Diagnostic dilemma in maxillofacial pathologies: a case series.

BACKGROUND: Head and neck are a site of numerous pathologies with different aetiologies and presentations. Rare pathologies, although infrequent still do exist. Diagnostic dilemma in maxillofacial pathologies can be the most challenging situation. Dealing with uncertainty, although difficult, is a reality in surgical practice. Being thorough, attentive to details and clues, and maintaining an open mind are critical strategies in the approach to such a patient. CASE PRESENTATION: In our paper we are reporting a spectrum of 4 unusual variants of head and neck pathologies, whose age and sex were 52 years/ M, 37 years/F, 41 years/ F, 30 years/F respectively. All the patients were of Indian origin. The diagnosis ranged from autoimmune diseases to lymphatic cancer which posed a unique challenge both in the terms of diagnosis and management. CONCLUSION: A thorough systematic evaluation along with a multidisciplinary approach is mandatory in the diagnosis of unusual head and neck pathologies.

Knotless barbed suture versus conventional polydioxanone suture material for intraoral surgical incisions - A randomized controlled trial.

Purpose: To evaluate and compare the perioperative wound management and healing of intraoral surgical incisions between the conventional and knotless barbed Polydioxanone suture materials. Materials and methods: A Randomized Controlled Trial was conducted with well-constructed inclusion and exclusion criteria. 46 participants were allotted into the control and test groups based on a computer-generated randomization sequence. The materials used were 3-0 Stratafix™ knotless barbed PDS suture and conventional 3-0 Ethicon PDSTMII suture materials. Parameters assessed included intraoperative time taken for closure and assessment with Early Wound Healing Score (EHS) on postoperative day 1 and Landry, Turnbull, and Howley (LTH) Healing index on postoperative days 3 and 7. Statistical analyses were done using the Chi-square test and student's t-test with a p-value less than 0.05 indicating statistical significance. Results: 32 patients had surgical intervention for maxillofacial fracture management and 14 patient for orthognathic osteotomies. Surgical sites (n = 60) included maxillary and mandibular vestibules. Intraoperative closure time was better in the test group with statistical significance (p-value = 0.0472). The healing scores on the 3rd and 7th postoperative days were compared between the control and test groups exhibiting statistical significance favouring the test group. The p-values were 0.0479 and 0.0393 respectively. Conclusion: To conclude, our study concurred with the existing literature in terms of reduced operating time, and better wound healing observed with the knotless barbed suture. Along with statistical significance, all the variables exhibited clinical relevance and better wound management in the test group.

Classification of unusual fracture patterns of the mandible: A retrospective study.

The aim of this study is to devise and summarize a classification of fracture patterns involving multiple anatomical sites of the mandible. A retrospective study was conducted by reviewing clinical case records, imaging records, and the surgical management of patients presenting with mandibular fracture. Demographic data were collected and causes of the fractures were studied. Following radiological evaluations based on the courses of fracture lines, these fractures were categorized into three components: horizontal (H), vertical (V), and sagittal (S). In case of horizontal components, the mandibular canal was used as a reference. For vertical components, the fracture lines were classified according to where they terminated. With sagittal components, the direction of the bicortical split at the base of mandible was used as a reference. Out of a total of 893 mandibular trauma patients, 30 unusual fractures were identified (21 in males and nine in females), which do not fit into existing classifications. These were mainly due to road traffic accidents. Horizontal components of fractures were classified as H-I, H-II, and H-III, and vertical components as V-I, V-II, and V-III. For sagittal components, two types were identified - S-I and S-II - resulting in a bicortical split of the mandible. This classification is proposed to help understanding the complex fractures and to allow standardized communication among clinicians. Moreover, it is designed in such a way that aids in the choice of fixation technique. Further studies are needed to establish standardized treatment algorithms for efficient management of these unusual fractures.

Open Reduction Internal Fixation of Condylar Head/Diacapitular Fracture of Mandible: Case Series.

OBJECTIVE: Surgical management of condylar head is largely deferred due to the lack of appropriate armamentarium or instrumentation, restricted surgical access and risk of iatrogenic complications. Here we delineate open reduction internal fixation of condylar head fracture with various fixation modalities using specialized instrumentation for visualization and providing access for reduction with minimal complications. METHODS: A total of 21 patients were reported with condylar head fracture of mandible to the Department of Oral and Maxillofacial Surgery from January 2017 to June 2018. Three patients had bilateral condylar head fracture, making it a total of 24 fractures. All patients had clinical symptoms including deranged occlusion, limited mouth opening, jaw deviation and restricted mandibular movements. The radiological findings were dislocated or displaced condylar head medially or laterally. All patients were treated by open reduction internal fixation using lag screws or standard long screws. RESULTS: Among condylar head fractures, 19 of the study population were male and 2 were female. Distribution of age among the condylar head fractures ranges from 19 years to 40 years with the mean being 22 years. At the end of three-month follow-up, all patients had satisfactory results, both clinically and radiologically. The functional outcome of this study was found to be superior. CONCLUSION: We recommend open reduction internal fixation of condylar head for patients with high risk of ankylosis, and it is possible without complications due to the availability of minimally invasive surgical access system.

