Osteomyelitis of Jaw Bone due to Aspergillosis in Post-COVID-19 Patients: An Observational Study.

Background: In the second wave of COVID-19 pandemic, there has been an increase in number of cases with Post-COVID-19 fungal osteomyelitis of jaws. Aspergillosis was found to be one of the causes of osteomyelitis of jaw bones in these patients. Aim: To evaluate the incidence and pattern of osteomyelitis of jaw due to aspergillosis in post-COVID-19 patients and to discuss the management protocol of the same. Method: Data were obtained at our institution from the period of January 2021 to June 2021. Patients of all age groups with Post-COVID-19 osteomyelitis of jaw due to aspergillosis and those with combined aspergillosis and mucormycosis infection were included. Patients having rhino-orbito-cerebral fungal infection were excluded. Results: A total of 47 patients reported to our center. Demographically the average age of the patients was 49.11 years with 72% being males. All 47 patients (N = 100%) had received steroids. 21 of them (N = 44.7%) had diabetes mellitus and 14 (N = 29.8%) patients had other comorbidities. Out of 47 patients, 42 (N = 89.7%) patients were diagnosed with aspergillosis and the remaining 5 (N = 10.3%) cases had a mixed fungal infection of mucormycosis and aspergillosis. On fungal culture Aspergillus flavus was the most common species detected followed by Aspergillus niger and Aspergillus fumigatus. All patients were treated with oral Voriconazole and local surgical debridement. Prompt laboratory testing such as a timely KOH mount, galactomannan test, beta-D-glucan test, histopathology of tissue specimens could help to give an early and definitive diagnosis. The mortality rate we encountered in this study was nil. Conclusions: Early and definitive diagnosis and immediate initiation of antifungal drug therapy and surgical intervention will significantly reduce the rate of morbidity and mortality.

Management of bilateral condylar agenesis by distraction osteogenesis: a rare case report.

Condylar agenesis is a rare case involving developmental disturbances related to growth of mandible, facial aesthetics, dentition development, muscle deformation, and occlusal problems. As such, this is a rare condition, and there is no internationally accepted protocol for the same. Underdevelopment or defective formation of condyle may be congenital or acquired. Condylar agenesis is congenital non formation of condyle, while hypoplasia is poor development. We report a case of bilateral condylar agenesis in a 30-year-old female patient.

Evaluation of maxillary alveolar ridge formation and ridge continuity after secondary alveolar bone grafting using cancellous and cortico-cancellous bone graft in unilateral cleft alveolus using cone beam computed tomographic scan - a randomized controlled trial.

PURPOSE: The aim of present study was to compare and evaluate the maxillary alveolar ridge formation and ridge continuity using cancellous and corticocanellous bone graft harvested from anterior iliac crest for complete secondary unilateral cleft alveolus defects. MATERIAL AND METHOD: All patients were randomized into two groups for secondary alveolar bone grafting. Group I (n = 10) patients treated with cancellous particulate bone graft and group II (n = 10) patients treated with cortico-cancellous block graft. Maxillary alveolar ridge bone formation was assessed with the help of cone beam computed tomography (CBCT) scan using Planmeca Romexis Viewer 5.0 software. Maxillary alveolar ridge continuity was assessed with axial section of CBCT scan and clinical occlusal photograph. Preoperative CBCT scan and occlusal photographs were compared with post-op 6-month CBCT scan and occlusal photographs. RESULT: The mean preoperative volume of cleft defect in group I was 4.2576 cm3 whereas in group II it was 4.2268 cm3. The mean postoperative bone bridge formation after 6 months in group I was 4.055 cm3 whereas in group II it was 3.8103 cm3. Preoperative and 6-month postoperative axial sections of CBCT scans were compared and 100% maxillary alveolar ridge continuity was achieved in both groups. The preoperative and postoperative occlusal photographs of both the groups were compared and showed accurate bone and well aligned maxillary alveolar ridge formation in all patients. CONCLUSION: The present study concluded that maxillary alveolar ridge formation rate is less in cortico-cancellous iliac crest block graft compared to cancellous iliac crest particulate graft, but is equally good as cancellous bone graft. CLINICAL TRIAL REGISTRATION NO: (REF/2020/09/031605)/ CTRI/ 2020/09/028001.

