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Background and aims: Proton therapy (PRT) for Head Neck Cancer (HNC), in view of the Bragg peak, spares critical structures like oral mucosa better than IMRT. In PRT, mouth-bites, besides immobilising and separating mucosal surfaces, may also negate the end-of-range effect. We retrospectively analysed the details and dosimetric impact of mouth-bites in PRT for HNC. Materials and methods: The data of consecutive HNC patients treated with IMPT from May 2020 to August 2022 were studied retrospectively. Details of the mouth-bite used, compliance and resultant mucosal separation were noted. Further analysis, restricted to previously unirradiated patients, comprised volumetric dosimetric data pertaining to the mouth-bite and distal mucosal surfaces. High LET zones, corresponding to 6-12 keV/micron, for mouth-bite doses above 30 Gy, were recalculated from existing plans. Results: A mouth-bite was used in 69 of 80 consecutively treated patients, ranging from 8 to 42 mm in thickness, and 12 to 52 mm in the resultant mucosal sparing. In 42 patients in whom the mouth-bite V 32 Gy was > 0, median Dmean, absolute V32, V39, V50 and V60 GyE (Gray Equivalent) of the mouth bite was 35.65 GyE (Range: 2.65 - 60 GyE), 10 cc (Range: 0.1 - 32 cc), 7.6 cc (Range: 0.1 - 30.8 cc), 5.7 cc (Range: 0.2 - 29.2 cc) and 1.45 cc (Range: 0.2 - 18.1 cc) respectively, all significantly more than the spared adjacent mucosal surface. In absence of a mouth-bite, the spared mucosa would have at least partially received the high dose received by the mouth-bite. High LET zones were noted in 12 of 48 mouth-bites. Conclusion: In PRT for HNC, mouth-bites play a vital role in improving the sparing of mucosa outside the target.
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INTRODUCTIONS: Understanding the factors influencing craniofacial structure growth is crucial for addressing craniofacial deformities. This study evaluates masseter muscle volume, activity, and maximum bite force across different skeletal malocclusion groups and aims to evaluate the masseter muscle volume, activity, and maximum bite force (BF) according to different skeletal malocclusion groups. METHODS: This study aimed to assess masseter muscle volume, activity, and maximum bite force (BF) across different skeletal malocclusion groups in 60 young adults (18-30 years) seeking treatment at Kirikkale University Faculty of Dentistry. Cone-Beam Computed Tomography (CBCT) imaging, radiological measurements, surface electromyography (sEMG), and force sensor measurements were employed. RESULTS: Results revealed significant differences in sEMG measurements based on sagittal classification. Vertical direction groups showed notable results in muscle volume and BF, though no significant differences were observed in sEMG values. A correlation was identified between BF and sEMG, but no correlation was found between muscle volume and other parameters. CONCLUSIONS: The findings obtained in this study suggest that the significant relationship between EMG and sagittal skeletal classification could be a valuable diagnostic tool. However, concerns about reliability were raised due to uneven distribution in muscle volume and BF among vertical direction groups. The lack of significant results in muscle volume, sEMG, and BF was attributed to CBCT limitations in soft tissue imaging and the small sample size, emphasizing caution in interpreting the findings.
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We present the case of a 27-year-old man who sustained a bite wound from a stray dog found on the side of a highway. He had cleaned the wound well, hoping to avoid infection, but when it swelled and became red, he sought medical attention. The authors describe the management of cellulitis and prophylaxis for rabies and tetanus.
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Aligners became popular among adult patients for their superior aesthetics and comfort in comparison to conventional fixed appliances. It has undergone numerous enhancements over time, allowing it to address more complex malocclusions. Many researchers argued that managing vertical discrepancies is more challenging than addressing anteroposterior issues. This complexity arose from the mechanical requirements for treatment and the required mechanics to prevent relapse. Studies assessing the treatment outcome of anterior open bite closure using clear aligners have yielded conflicting results regarding the mechanisms of bite closure. Proposed mechanisms included extrusion of upper or lower incisors, lingual tipping of upper or lower incisors, intrusion of upper or lower molars, counterclockwise rotation of the mandible, or various combinations of these mechanisms. The research highlighted the biomechanical challenges associated with using aligners for the treatment of deep bites as mandibular incisor intrusion and leveling the curve of Spee remain among the least predictable movements. Given the widespread use of aligners, it is imperative to rigorously assess the effectiveness of clear aligners in achieving overbite correction to ensure they deliver the desired outcome. This review aimed to assess the performance of Invisalign in the management of vertical discrepancies. It sought to identify the dentoskeletal effects of clear aligners in addressing deep bite and anterior open bite cases, understand the mechanisms behind overbite correction, and provide a comprehensive overview of the existing research on this topic.