Effect of Heartfulness Meditation on Anxiety and Perceived Pain in Patients Undergoing Impacted Third Molar Surgery.

PURPOSE: Oral-maxillofacial surgical procedures like impacted third molar surgery (ITMS) may lead to increased perioperative anxiety and pain perception in patients. Psychological interventions like meditation have been shown to decrease acute anxiety levels in individuals. The purpose of this study was to investigate the effect of heartfulness (HFN) meditation during ITMS. We hypothesized that heartfulness meditation would reduce the intraoperative anxiety and pain perception in patients undergoing ITMS procedures. PATIENTS AND METHODS: The prospective interventional study included 60 participants. They were randomly assigned to heartfulness meditation group (26 participants) and control group (34 participants). The heartfulness meditation group was given meditation before their ITMS procedure. Perioperative anxiety and pain perception were assessed using the Spielberger State - Triat Anxiety Inventory (STAI - T, STAI - S), Modified Dental Anxiety Scale (MDAS) and Numerical Rating Scale (NRS). Descriptive statistics such as frequency, percentage, mean and standard deviation were used to describe the data. Inferential statistics such as Chi-square test, Unpaired T test and Pearson correlation were used to analyze the data. RESULTS: The heartfulness meditation group reported less intraoperative anxiety (STAI - S) compared to the control group which was statistically significant (P < 0.002). There was a positive correlation between triat and situational anxiety levels of the participants. There was no significant difference between the groups in relation to dental anxiety and intraoperative pain perception. CONCLUSION: A single session of heartfulness meditation was effective in reducing the intraoperative anxiety levels in impacted third molar surgery. However, its effectiveness in reducing dental anxiety and pain perception was not significant.

Sequencing of Fixation in Panfacial Fracture: A Systematic Review.

OBJECTIVE: In panfacial fracture management, the controversy still exists in the sequencing of fixation. The purpose of this systematic review is to establish the best sequence pattern which assists in achieving definite facial width, vertical height and anteroposterior projection. METHODS: The review was conducted according to the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA) guidelines. Two independent authors performed a comprehensive search of the PUBMED, EBSCO, J-Gate, SCOPUS and NDH for articles published up until December 2018. Sequence of fixation, timing of intervention, outcome, follow-up period and complications were evaluated for patients with panfacial fracture. RESULTS: In total, 202 articles were identified from the databases. After screening and full text analysis, 25 studies were included in this systematic review. Nineteen studies reported bottom-to-top sequence and two studies reported top-to-bottom approach. However, four studies reported both the approaches. The follow-up period ranges from 3 weeks to 4 years. CONCLUSION: Based on the literature support and evidence, good and satisfactory outcome achieved in "Bottom-top and outside-in" sequence when compared with other sequence pattern. Early repair of panfacial fracture is advised for proper reduction and fixation, but can be delayed in accompanying life-threatening injuries. Complications are perceptible in all the sequences; it can be avoided by definitive treatment planning and stepwise management.

Adsorption of Anionic Dyes Using a Poly(styrene-block-4-vinylpyridine) Block Copolymer Organogel.

An organogel was prepared by chemically cross-linking a poly(styrene-block-4-vinylpyridine) diblock copolymer using dibromododecane in dimethylformamide. Analysis of the prominent structure peak in small-angle X-ray scattering along with the results of light scattering and rheological profile suggests the bridging of the spherical micelles to one another to form an interconnected network after gelation. The use of this organogel as a selective adsorbent for removing anionic dyes from individual aqueous dye solutions and in a mixture of cationic and anionic dye solutions has shown more than 90% removal of the anionic dyes within 2 h. The regeneration and reusability studies showed that even after 20 cycles, the adsorption property of the organogel holds extremely well still beyond 90%. These results are indicative of the potential use of poly(styrene-block-4-vinylpyridine) organogel for the anionic ions removal in wastewater treatment.

Management of vascular malformations in the Oral and maxillofacial region: A systematic review.

OBJECTIVE: The purpose is to determine the comprehensive review and the current concepts on the management of vascular malformation and to evaluate the long term outcomes, recurrence and complication rate. METHODS: This systematic review followed PRISMA guidelines and registered in PROSPERO (CRD42020173735). The PUBMED, EBSCO, SCOPUS and NDH databases were used to perform a comprehensive search of articles published up until July 2020. The database search identified 1719 articles. After an intricate review, 34 studies were estimated for eligibility. RESULTS: A total of 1719 patients with mean age of 27.48 years were treated for vascular malformation in the oral and maxillofacial region. Moderate heterogeneity was observed for the outcome (P = 0.166; 95% CI:1.01-1.46, I2 = 48%). As determined by one-way ANOVA, there was no statistically significant difference between the type of diagnosis and the recurrence (F = 2.313, p = 0.092) and the complication rate (F = 2.112, p = 0.117). CONCLUSION: In accordance with the available scientific literature, this review has highlighted the modalities and advancement in the management of vascular malformations. Complications and recurrence were reported in all types of management. It can be avoided by careful diagnosis, pre-operative assessment and treatment planning.