Comparison of Two Types of Patient Specific Implants (PSI) and Quad Zygoma Implant (QZI) for Rehabilitation of Post-COVID Maxillary Mucormycosis Defect (PCMMD): Finite Element Analysis.

Introduction: The residual post-COVID maxillary mucormycosis defect (PCMMD) were extensive, due to unilateral or bilateral maxillectomies. The Goal of rehabilitation of PCMMD is to deliver a prosthetically driven reconstruction. FEA was to evaluate the biomechanical response of PSI struts (PSI 1), PSI Screw retained (PSI 2) and QZI to masticatory load on virtual simulation to improve accuracy and enhance the design. Aim: To validate and compare the Biomechanical benefit of the PSI struts, PSI Screw retained, QZI in a case of rehabilitation of post-COVID maxillary mucormycosis defect (PCMMD) by FEA study. Methodology: The result of stress to masticatory load on virtual simulation for (1) Maximum and minimum stress (Von Mises stress); (2) the Displacement (in three positions) and (3) the Deformation (Plastic strain) was compared on virtual simulation for PSI 1 and PSI 2 and QZI. Conclusion: The FEA and comparative evaluation of PSI 1, PSI 2 and QZI showed a good resistance to displacement. The stress and strain values are low and acceptable. In comparison QZI shows more stress in the anterior region.

A Comparative Volumetric Assessment of Cancellous and Cortico-Cancellous Bone Graft in the Management of Unilateral Alveolar Cleft Defect using Cone Beam Computed Tomographic Scan-A Randomized Controlled Trial.

Introduction: The most commonly preferred procedure for surgical correction of alveolar bone defect and restoration of bony contour is anterior iliac crest graft. Since the ancient time, cancellous bone graft is considered as a gold standard, but it has a high resorption rate and many other disadvantages, and hence we conducted this study to evaluate the efficacy of Cortico-cancellous bone graft harvested from anterior iliac crest to find out whether it can be used as a substitute for cancellous bone graft or not. Aims & Objectives: The objectives of present study were to compare and evaluate the bone bridge formation rate, resorption rate, and uptake of bone graft at recipient site using cancellous and corticocanellous bone graft harvested from anterior iliac crest for complete unilateral cleft alveolus defects. Patients and Method: Total 20 patients were divided into two groups by lottery method of randomization. Each group comprises of total 10 patients treated with cancellous bone graft in group 1 and corticocancellous bone graft in group 2 patients harvested from anterior iliac crest. Preoperatively and postoperatively CBCT scans were taken for each patient to calculate the volume of cleft defect and volume of newly formed bone after 6 months, respectively. Grafting fill rate was calculated and mean graft filling rate observed in the patients of group 1 was 1.14 ± 0.03, and in patients of group 2, it was 1.17 ± 0.03. The mean bone bridge formation rate observed in the patients of group 1 was 91.85 ± 0.81 and in patients of group 2 it was 87.89 ± 0.75. The mean bone resorption rate obtained in the patients of group 1 was 18.74 ± 0.42 and in patients of group 2 it was 16.87 ± 0.52. Conclusion: The present study concluded that accurate estimation of the amount required for bone grafting in the alveolar cleft can be performed by CBCT scan data using Planmeca Romexis viewer version 5.0 software. Even though the corticocancellous bone graft has some drawbacks, it is equally good as cancellous bone graft because of its less resorption than cancellous bone graft and can be considered as a second best option for secondary alveolar bone grafting.Clinical trial registration no (REF/2020/09/031605)/(CTRI/2020/09/028001).

Clinical outcome following conservative treatment of 58 mandibular ameloblastoma patients: a retrospective study.