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OBJECTIVES: To assess the influence of Invisalign precision bite ramp use on skeletal deep overbite correction and root length and volume of maxillary anterior teeth. MATERIALS AND METHODS: This was a retrospective study of 60 adults with skeletal deep overbite. Patients were divided into three groups: Invisalign (Align Technology, San Jose, Calif) with precision bite ramps (Invisalign with Bite Ramps [IBR] = 12), Invisalign with no bite ramps (INBR = 22), and full-fixed appliances (FFA = 26). Cone beam computed tomography records at T1 (pretreatment) and T2 (posttreatment) were used to measure eight skeletal, nine dental, and three soft-tissue cephalometric variables. Maxillary anterior teeth root length (mm), root volume (mm3), and percent root volume loss between T1 and T2 (%) were also recorded. RESULTS: Significant changes from T1 to T2 among the three groups were seen in ANB(o), lower face height (%), ODI (overbite depth indicator) (o), and U1-SN (o). Reduction in root length was significantly less (P < .001) in the INBR and IBR groups compared to the FFA group. Reduction in root volume and percent volume loss were significantly higher in the INBR group compared to the IBR group (P < .001), but the difference between the two Invisalign groups and the FFA group was not significant. CONCLUSIONS: Skeletal deep overbite correction using Invisalign with or without bite ramps is comparable to FFA. Reduction in root length was significantly less with Invisalign compared to FFA. Bite ramps influenced root volume and volume loss but not root length.
Subject(s)
Cephalometry , Cone-Beam Computed Tomography , Overbite , Tooth Root , Humans , Retrospective Studies , Female , Male , Adult , Tooth Root/diagnostic imaging , Cephalometry/methods , Overbite/therapy , Cone-Beam Computed Tomography/methods , Young Adult , Maxilla , Orthodontic Appliance Design , Orthodontic Appliances, Fixed , Orthodontic Appliances, Removable , Incisor/diagnostic imagingABSTRACT
Many factors need to be considered when selecting treatment protocol for surgical correction of skeletal open bite deformities. In order to achieve stable long-term results, it is essential to explore the origin of the open bite, including dysfunction of the temporomandibular joint, tongue and compromised nasal breathing, in addition to the skeletal deformity. Recurrence of skeletal open bite is associated with relapse of the expanded transverse width. Three-dimensional virtual planning allows different treatment options to be explored and final decisions to be made together with the orthodontist. This study presents a treatment protocol for predictable and stable widening of the maxillary transverse width over the long term, involving premolar extraction and rounding and shortening of the upper dental arch by advancing the molar segments. The stability of inter-canine, inter-premolar, and inter-molar distances, as well as overjet and overbite, were measured in 16 patients treated with this technique; measurements were obtained pre- and post-surgery, and the mean follow-up was 43 months. Orthodontic treatment was designed digitally and finished with robotically bent wires (SureSmile), which allowed exact planning of the overall treatment, thus making orthognathic surgery more predictable for the patient. The changes in transverse width were significant and stable over time.
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Premature loss of first permanent molars is a common occurrence in clinical practice, leading to abnormal occlusion and inefficient mastication for patients. This case report presented the orthodontic retreatment of a 32-year-old female patient who suffered from premature loss of mandibular bilateral first molars. The mesial tipping of the mandibular second molars led to an occlusal interference, resulting in a clockwise rotation of the lower jaw and an anterior open bite (AOB). We achieved long-distance molar mesialization using clear aligners with Albert cantilever arms. After 42 months of treatment, the patient's occlusion and facial profile significantly improved. The cantilever combined with the cleat aligner treatment has been clinically effective for the protraction of mandibular posterior teeth, extending the field of application of clear aligners.
