A Changing Trend in Pattern of Maxillofacial Trauma in Mumbai: A Prospective Study.

INTRODUCTION: Maxillofacial skeleton is the most vulnerable site for trauma due to its prominence. The aim of our study was to analyse the cause and pattern of maxillofacial injuries & to correlate the aetiology and pattern of facial injury. MATERIALS AND METHODS: This prospective study includes 304 patients with facial trauma, who reported to our institute within a time span of 2 years. Data were collected on basis of sociodemographic status plus additional data obtained on type of injury, aetiology, location and status of the victim. RESULT: The most frequent cause of maxillofacial trauma (MFT) was fall (43.3%) followed by RTA (34.2%) and assault (15.1%). In upper 3rd face region frontal bone fracture was prevalent with 1.3%, while in the midface, zygomatic complex (ZMC) fracture (3.9%) and in lower 3rd part of face, mandible fracture (42.8%) and dentoalveolar fracture (30.2%). Mandible was the most prevalent site for trauma. Although fall was the main aetiological factor in our study, midfacial injuries were mainly due to assault and RTA. Combination of mandibular fracture and soft tissue injury were mainly seen in RTA and injury due to fall. Conservative management was mainly employed for treatment with 46.1% followed by ORIF with 36.2%. CONCLUSION: Changing trend in aetiology of MFT was noted. Furthermore, study should be conducted for better understanding, and to carry out preventive measure for the same.

Giant Multilobular Lipoma of Neck - A Case Report.

RATIONALE: Presenting a rare case report of a giant multilobular lipoma in submandibular and submental spaces of anterior and lateral aspect of neck. PATIENT'S CONCERNS: The patient's main concern was persistent diffuse swelling in right lower face and neck region for 5-6 years. DIAGNOSIS: The lesion was diagnosed as multiple septate lipoma measuring 11.5 cm × 10.5 cm × 6.5 cm involving submandibular region and anterior triangle of the right neck following fine-needle aspiration cytology and radiological imaging. TREATMENT: Extraorally complete surgical excision was carried out through submandibular approach under general anesthesia. OUTCOMES: The patient's postoperative recovery was uneventful. The patient was followed up on a monthly basis for 6 months. No recurrence was observed. The patient was satisfied with the treatment. LESSONS: Lipomas should be considered as a rare differential diagnosis for anterior neck swelling. Biopsy is not necessary to confirm the diagnosis. Surgical excision remains the mainstay of treatment following final diagnosis through imaging modalities.

Retrospective analysis of Desmoplastic Ameloblastoma: Clinical review / Análisis retrospectivo del ameloblastoma desmoplásico: Revisión clínica

Background: Desmoplastic Ameloblastoma (DA) is a rare, true neoplasm of jaws with reported incidence of4-13% among other variants of Ameloblastoma, however this appears distinct than the classic Ameloblastoma inanatomical distribution and clinical presentation. This is often mistaken as a fibro-osseous lesion because of itssimilar radiological appearance.Material and Methods: To describe the clinical, radiographic and histopathological characteristics through a se-ries of new cases of histologically proven DA including a case of an exceptionally large, recurrent lesion alongwith retrospective analysis of cases from literature available for an improved understanding of the behaviour andprognosis of DA. A total of 50 cases were analysed for the anatomical distribution, radiographic presentation andmanagement. Out of the 50 cases, 47 cases were from the English literature reported from 2011 to 2019 and 3 werenew cases.Results: DA showed a slight male predilection (male: female=1.17:1) with a predominance in the fourth and fifthdecade of life. Mandibular involvement (52%) was more commonly seen with a marked tendency for the anteriorregion. Radiographically, most of the lesions presented mixed radiopacity with radiolucency(80%) and root dis-placement was observed in only 70.27 % cases. Recurrence rate of 26 .47 % was observed. Cases treated withresection resulted in lesser recurrence as compared to those treated with enucleation and curettage. Conclusions: DA is distinguished by a peculiar display of clinicalopathological parameters. DA has tendency of lo-cal disposition and propensity of recurrence, which thus necessitates its aggressive management. It is not possible toconclude or report on the aggressive/recurrent nature and appropriate treatment modality for DA due to inadequatefollow-up results.(AU)

Influence of platelet-rich fibrin on wound healing and bone regeneration after tooth extraction: A clinical and radiographic study.

AIM: The aim of the study was to evaluate the influence of autologous platelet-rich fibrin (PRF) on soft tissue healing and bone regeneration following tooth extraction clinically and radio-graphically. MATERIALS AND METHODS: 30 Patients between the age group of 18-40 years requiring extraction of bilateral mandibular molars except third molars were selected to conduct a split-mouth study after ethical approval. Teeth extraction was done on both sides in the same appointment. Autologous PRF was placed into the socket on one side randomly, and the socket on the other side was taken as control side. Parameters evaluated were soft tissue healing and bone regeneration. Soft tissue healing was evaluated on post-extraction day-3, day-7 and day-14 using healing index by Landry et al. Bone regeneration was assessed immediately and 4 months post-extraction by observation of change in radiopacity through digital panoramic-radiograph. Data obtained was statistically analysed and comparison of outcome variables was done using Mann-Whitney U-test, p < 0.05 was considered statistically significant. RESULTS: Case group had better soft tissue healing when compared to the control group with the p-value of 0.025 at 3rd day 0.039 at 7th day and 0.00 at 14th day. The rise in radiopacity at the end of 16th week for PRF group was higher as compared to control group but did not differ significantly. CONCLUSION: PRF is significantly better in promoting soft tissue healing and also hastens bone formation in extraction socket. PRF may be recommended as a valuable material for encouraging soft tissue healing and bone regeneration.