The aim of this study was to retrospectively analyze the surgical outcome of the patients with mandibular ameloblastoma (MA) with intact inferior cortex and the lingual cortex of the mandible, treated with conservative management in the form of enucleation with peripheral ostectomy, mechanical curettage, chemical cauterization, dredging, and marsupialization. The patients were included with the diagnosis of MA between the age group of 14 to 60 years with their computed tomography (CT) scans showing intact inferior cortex and the lingual cortex of the mandibular walls. Out of 96 cases of ameloblastoma, 58 (61%) were in mandible and 38 (39%) cases in maxilla. We analyzed these 58 patients retrospectively which were operated conservatively between January 2009 and December 2018. The treatment protocol for all the solid variants and the unicystic variants with intact buccal, inferior, and the lingual cortex was enucleation with peripheral ostectomy followed by mechanical curettage, chemical cauterization, and subsequent dredging. This was performed in 90% (n = 52) cases, whereas the treatment protocol for unicystic variants with perforated buccal cortex and intact inferior and lingual cortex was marsupialization followed by the enucleation with peripheral ostectomy, mechanical curettage, chemical cauterization, and subsequent dredging which was performed in 10% (n = 6) cases. Chi square test was applied to the effectiveness of conservative management as outcome variable. The new bone formation along with bony trabeculae was found in 96.6% (n = 56) of the cases. Recurrence was noted in 3.44% (n = 2) of the cases. A p value was 0.001, thus suggesting statistically highly significant result. On the basis of present study, though we can conclude that the MA with the intact inferior and the lingual cortex can be managed effectively with conservative treatment with long term regular follow up, still we would caution that the reader must use their best clinical judgement based on latest available data. For some patients, returning to clinic frequently and undergoing multiple minor procedures may not be suitable to be considered the best, whereas resection and reconstruction may be deemed more appropriate.

Outcome of Open Surgery in Disease Progression of Post-COVID Rhinomaxillary Mucormycosis Treated by Functional Endoscopic Sinus Surgery and Proposed Evaluation Scale for Maxillary Sinus Disease and Osteomyelitis.

Introduction: Rhinomaxillary Mucormycosis (RMM) is a condition peculiarly seen as post-COVID-19 opportunistic infections with Maxillary Sinus Disease and Osteomyelitis (MSDO). The open method of debridement and closed method are two types of surgical modalities available. There is no scoring method for this infection in maxilla. This paper aims to study the clinical and CT-based outcome of open versus closed surgery of MSDO in post-COVID-19 RMM and propose a new scoring method to evaluate the disease severity, progression as well as recovery. Material and Methods: Symptomatic cases of RMM (n = 17) with a history of closed surgical treatment were enrolled for this prospective clinical study. These cases were then treated by medicinal and open surgical method. The clinical and CT scan outcomes were compared by proposed new scoring method.The CT-based score for Maxillary Sinus Disease (MSD) and Maxillary Osteomyelitis (MO) from pre-FESS (CT1), Post-FESS (Preoperative, CT2), and Post-operative (CT3) were compared for both right and left sides. One-way ANOVA test and post HOC tests were used for statistical evaluation. Conclusion: The open method of maxillary sinus surgery has given significant improvement in the treatment of RMM already treated by a closed endoscopic approach. Supplementary Information: The online version contains supplementary material available at 10.1007/s12663-022-01803-5.

Zygomaticomaxillary Osteomyelitis due to COVID-19 Associated Mucormycosis (CAM): A Case Series of 10 Patients.

Aim: To highlight the incidence of osteomyelitis due to CAM and to elucidate the mode of spread of infection from maxilla to zygomatic bone, to highlight how that is distinct from other cases of zygomatic osteomyelitis due to other etiologies. Methods: A standard protocol of treatment of the cases of CAM with zygomatic involvement based on our own outcomes was furnished. All 10 patients were treated with dual antifungal therapy and aggressive surgical resection via extraoral approach, in conjunction with functional endoscopic sinus surgery (FESS). Results: Ten out of 116 patients of CAM reporting to our institute presented with zygomatic bone involvement with an incidence rate averaging at 8.6%, whereas in previous literature osteomyelitis of zygomatic bone was extremely rare with an incidence pattern of just 1.42%. Conclusions: The treatment protocol followed by the authors gave good outcomes to all patients treated, with no mortalities.