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Dog-bite injuries are common in the facial and neck areas of pediatric patients on account of their size. The incidence of dog-bite etiology for facial fractures in Mexico is unknown as they are underreported. We present a case of a pediatric patient with facial fractures due to dog-bite injuries. We describe the patient's surgical management with absorbable plates and its aftermath and engage in a literature review of dog-bite facial fractures. The patient demonstrated generally favorable results, with minimal postsurgical sequelae. The use of absorbable plates leads to positive outcomes in pediatric patients with dog-bite-related facial fractures.
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Key Clinical Message: Abscess at a previous surgical site induced by an insect bite has rarely been reported. Here we report a case of abscess at the breast surgical site, which occurred 7 years after mastectomy following an ant bite. Abstract: Surgical site abscess generally occurs following operation within 30 days. However, surgical site abscess induced by an insect bite, which occurs several years after surgery, has rarely been reported. Here, we report a 65-year-old female patient with a history of breast cancer presenting with an abscess at the site of her mastectomy and ipsilateral arm lymphedema. Her left foot was bitten by an ant 25 days earlier and itchy red bumps with whiteheads were raised. After antibiotic treatment and abscess incision and drainage, the abscess healed, but the ipsilateral arm lymphedema persisted. This unique case demonstrates that surgical procedures can alter the susceptibility of tissues to allergic or infectious cues long after the operation.
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BACKGROUND: The literature is unclear about how the different attachment systems for overdentures impact the maximum bite force, the masticatory efficiency and how this impact in the oral health self-perception in patients. OBJECTIVE: To evaluate the effect of two attachment systems (O-ring and Locator) for mandibular overdenture using single implant on quality of life, maximum bite force (BF) and masticatory efficiency (ME). METHODS: Twenty-eight completely edentulous denture wearers with a mandibular symphysis implant were randomly selected and allocated into two groups in a crossover study, considering O-ring and Locator attachment types. The quality of life and self-perception of oral health were assessed using the Oral Health Impact Profile (OHIP-Edent) and Geriatric Index of Determination of Oral Health (GOHAI) questionnaires, respectively. BF was measured using a gnathodynamometer and ME by chewing silicone cubes and almonds in different numbers of cycles. RESULTS: There was no difference between the attachment systems about self-perceived oral health and impact on quality of life (p > .05). The O-ring-type system obtained a significantly higher BF than the locator-type system (p = .04). Regardless of the food chewed, no statistically significant difference was observed with the type of attachment (p > .05). The ME was directly proportional to the masticatory cycles only for almonds (p < .01). CONCLUSIONS: Locator and O-ring inserts had a similar impact on patients' quality of life, self-perception of oral health and ME. Additionally, the O-ring system exhibited superior properties in the BF.
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The most prevalent oral habit and one of the most often habitual behavioral patterns in preschool-aged children is thumb-sucking. This behavior is crucial to the development of malocclusion and must be addressed carefully since it may cause a secondary tongue thrust that worsens the issue. Developing an effective treatment plan requires determining the underlying cause, which may include psychological, physiological, and or anatomical factors. Overall prevention of behavior needs to be planned for successful outcomes. One such device for treating tongue-thrusting and thumb-sucking habits is the palatal crib. The present case shows the possible effectiveness of palatal crib use in conjunction with myofunctional therapy for a child whose diagnosis involves habitually holding the tongue low and sucking the thumb that causes an anterior open bite (AOB). An 11-year-old boy with flared and spaced upper and lower incisors also had an AOB. Myofunctional therapy was combined with palatal cribs to help the tongue reposition itself and discourage the habit of sucking. The AOB was successfully corrected with an appropriate overjet and overbite after a total of three months of treatment.
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This study delves into the rare occurrence of rhabdomyolysis induced by wasp stings, emphasizing its toxic systemic repercussions. Drawing parallels with documented instances of insect bites worldwide, including those by honey bees and Africanized bees, the research explores the correlation between multiple wasp stings and acute renal failure associated with rhabdomyolysis. The venom's active components, such as amines, kinins, and histamine-releasing peptides, underpin toxic systemic reactions, leading to hemolysis, coagulopathy, and severe cytotoxicity-induced acute renal failure. Noteworthy is the emergence of blackish necroses at the sting site, suggesting intense cytotoxicity. The study also highlights skin necrosis as a prognostic indicator for toxic systemic reactions. The presented case manifests an anaphylaxis-like reaction, revealing insights into toxic responses devoid of IgE-mediated allergic reactions. Timely intervention, encompassing hydration, transfusion, and dialytic support, proves imperative in scenarios involving multiple wasp stings, offering successful outcomes documented through plasma exchange in severe cases. This research prompts considerations beyond anaphylaxis, urging exploration of severe toxic systemic reactions in the context of multiple wasp stings.