Feasibility of Endoscopically Assisted Repair of Zygomatico-Maxillary Complex Orbital Fractures: Case Series.

AIM: To assess the feasibility and the outcome of endoscopically assisted repair of zygomatico-maxillary complex orbital fractures in a tertiary care hospital. MATERIALS AND METHODS: A descriptive study was carried out over a period of 2 years (01. 11. 2014-31. 10. 2016). 0°-4 mm endoscopes were used for intra-operative endoscopic exploration. Regular armamentarium for management of maxillofacial trauma along with standard plating systems was used. Commercially available medical grade titanium meshes were utilised for orbital floor reconstruction. RESULTS: Fifty-seven of hundred and twelve surgically managed zygomatico-maxillary complex fractures required orbital exploration. Twenty-one of these had reconstruction of the orbital floor. Endoscopically assisted exploration was performed in 10 of the 21; trans-nasally in three cases, the Caldwell-Luc approach was used in three cases, and in another three, the existing fracture in the anterior wall of the maxilla was utilised. In addition, an endoscopic trans-nasal-sphenoidal approach was opted for to access the orbital apex to manage fractured bone fragments that were impinging on the optic nerve in one of the patients. CONCLUSION: Endoscopes serve as the primary tool in minimally invasive procedures. They are yet to evolve as a major role player in the maxillofacial arena. The authors conclude that endoscopes are truly beneficial as an adjunct to existing techniques. They hold much promise for the future.

KIMURA'S Disease - An E[X]clusive Condition.

Kimura's disease is a rare autoimmune disease of unrecognized etiology. Due to its unspecific clinical presentation and laboratory studies, Kimura's is a diagnosis of exclusion . A systematic multidisciplinary approach is mandatory to rule out the other common causes of cervicofacial lymphadenopathy. A thorough Histopathological examination including immunohistochemical analysis along with the presence of specific biochemical markers, including raised Absolute eosinophilic count is necessary to conclude the diagnosis as Kimura's Disease. In this article we present a case of a middle aged Asian woman with cervicofacial lymphadenopathy with no associated illness. The above described protocol of clinical, radiological and histolopathological investigations was followed before establishing the final diagnosis of Kimura's. The review of literature on contemporary management and prognosis is discussed.

Investigations on the antiretroviral activity of carbon nanotubes using computational molecular approach.

Carbon nanotubes are the interesting class of materials with wide range of applications. They have excellent physical, chemical and electrical properties. Numerous reports were made on the antiviral activities of carbon nanotubes. However the mechanism of antiviral action is still in infancy. Herein we report, our recent novel findings on the molecular interactions of carbon nanotubes with the three key target proteins of HIV using computational chemistry approach. Armchair, chiral and zigzag CNTs were modeled and used as ligands for the interaction studies. The structure of the key proteins involved in HIV mediated infection namely HIV- Vpr, Nef and Gag proteins were collected from the PDB database. The docking studies were performed to quantify the interaction of the CNT with the three different disease targets. Results showed that the carbon nanotubes had high binding affinity to these proteins which confirms the antagonistic molecular interaction of carbon nanotubes to the disease targets. The modeled armchair carbon nanotubes had the binding affinities of -12.4 Kcal/mole, -20 Kcal/mole and -11.7 Kcal/mole with the Vpr, Nef and Gag proteins of HIV. Chiral CNTs also had the maximum affinity of -16.4 Kcal/mole to Nef. The binding affinity of chiral CNTs to Vpr and Gag was found to be -10.9 Kcal/mole and -10.3 Kcal/mole respectively. The zigzag CNTs had the binding affinity of -11.1 Kcal/mole with Vpr, -18.3 Kcal/mole with Nef and -10.9 with Gag respectively. The strong molecular interactions suggest the efficacy of CNTs for targeting the HIV mediated retroviral infections.

Screening of photosynthetic pigments for herbicidal activity with a new computational molecular approach.

There is an immense interest among the researchers to identify new herbicides which are effective against the herbs without affecting the environment. In this work, photosynthetic pigments are used as the ligands to predict their herbicidal activity. The enzyme 5-enolpyruvylshikimate-3-phosphate (EPSP) synthase is a good target for the herbicides. Homology modeling of the target enzyme is done using Modeler 9.11 and the model is validated. Docking studies were performed with AutoDock Vina algorithm to predict the binding of the natural pigments such as ß-carotene, chlorophyll a, chlorophyll b, phycoerythrin and phycocyanin to the target. ß-carotene, phycoerythrin and phycocyanin have higher binding energies indicating the herbicidal activity of the pigments. This work reports a procedure to screen herbicides with computational molecular approach. These pigments will serve as potential bioherbicides in the future.