Anti-fungal therapy: An overview for maxillofacial surgeons in post-covid-19 fungal infections.

India is well known as the diabetes "capital" of the world but now it is also becoming the mucormycosis "capital" of the world. Indian Council of Medical Research has formed an "Evidence-Based Advisory in The Time of COVID-19 on Screening, Diagnosis, and Management of Mucormycosis." As per this advisory, an oral and maxillofacial surgeon forms an integral part of the team dedicated to fight this epidemic of mucormycosis. Also, there are other fungal infections such as aspergillosis which are getting reported in these patients affecting the paranasal sinuses and the jaws. Aggressive surgical debridement and a thorough knowledge of anti-fungal therapy are must in treating these fungal infections. The aim of this article is to give an overview on the available anti-fungal therapy required to manage the ever-increasing rise in fungal infections faced by maxillofacial surgeons in post-COVID-19 patients.

Prevalence of oral neurofibroma in Central Indian population: A retrospective study of 20 years.

CONTEXT: Neurofibroma is a benign peripheral nerve sheath tumor. Commonly found in the peripheral soft tissues, it can manifest as a solitary mass or as a component of neurofibromatosis. AIMS: The purpose of the retrospective cross-sectional study was contributing to the literature by providing data about the prevalence of oral neurofibroma in Central Indian population. SETTINGS AND DESIGN: Retrospective, cross-sectional study. SUBJECTS AND METHODS: All histopathologically diagnosed cases of oral neurofibroma were retrieved from the archives of our department and were reviewed. All the cases that met the inclusion criteria were reviewed in terms of the year when the patient reported, patient's age, gender, location of the lesion, i.e., soft tissue or intraosseous, clinical appearance, i.e., growth or swelling, histopathologic diagnosis and immunohistochemistry results if available. The results were aggregated and described qualitatively using Microsoft Excel 2013. RESULTS: In our retrospective analysis of 20 years (2000-2019), we came across 14 reported cases of oral neurofibroma, in five males and nine females. Two of these cases showed a recurrent nature and one case showed transformation into atypical neurofibroma. Two cases were encountered in the mandible as an intraosseous oral neurofibroma. CONCLUSIONS: In our study, we found that oral neurofibroma was more common in the third decade with a female predilection. Gingiva was the most common site. Of the 14 cases that were encountered, two cases showed recurrence and one case showed malignant transformation. Hence, in spite of being a benign neoplasm, oral neurofibroma is locally aggressive and should be diagnosed accurately.

Qualitative assesement of newly formed bone after distraction osteogenesis of mandible in patients with facial asymmetry using 3 dimensional computed tomography.

INTRODUCTION: Distraction osteogenesis is a surgical technique of new bone formation between the osteotomized bone segments with the help of gradual incremental traction. As distraction osteogenesis is slow biologic process, soft tissue changes gradually follow the new bone formation. Mandibular distraction is one of the accepted modalities to treat the triad of TMJ ankylosis, obstructive sleep apnoea & micrognathia and also for facial asymmetry cases like hemifacial microsomia, mandibular hypoplasia etc. After the distraction osteogenesis, some relapse has been noticed in patients. Therefore, this study was conducted to assess the quality of the newly formed bone after distraction osteogenesis of mandible using 3 dimensional computed tomography (3DCT Scan) to evaluate its relation with relapse if any. OBJECTIVES: 1) To objectively analyse the quality of bone formed after mandibular distraction osteogenesis.2) To observe the site & architecture of newly formed bone after distraction is complete. MATERIAL AND METHODS: Total 5 patients of facial asymmetry reported to the Department of Oral and Maxillofacial Surgery were enrolled. Distraction osteogenesis of mandible was carried out in all the patients. Radiographic analysis (CT Scan) was done after 1 year of surgery for further planning and management of deformity. The non-distracted site was considered as a control side and it was compared with newly formed bone at distraction site. The standard & universally accepted radio density measuring Hounsfield Unit (HU) in 3DCT scan was calculated in axial,coronal, sagittal sections from distraction site and it was compared with non-distraction site, as Hounsfield unit is considered as a standard tool for measuring the bone density to evaluate the quality as well as quantity of newly formed bone. RESULTS: The total mean Hounsfield Unit of distracted site of all three sections was 359.8 HU and non-distracted site was 545.2 HU. Statistical analysis was carried out using students paired ttest and p value was obtained which was <0.01 suggestive of statistically significant difference between the quality of bone in distracted site and non-distracted site. CONCLUSION: The findings of our study concluded that the quality of bone formed after distraction osteogenesis was satisfactory but it was less mineralized with less dense trabecular pattern compared to non-distracted bone region of mandible which leads to some relapse. Therefore it was advisable to reinforce the distracted bone segment by cutting the activation arm of distractor itself or mini plate or reconstruction plate to prevent relapse.