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Introduction: The arrival date young patient's first orthodontic consultation is unrestricted but may influence the choice of treatment plan as well as its modalities. The objective of this study was to determine the factors that influence the date of the first consultation at the orthodontic office: advice from a third party or a health professional, the patient's gender, the socioeconomic level, the actual need for orthodontic treatment, and the vertical and anteroposterior skeletal dysmorphia. Materials and Methods: Young patient's file younger than 16 years were systematically included. A Wilcoxon and Kruskal-Wallis test was performed in univariate and multivariate analysis. The threshold was 5%. Results: 456 young patients were included. Anteroposterior skeletal discrepancy, referral by an acquaintance, and socioeconomic level appeared to be factors influencing patient arrival date. Gender, actual need for orthodontic treatment, referral from a health professional, and vertical skeletal discrepancy did not influence the arrival date at the office. Discussion: The date of consultation is not related to the actual orthodontic treatment need. Word-of-mouth seems to play an important role. Patients seem to relate an anteroposterior discrepancy to the need to consult an orthodontist, but do not relate it to vertical discrepancy, although ventilation may be related to severe dysmorphia. Conclusion: This study encourages more communication about orthodontic treatment indications with patients and caregivers.
Introduction: La date d'arrivée du jeune patient en première consultation orthodontique est libre mais peut influencer le choix du plan de traitement, ainsi que ses modalités. L'objectif de cette étude était de déterminer les facteurs qui influencent la date de première consultation au cabinet d'orthodontie : le conseil d'un tiers ou d'un professionnel de santé, le genre du patient, le niveau socio-économique, le besoin réel de traitement orthodontique, la dysmorphie squelettique verticale et antéro-postérieure. Matériels et méthodes: Les dossiers de jeunes patients de moins de 16 ans ont été systématiquement inclus. Un test de Wilcoxon et Kruskal-Wallis a été effectué en analyse univariée et multivariée. Le seuil retenu était de 5 %. Résultats: Au total, 456 patients ont été inclus. Le décalage squelettique antéro-postérieur, le fait d'être adressé par une connaissance et le niveau socio-économique semblent être des facteurs influençant la date d'arrivée du jeune patient. Le genre, le besoin réel de traitement orthodontique, le fait d'être adressé par un professionnel de santé, le décalage squelettique vertical n'ont pas d'influence sur la date d'arrivée au cabinet. Discussion: La date de consultation n'est pas liée au besoin réel de traitement. Le bouche à oreille semble jouer un rôle important. Les patients semblent faire le lien entre un décalage antéro-postérieur et la nécessité de consulter un orthodontiste, mais ne le font pas pour le décalage vertical alors que la ventilation peut être liée à des dysmorphies sévères. Conclusion: Cette étude encourage à communiquer davantage sur les indications de traitement orthodontique avec les patients et les soignants.
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Orthodontics, Corrective , Humans , Male , Female , Adolescent , Child , Orthodontics, Corrective/methods , Orthodontics, Corrective/statistics & numerical data , Referral and Consultation/statistics & numerical data , Time Factors , Malocclusion/therapy , Socioeconomic Factors , Dental Offices/statistics & numerical data , Orthodontics/methods , Orthodontics/statistics & numerical data , Sex FactorsABSTRACT
Background: Streptobacillus moniliformis is the primary causative agent of rat bite fever, an infectious disease transmitted through contact with rats through bites, scratches, or exposure to excrement. Before this report, only two instances of spinal epidural abscess (SEA) due to S. moniliformis infection have been documented. We present the case of a 76-year-old male who developed a cervical SEA secondary to S. moniliformis infection, requiring neurosurgical decompression of the spinal cord. Case Description: A 76-year-old male presented to the emergency department with bilateral shoulder and back pain, upper extremity weakness, left hip pain, and left thumb pain. He denied any recent exposure to pets or animals, and the initial workup did not yield the source of the infection. Enhanced magnetic resonance imaging of the cervical spine demonstrated C6-7 discitis/osteomyelitis and an associated ventral SEA, as well as discitis/osteomyelitis of the C2 vertebral body and C5-6 endplates. Subsequently, the patient underwent a C3-7 laminectomy and received a 6-week postoperative course of intravenous ceftriaxone, resulting in complete resolution of the abscess. Blood tests revealed the presence of S. moniliformis, which the patient attributed to potential rat exposure at his workplace. Conclusion: Identification and diagnosis of S. moniliformis infection requires a high index of suspicion. Neurosurgeons should consider this rare pathogen in the differential diagnosis of SEA to facilitate early detection, diagnosis, and surgical intervention, ultimately improving patient outcomes.
