The lesion was resected with a safe margin of 1 cm away from the stained tissue. Neck dissection was done according to the nodal status. The tumor along with the resected margins was sent for histopathological examination. Statistical analysis was performed to calculate specificity of the vital stain. The cross tabulation between epithelium of the stained and unstained margins was done and subjected to Chi-square test to calculate the significance. Results: The toluidine blue vital stain has a sensitivity of 93.33%. Out of 15 cases, 2 patients recorded positive excision margins leading to recurrence at primary site; 1 patients recorded positive excision margins leading to recurrence at secondary site; 1 patient recorded free excision margins but had recurrence at secondary site; remaining 11 patients recorded free excision margins and did not have recurrence. Conclusion: Vital staining with toluidine blue is concluded to be specific in demarcating the dysplastic tissue adjacent to the carcinomatous lesion, which when excised along with the adjacent dysplastic tissue leads to a decrease in the recurrence in oral squamous cell carcinoma cases. Furthermore, it is inexpensive, easily available and does not add significantly to the operating time. Moreover, it provides a gross visualization of dysplasia surrounding the lesion especially in cases where in the margins are not well defined. Hence, toluidine blue can be a useful and inexpensive adjunct to identify margins intra-operatively in the current scenario where intra-operative frozen sections are not available.

Evaluation of Metastatic Lymph Nodes in Oral Squamous Cell Carcinoma: A Comparative Study of Clinical, FNAC, Ultra Sonography and Computed Tomography with Post Operative Histopathology.

All the head and neck tumours, more than 90% are squamous cell carcinomas (SCC). The presence of metastatic cervical lymph nodes histologically positive for SCC provides one of the simplest and most important prognostic factor in patients with head and neck cancer. In this study, all patients were examined clinically for, location, number, size, shape, consistency and fixation of cervical neck nodes to the underlying structure, and the same was carried out by FNAC, USG and CT. Findings of these modalities and histopathological results were compared for the overall metastases of lymph nodes in the neck. The accuracy of clinical examination was 87.77% and sensitivity only 41.66%. FNAC has the greatest specificity, 98.71% and least sensitivity, 33.33%. The accuracy of FNAC was 90%. The positive predictive value and negative predictive value of FNAC were 80.0% and 90.58% respectively. USG revealed 50% of sensitivity. Specificity of USG was 93.58% and accuracy 87.77%. CT scan have the highest sensitivity among all other tests, 66.66%.The negative predictive value for CT scan was also the highest, 94.59%. Specificity and accuracy of CT scan was 89.74% and 86.66% respectively. This study concludes that USG with FNAC is the most accurate in evaluating metastatic lymph nodes in oral squamous cell carcinoma patients along with other investigations like CT scan for staging of the oral squamous cell carcinoma.

Management of Sub-Condylar and Angle of Mandible Fracture by a Trans-Buccal Trocar Along With an Intra-Oral Approach.

To evaluate the management of sub-condylar and angle of mandible fracture by a trans-buccal trocar along with an intra-oral approach. Study parameters included were assessment of adequacy of anatomical repositioning, fixation and stability of fracture site by radiographs, pre and post - operative occlusion by photographs. Evaluation of anatomical repositioning was done with fracture gap measurement on orthopantomogram after 6 months by applying paired student's T test. In mandibular angle fracture, pre- operatively, the mean of anatomical repositioning fracture gap measurement on orthopantomogram was 4.06 mm with a standard deviation of 1.42 mm and 6 months post-operatively, the mean was 0.5 mm with a standard deviation of 0.32 mm. The P value was < 0.00001, which shows a very high significant. In sub-condylar fractures, pre- operatively, the mean of anatomical repositioning fracture gap measurement on orthopantomogram was 6.77 mm with a standard deviation of 3.54 mm and 6 months post-operatively, the mean was 1.57 mm with a standard deviation of 2.37 mm. As the sample size was small, P value could not be calculated. The use of the trans-buccal trocar provides adequate anatomical repositioning, fixation, stability, occlusion and good accessibility during placement of plate and screws.

GAPO Syndrome-A Rare Cause of Osteomyelitis of Jaws; Report of 4 Cases With a Brief Review of the Literature.

GAPO syndrome is characterized by growth retardation, alopecia, pseudoanodontia, and ophthalmic abnormalities. This very rarely reported syndrome affects various ethnic groups and can present with manifestations other than those usually reported. Pseudoanodontia is a rare clinical and radiologic manifestation that is always associated with GAPO syndrome. Osteomyelitis of the jaws is a less common disease that is usually attributed to odontogenic causes. This case report describes osteomyelitis of the mandible in a patient with GAPO syndrome. Further, an additional 3 cases of GAPO in the patient's family, with special emphasis on oral mucosal changes and pseudoanodontia, are discussed.