Comparative assessment of osteotomy cut using bur and saw for bilateral sagittal split osteotomy of mandible: a prospective clinical study.

PURPOSE: To compare the intraoperative utility of bur and saw and to examine the pattern of lingual split during bilateral sagittal split osteotomy of mandible. MATERIAL AND METHODS: This study prospectively compares the intraoperative utility of bur and saw in bilateral sagittal split osteotomy as split-mouth model. Study includes 16 patients (representing 32 sagittal split osteotomies) divided into two groups. The procedure to be performed was explained to the patient, followed by written informed consent. The institutional ethical committee approved the clinical study and all subjects gave informed consent. RESULTS: We found that the ease of handling of the bur was good compared to saw. The duration required for completion of osteotomy using bur was less compared to saw. CONCLUSIONS: The use of surgical drills and burs is still the gold standard in most developing nations and countries in transition like India. Depending upon the expertise of the surgeon, availability of precise dissecting instruments, one can go with either of the instrument for BSSO.

Reconstruction using sternocleidomastoid muscle flap versus posterior belly of digastric muscle flap compared with no reconstruction following superficial parotidectomy.

INTRODUCTION: The most common complications following superficial parotidectomy are formation of contour deformity and development of Frey's syndrome. Multiple modalities are being used to prevent these complications. We hereby intend to compare the reconstruction modalities (sternocleidomastoid (SCM) muscle flap, posterior belly of digastric (PBD) muscle flap) with) No reconstruction (NR) following superficial parotidectomy. MATERIALS AND METHODS: A comparative study was designed which included 15 patients requiring parotidectomy. These patients were divided into three groups viz. SCM, PBD, and NR. The functional outcome (facial nerve involvement, Frey syndrome, ear lobule sensation, neck movements) and the esthetic results were evaluated subjectively and objectively. The outcomes were statistically evaluated using chi-square test and ANOVA test. RESULTS: Facial nerve palsy occurred in 2 cases in each group, and all of them recovered completely within 6 months. The Minor starch iodine test was positive in 1 patient in the SCM group, in 2 patients in the PBD group, and in 4 patients in the NR group; only 1 patient of PBD group and 3 patients of NR group complained of gustatory sweating. Neck movements were unaffected in the PBD and NR groups; however, 1 patient complained of mild discomfort and pain during neck movements in the SCM group. CONCLUSION: Primary closure showed the worst results regarding cosmetic deformity. Hence, it is recommended to mandatorily reconstruct the defect. However, the sternocleidomastoid muscle flap is a better cosmetic option compared with posterior belly of digastric muscle flap. In cases with larger defects, a combination of both the flaps can be used. SCM flap also lowers the incidence of Frey syndrome objectively and subjectively with no reported hazard of the spinal accessory nerve and mildly affected neck movements.

Efficacy of Prednisolone Mouthwash in Management of Grade III Oral Submucous Fibrosis: A Newer Drug Regimen.