A Rare Case of Osteoclast-poor Osteopetrosis (RANKL Mutation) with Recurrent Osteomyelitis of Mandible: A Case Report.

Osteopetrosis (OP) is a group of rare genetic bone disorders. Osteoclast-poor form of osteopetrosis is much rarer in humans and represents a small percentage of the total cases of autosomal recessive osteopetrosis presenting with impaired bone remodeling due to defective osteoclastic activity and is characterized by distinctive increase in bone density and high bone fragility. Reduction in marrow spaces with decreased vasculature to the bone owing to increased bone mass makes the bones vulnerable for varied infections resulting in osteomyelitis. This case report discusses challenges in management of recalcitrant osteomyelitis of mandible developed as a complication in an 8-year-old girl child identified with rare, dual heterozygous mutations in RANKL (TNFSF11) gene and COL5A1 gene with uncertain significance responsible for osteoclast-poor osteopetrosis and Classic Ehlers-Danlos, respectively. HOW TO CITE THIS ARTICLE: Sharma A, Ingole SN, Deshpande MD, et al. A Rare Case of Osteoclast-poor Osteopetrosis (RANKL Mutation) with Recurrent Osteomyelitis of Mandible: A Case Report. Int J Clin Pediatr Dent 2020;13(6):717-721.

Dual Pathology of Mandible.

Aneurysmal Bone cyst (ABC)is a rare benign lesion of the bone which is infrequent in craniofacial region (12%). Rapid growth pattern causing bone expansion and facial asymmetry is a characteristic feature of ABC. Giant cell lesion is another distinct pathological entity. Here we present to you a rare case of dual pathology in an 11 year old female patient who presented with a large expansile lesion in the left hemimandible. All radiographic investigations were suggestive of ABC, aspiration of the lesion resulted in blood aspirate. However only after a histologic examination the dual nature of the lesion was revealed.

Use of Temporalis Fascia Flap in the Treatment of Temporomandibular Joint Ankylosis: A Clinical Audit of 5 Years.

AIM: Restoration of normal function and jaw movements in patients with temporomandibular joint (TMJ) ankylosis has been a challenge. Various techniques have been provided for its treatment; but the results have been variable. The purpose of this paper is to present an easy and versatile method for the treatment of TMJ ankylosis and to decrease postoperative complications such as reankylosis. MATERIALS AND METHODS: This paper is a review of surgical outcome of interposition arthroplasty with temporalis fascia in 17 patients of unilateral TMJ ankylosis who underwent the above procedure. The review is based on the pre-, intra- and post-operative evaluation of these seventeen patients who were treated between 2008 and 2013. The follow-up time was 1-5 years. RESULTS: Reankylosis was seen in only one of the patients; the remaining patients had satisfactory mouth openings. CONCLUSION: Surgical treatment of TMJ ankylosis with interposition of temporal fascia is an effective and easy procedure for prevention for reankylosis. The autogeneous nature and proximity to the joint are the main advantages of the temporal fascia flap when compared with other interpositional materials.

Solitary intraosseous neurofibroma: Report of a unique case.

Neural tumors located centrally in jaw bones are relatively rare compared with soft tissue neurofibromas. Less than 50 cases have been reported in the literature with a predilection for mandible. This article aims to elucidate a unique case of intraosseous neurofibroma of mandible in a 62-year-old edentulous female patient associated with facial asymmetry due to the swelling extending from the right body of mandible to left body of mandible. The uniqueness of this case is related to the age and extensiveness of this lesion. A review of clinical, radiographic, histological, and immunohistochemical features, and the surgical management pertaining to this case are discussed along with a review of the literature.

A prospective study evaluating efficacy of polymer free Pronova XR stent in treatment of denovo coronary artery stenosis.

BACKGROUND: Drug eluting stents have remarkably improved results of percutaneous coronary angioplasty. Most of the currently available drug eluting stents uses a durable polymer as drug carrier which has been implicated in local inflammatory response and continued incidence of late and very late stent thrombosis. The Pronova XR stent is one from those new generation polymer free sirolimus eluting stents in which pharmaceutical excipient is used for the timed release of sirolimus from the XR stent platform instead of a polymeric coating. METHODOLOGY: We consecutively recruited 121 patients undergoing elective or urgent PCI at our center. All the patients were followed up clinically and mandatory follow up angiogram at 6 months was done for one third of the total patients. An independent core lab analyzed paired angiograms. RESULTS: The primary efficacy endpoint was death, MI, TVR at 6 months which occurred in 6.66% patients. The QCA analysis showed reference vessel diameter of 2.5 + 0.44 mm at baseline and the minimal luminal diameter was 0.88 + 0.43 mm giving baseline diameter stenosis of 65.26 + 15.89%. The immediate post procedure in-segment diameter stenosis assessed was 23.68 + 8.96% which increased to 36.02 + 24.48% at follow up with a late lumen loss of 0.25 + 0.76 mm at mean of 191 days. CONCLUSION: Coronary angioplasty with polymer free Pronova XR stents results in acceptable late lumen loss and very low target lesion revascularisation at short and intermediate term in unselected patients.

Solitary Periosteal Osteoma of the Mandible: A case report.

Osteoma of the jaw bones is a rare entity with very few cases reported in the literature. Osteomas are benign, slow-growing osteogenic tumours of the bone commonly encountered in the craniofacial skeleton and characterised by the proliferation of compact or cancellous bone. They can be central, peripheral or extra-skeletal in their location. In the facial region, periosteal osteomas occur more frequently in the paranasal sinuses, but solitary periosteal osteomas of the jaw bones are quite rare. The mandible is more commonly affected than the maxilla, with the sites of predilection being the lingual aspect of the body, the angle and the inferior border. We report a case of a solitary periosteal osteoma on the buccal aspect of the mandible in a 42-year-old woman.