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AIM: This study aimed to identify pretreatment cephalometric variables as possible predictors of the mandibular length increase in Class II patients with mandibular retrusion, treated by means of the Bite Jumping Appliance (BJA). MATERIALS AND METHODS: Forty-three subjects (22 males and 21 females) with Class II malocclusion, treated with a BJA, were selected on the basis of the following inclusion criteria: full Class II molar relationship, Overjet (OVJ) ≥ 6 mm and a skeletal Class II malocclusion with mandibular retrusion at the start of the treatment (T0); cervical vertebral maturation stage 2 or 3 at time 0 (T0). The following mandibular structural features were measured on lateral cephalograms at time 0 and time 1 (15 months of treatment): the width and height of the mandibular symphysis and its width/height ratio, the width and height of the mandibular ramus and its width/height ratio, the antegonial notch depth and the Condilion-Gonion-Menton (Co-Go-Me) angle. Post-treatment changes were assessed by Pancherz's cephalometric analysis, evaluating the increases in mandibular length. A regression statistical model was used to test the association between morphologic variables and mandibular length changes. RESULTS: At T1, a significant increase in mandibular length (7.1 + 3.4 mm, p < .001) was measured. A significant negative association between the pretreatment Co-Go-Me angle and mandibular length change was found (p < .05). IMPA angle was negatively associated with mandibular length change. All the others morphological feature were not statistically related to mandibular length change. CONCLUSION: Co-Go-Me angle and IMPA angle at T0 can be used as predictors for mandibular response to the treatment with BJA.
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PURPOSE: Wild boar (Sus scrofa) has spread and colonized urban areas. The closer contact with humans can lead to wild boar-inflicted injuries. The objectives of this study are: 1) to systematically review the literature on wild boar-inflicted injuries; 2) to describe our wild boar-inflicted wound management protocol; and 3) to analyse the features, outcomes and complications of our case series. METHODS: First, a systematic search of the literature was performed using the PubMed (MEDLINE) electronic database. Then, our evidence-based wild boar-inflicted wound management protocol was described. Finally, a retrospective case series study including all the patients with wild boar-inflicted injuries attended in our Emergency Department (2020-2022) was analysed. RESULTS: Fourteen studies (twelve case reports and two case series) were selected for the literature review. Our case series included 34 patients: 50.0% of them presented superficial wounds and 38.2% penetrating wounds. Most of the wounds occurred in the lower limbs (71.9%). Following our protocol, 30.0% of the wounds were primarily closed, the 70.0% of the patients received antibiotics (92.3% in penetrating injuries) and the 26.7% received an antitetanic vaccine. Only one patient (2.9%) presented a complication. CONCLUSIONS: This study reports the first specific wild boar inflicted-wound management protocol, which led to a low complication rate. Open wounds affecting the lower limbs were the most common lesions. Care should be taken with penetrating tusk injuries. Wide-spectrum antibiotic and antitetanic treatments are recommended. Decisions on wound management should be taken case-by-case, while antirabies vaccination depends on the local status of the disease.