Lugol's iodine identifies dysplastic tissue in precancerous lesions: A clinical trial.

INTRODUCTION: Intraepithelial dysplasia, or "invisible" precancerous lesions, provides a challenge for visualization to the surgical team. The prognostic relevance of dysplasia and carcinoma in situ at surgical margins is well documented. MATERIALS AND METHODS: We evaluated the use of Lugol's iodine in visualizing the surgical margins of dysplastic tissue by an observational study of 100 patients having oral precancerous lesions between June 2013 and March 2016. CONCLUSION: Lugol's iodine is a simple, inexpensive, and apparently effective means of diagnosing and visualizing the surgical margins of the dysplastic tissue in oral precancerous lesions.

Parotid angiofibroma.

Angiofibromas are rare, benign, locally invasive vascular tumors, which represent 0.05-0.5% of all head and neck tumors. Most frequent site of occurrence is the posterior nasopharynx, called as nasopharyngeal angiofibromas (NA), when these arise outside the nasopharyngeal region they are termed as extranasopharyngeal angiofibromas (ENA). Only 65 cases of ENA have been reported, and the most common site has been reported to be maxilla followed by ethmoids. Other unusual sites of occurrence reported so far in literature are nasal cavity, nasal septum, larynx, sphenoid sinus, pterygomaxillary fissure, infratemporal fossa, cheek, oropharynx, retromolar area, middle turbinate, inferior turbinate, and tonsil. ENA arising from the superficial lobe of parotid gland has not been reported in the literature so far and this case is the first to be reported.

Ultrasound guided drainage of submasseteric space abscesses.

BACKGROUND AND OBJECTIVES: The objective of this study was to evaluate the usefulness of ultrasound guided surgical drainage in submasseteric space abscess of odontogenic origin without incision. MATERIALS AND METHODS: Eleven patients (4 males and 7 females) aged 18 to 36 years were included in this study. Each patient had clinically and radiologically diagnosed submasseteric space abscesses of odontogenic origin. All the patients underwent ultrasound guided drainage by using 5.7 MHz B-mode, gray scale, ultrasound scanner. The aspirated pus was sent for microbiological culture and sensitivity tests. All the patients were given a prescription of antibiotics like Amoxicillin with Clavulanate in a dose of 625 mg 8 hourly daily, Metronidazole 400 mg 8 h daily and analgesic Diclofenac potassium in a dose of 50 mg 8 h daily. Infection was considered resolving when the following criteria were met like ceased or minimal drainage. RESULTS: There was successful resolution of abscess in 10 cases, 1 case underwent incision and drainage because of spread of infection to other spaces. CONCLUSION: This study on 11 cases supported ultrasonography as an intraoperative aid in the assessment of the abscess cavity and its real-time imaging facility will help in the location and drainage of the abscess cavity effectively. It avoids large, unsightly, postoperative facial scars and often eliminates the need of general anesthesia and hospitalization.

Parapharyngeal ganglioneuroma of hypoglossal nerve in a 4 year old girl: a rare case report.

Parapharyngeal ganglioneuroma of hypoglossal nerve is very rare benign tumor arising from sympathetic nervous system producing mass and functional effect. We present a rare case in 4 year old girl with history of swelling and odynophagia in left side of neck. Extensive clinical, immunohistochemistry, and imaging of the swelling confirmed the diagnosis of ganglioneuroma after surgical excision.

Use of amnion as a graft material in vestibuloplasty: a clinical study.

The need to cover the exposed periostium has meant that a number of materials including mucosal and skin grafts are regarded as suitable for grafting in oral and maxillofacial surgery. To circumvent the disadvantages of other materials such as skin, biological membranes have been suggested as options, including fetal membrane. The objective of the present study was to evaluate the clinical efficacy of amnion as a graft material for vestibuloplasty, to increase the depth of the sulcus for complete rehabilitation with dentures in 10 patients with a follow up period of 3 months. Ten patients with deficient depth of the mandibular vestibular sulcus who were referred from the Department of Prosthodontics were listed for mandibular labial vestibuloplasty using Clark's technique followed by grafting with amnion over the denuded periostium. The vestibular depth was evaluated at the end of the 1st week, 2nd week, 4th week, and 3rd month postoperatively, and compared with the preoperative vestibular depth. We had no cases of graft necrosis either complete or partial. However, the reduction in the depth of the labial vestibule ranged from 17% to 50% after 3 months' follow up. A mean (SD) labial vestibular depth of 13.3 (1.8)mm was achieved immediately postoperatively, and 10.0 (3.1)mm at 3 months' follow up. We conclude that grafts of amniotic membrane are viable and reliable for covering of the raw surface, prevent secondary contraction after vestibuloplasty, and maintain the postoperative vestibular depth.