INTRODUCTION: This clinical randomized controlled trial evaluates the effectiveness of prednisolone mouthwash as a treatment modality for moderately advanced cases of oral submucous fibrosis. MATERIALS AND METHOD: Sixty-four patients were enrolled for the study and randomized into two groups (n = 32 in each group). The experimental group was treated with prednisolone mouthwash and antioxidant capsule as per GDCH Nagpur protocol, and control group was treated with antioxidant capsule only. The primary outcome variables were interincisal mouth opening, burning sensation, and recurrent ulceration. Clinical responses were obtained at the time of the allocation, at 1, 3, 6, and 9 months into the intervention, and 6 months thereafter. RESULTS: The average increased mouth opening achieved was 10.46 mm (p < 0.5) in group A (experimental group) and only 1.04 mm (p < 0.5) mm in group B (control group). In addition, there was a significant difference in relief of burning sensation and recurrent ulceration. Relief of burning sensation and recurrent ulceration was within 12.81 and 10.93 days, respectively, in group A when compared to group B which was within 21.56 and 20.06 days, respectively. CONCLUSION: We conclude that in our trial, prednisolone mouthwash with antioxidants was seen to be efficacious, safe, and reliable in the management of oral submucous fibrosis.

Utility of tooth as an autogenous graft material in the defects of alveolar cleft - A novel case report.

Reconstruction of the alveolar cleft is very important for providing both aesthetic as well as functional benefits to the patients with cleft lip and palate. The autogenous iliac crest is the most widely used bone graft in SABG procedures. There are very few published studies in the literature where tooth as an autogenous graft is used in dentoalveolar defects. Through the medium of this article, we present a novel idea of the tooth as a graft in a 20-year-old male patient with bilateral cleft alveolus. Grafting of the bilateral cleft alveolus was done by using an autogenous graft from the teeth which were indicated for extraction. The patient was monitored at 1-week, 1-month, and 6-month intervals postoperatively. On the Bergland scale, the bone graft of Type I was seen on the right side as the interdental bone level was normal and Type II was seen on the left side as the interdental bone level was greater than three-quarters of normal height. The result of this report proves that autogenous tooth graft is equally effective as compared to the other options available today. The postoperative complications are also minimal with no donor site morbidity.

Subjective Overload and Psychological Distress among Dentists during COVID-19.

Psychological distress during the COVID-19 pandemic is not solely limited to SARS-CoV-2 infection. It may also be related to social, cultural, and environmental factors, which may act as additional stressors. The aim of the current study was to explore the association between psychological distress and subjective overload among dentists in different countries, and whether it is associated with COVID-19-related factors. A cross-sectional survey was conducted among 1302 dentists from China, India, Israel, Italy, and the UK, who filled out demographics data, COVID-19-related factor questions, subjective overload, and psychological distress scales. Our findings showed that the positive association between subjective overload and psychological distress was different among countries, suggesting higher rate of intensity in Italy compared to China, India, and Israel (the UK was near significance with China and Israel). The interaction variable of the subjective overload × psychological distress was significantly associated with a particular country, with those individuals reporting fear of contracting COVID-19 from patients, fear of their families contracting COVID-19, and receiving enough professional knowledge regarding COVID-19. Given the above, dentists were found to have elevated levels of subjective overload and psychological distress, which differed among the countries, presumably due to certain background issues such as social, cultural, and environmental factors.

Simultaneous Placement of Endosseous Implants in Free Fibula Flap for Reconstruction of Mandibular Resection Defects.

Functional reconstruction of the jaw defect due to tumor resection poses a challenging problem in maxillofacial surgery. Large bone defects in the mandible due to ablation for tumors may generate a series of problems, as far as function and esthetics of the patient is concerned. The use of free bone flaps for mandibular reconstruction has the obvious advantage of being a well vascularized tissue that can withstand the hostile environment of the oral cavity. Fibular bone presents favorable conditions for implant-supported prosthetic rehabilitation, due to its diameter and the good quality of its cortical bone. The outcome of current study supports the use of simultaneous placement of endosseous implants in free fibula flap for reconstruction of mandibular resection defects with better clinical, aesthetic, and functional outcomes.