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Dog bites are a serious public health problem. A campaign by the Dog and Cat Management Board of South Australia was launched to increase awareness that any dog can bite as a first step in reducing the incidence of dog bites. The aims of this study were to 1) evaluate changes in attitudes to dog bites following the media campaign, and 2) provide baseline data on dog bites and attitudes to interactions with dogs to help target future campaigns. The media campaign 'Good Dogs Have Bad Days' was run from July to October, 2023, using TV, radio, billboards and social media. A cross-sectional survey was conducted pre- and post-campaign, including demographics and questions relating to interactions and attitudes to dogs. A total of n = 402 to the pre- and n = 404 responses to the post-campaign surveys were received, with most having owned a dog, living in metropolitan areas, and an equal split of males and females. Over one third (36-37â¯%) of dog owners and 25-29â¯% of non-dog owners had been previously bitten by a dog, although most did not require medical attention. Respondents were more likely to agree that any dog can bite if they recalled seeing the campaign, and less likely if they were male and had poor knowledge of the scenarios in which a dog might bite. Older respondents and those from lower socioeconomic areas believed dog bites were a more serious community issue than younger respondents from higher socioeconomic areas. Approximately 70â¯% of dog owners believed it was safe for strangers to approach their dog, 34-37â¯% allowed children or other people to pat their dog without permission and less than half separated their dog from visitors or delivery people. In contrast few of the non-dog owners allowed their children to pat a dog without the owner's permission and only 2â¯% allowed them to play with dogs without supervision. The results demonstrate a relatively short campaign was associated with increased agreement any dog can bite. The proportion of respondents who had been bitten by a dog affirms the importance of public health campaigns targeting dog attacks. Some behaviours, such as supervising dogs around children and keeping dogs separate from delivery people, had relatively low agreement from dog owners and may be targeted in future campaigns. Public awareness campaigns and ongoing education will help to increase safer interactions with dogs, but it will take time and commitment to achieve a result.
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Bites and Stings , Health Knowledge, Attitudes, Practice , Dogs , Animals , Bites and Stings/epidemiology , Bites and Stings/prevention & control , South Australia , Male , Female , Humans , Cross-Sectional Studies , Adult , Middle Aged , Young Adult , Health Promotion/methods , Adolescent , Aged , Public HealthABSTRACT
Infection from Coxiella burnetti causes Q fever that manifests with vague symptoms. We report a case of an individual admitted to the hospital with recurrent fevers with a history of multiple tick bites. Further workup revealed examination and laboratory findings consistent with Q fever endocarditis. Fevers resolved with doxycycline and hydroxychloroquine. Our case highlights that suspicion for Q fever should be maintained in patients presenting to the hospital with fevers of unknown origin for prompt recognition and appropriate treatment.
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Introduction: Snake bites pose a significant common public health concern, with more prevalence in rural areas. Compartment syndrome (CS) is one of the rare and severe manifestations of snake bite wherein venom-induced swelling within a closed anatomical compartment leads to increased pressure, which may result in ischemic damage to nerves and muscle. Antisnake venom and prompt fasciotomy is recommended for management of CS secondary to snake bite. Case details: Here, the authors report a case of 47-year-old female with Green Pit Viper bite on the left hand. Upon arrival to hospital, initial resuscitation measures were initiated. Six hours following the bite, there was severe pain on passive stretch and paresthesia. Ten vials of antisnake venom administration along with fasciotomy of hand and arm resulted in notable alleviation of pain and swelling. Eighteen pints of blood was transfused for coagulopathy and low hemoglobin. After continued care of wound and intensive physiotherapy, functional limb could be achieved. Discussion: Snake bite envenomation is one of the biggest hidden health crises with case fatality rate of 7.8% in the southern plains of Nepal. As in our case, snake bites commonly affect upper extremities, accounting for around two third of all cases. CS must be differentiated from acute swelling, which sometimes may be difficult. Surgical decompression is indicated in presence of signs and symptoms of CS, in case of resource limited setting. Conclusion: Multidisciplinary and prompt management with initial resuscitation, ASV administration, fasciotomy, and rehabilitative measures can save both life and limb in such cases.
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Mandibular continuity defects can result in varying degrees of cosmetic disfigurement. Restoration of form and function may require surgical reconstruction of the affected area. While surgical reconstruction may improve the overall prognostic outcomes for the patient, the definitive prosthetic phase can commence only after a substantial time lag for adequate hard/soft tissue healing. This interim phase often challenges the patient's masticatory ability. The traditional reconstruction of hemimandibulectomy defects has its own limitations. This case report describes the fabrication of a 3D-printed bite splint for a patient with limited mouth opening and significant malocclusion due to surgical over-correction. The prosthesis given served as an appliance to improve the masticatory ability of the patient.