Advancement genioplasty--cephalometric analysis of osseous and soft tissue changes.

BACKGROUND: Genioplasty is often performed to esthetically improve patient's profiles in the lower facial third. Many factors account for the variability in soft tissue response like dissection technique, magnitude and direction of movement and stability of the genial segment. Optimum treatment planning thus requires an understanding of the soft tissue response to various genial procedures. AIMS AND OBJECTIVE: To determine the stability, ratio of hard and soft tissues and changes in the lower facial profile after advancement genioplasty. MATERIALS AND METHODS: Ten patients were evaluated cephalometrically for the soft tissue changes in relation to hard tissues after advancement genioplasty. Pre operative, immediate post operative and 6 months post operative lateral cephalogram were taken. Pre operative tracings were superimposed with post operative cephalograms to produce a composite tracing. Changes in the osseous tissues are assessed and related to the net changes in the soft tissues. RESULTS: The ratio of horizontal changes of osseous to soft tissues was found to be 1:0.89. The mean resorption was 0.85 mm (10.7%). The vertical changes are minimal and non significant. There are significant changes in the soft tissue profile such as decrease in the soft tissue thickness, facial convexity angle, lower facial submental angle and increase in mentolabial sulcus depth. CONCLUSION: The standard advancement genioplasty procedure by inferior osteotomy of the chin with broadest musculo-periosteal pedicle with rigid internal fixation was followed. The soft tissue response is almost equal to the bony movement. The stability of the hard tissues is good with minimum amount of resorption so as to achieve more predictable results.

Reconstruction of large cranial defect with alloplastic material (bone cement-cold cure polymethyl-methacrylate resin).

A 40-years-old male patient reported to our department with a chief complaint of persistent palatal fluid discharge and large depressed forehead defect. He gave a history of trauma 20 months back due to head on collision to electric pole and underwent surgery twice for open reduction and fixation of facial skeletal fractures. After 9 months of surgery again a third surgery was performed for the removal of frontal bone due to infection and osteomyelitis at the same site. Extra-oral examination revealed a large fronto-cranial defect extending from superior border of frontal bone to supra-orbital margins bilaterally in length, and from frontal right lateral to frontal left lateral side in width, measuring 8.0 cm in length, 10.5 cm in width and 1.5 to 2.0 cm in depth. Intra-oral sinus fluid discharge was from left posterior palatal region. Preoperative CT was taken and reconstruction of fronto-cranial defect was successfully performed with bone cement. Alloplastic implant reconstruction achieved an excellent esthetic result without any complications.

Cervical lymph node metastasis in oral squamous carcinoma preoperative assessment and histopathology after neck dissection.

BACKGROUND: The presence or absence of nodal metastasis has a great impact on the prognosis and survival of patients with head and neck cancer. The risk of occult metastasis is related to the method by which the lymph nodes are evaluated. It is possible to reduce the risk of undiagnosed metastasis with accurate imaging techniques and thus probably reduce the number of elective neck treatments. AIMS AND OBJECTIVES: To assess the accuracy of clinical palpation, CT Scan, Ultrasound and Ultrasound guided FNAC in prediction of lymph node metastasis in oral squamous cell carcinoma so that a suitable surgical neck dissection can be carried out. METHODS: Ten patients with oral squamous cell carcinoma who underwent 10 neck dissections (4 RND, 6 SOND) were included. All the patients underwent examination of neck pre operatively by palpation, Computed Tomography with contrast, Ultrasound and Ultrasound guided FNAC for no detection. The findings were correlated with the results of histopathologic examination of the neck specimen. The results were obtained after statistical analysis. RESULTS: Six neck dissection specimens showed metastatic lymph node involvement in postoperative histopathology. Lymph node involvement was identified preoperatively by palpation in 7 necks, CT in 3 necks, US in 9 necks and USFNAC was positive in 4 cases. The palpation showed 83% sensitivity, 50% specificity. CT showed sensitivity of 50%, specificity of 100%, US showed sensitivity of 100%, specificity of 25% and US-FNAC showed sensitivity of 67%, specificity of 100%. CONCLUSION: The palpation, CT Scan and US are equally accurate but the USFNAC is the most accurate technique in assessing metastasis in lymph nodes in patients with oral squamous cell carcinoma.