Conservative Algorithm for the Treatment of Locally Aggressive Tumors: A Retrospective Study.

Background: Aggressive benign odontogenic neoplasms are a group of lesions that have the potential to grow to an enormous size resulting in bony deformities, locally aggressive behavior and have high recurrence rate. Ameloblastomas, keratocystic odontogenic tumors, etc., are included under this group of lesions. Treatment of these lesions is challenging owing to their particular characteristics including high recurrence rate, locally aggressive behavior, etc. Materials and Methods: A retrospective study was conducted in 40 patients who had undergone enucleation and open packing as treatment for benign aggressive neoplasms in the department of oral and maxillofacial surgery. Results: In the study, all the cases were followed up for a minimum of 5 years clinically and radiographically. Satisfactory bone healing was noted with no evidence of recurrence in all cases. Conclusion: Enucleation followed by open packing with iodoform is an excellent conservative modality with proven minimal rate of recurrences in 5-year period.

Comparative evaluation of post treatment CT scan and clinical parameters in open reduction and closed reduction treatment of condylar fractures.

Background: Mandibular fracture is the second most common fracture of facial bone, next to nasal bone. Twenty-five to forty percent of mandibular fractures involve the condyle. In the literature, there exists no consensus "gold standard" treatment for mandibular condylar fractures, and there is a continuing debate on whether condylar fractures should undergo closed or open reduction. Materials and Method: Twenty patients who had undergone open reduction and closed reduction treatment were included in the study. Clinically maximal interincisal opening, laterotrusive and protrusive movements, pain on mouth opening, malocclusion, chin deviation on mouth opening, facial nerve palsy, hematoma, infected implant, and bite force were evaluated after a minimum of 3 months postoperatively. Also, a postoperative CT is done to evaluate the anatomical position of fragment. Results: On evaluation of clinical parameters, both groups had comparable results. However, none of the patients in open reduction group had deviation of mandible from midline on mouth opening. Also, better anatomical repositioning is obtained in open reduction group. Conclusion: The results of this study suggest that the open reduction method is a better alternative to closed reduction in treatment of mandibular condylar fractures.

Intraosseous schwanomma: A rare case report.

Intraosseous schwanommas are benign tumors that arise from Schwann cells. They are common in soft tissues of the head and neck region. However, intraosseous schwanommas are rare accounting for less than 1% of all bone tumors. They commonly manifest as a swelling that is usually asymptomatic. They can be treated with simple enucleation and curettage with a low rate of recurrence and malignant transformation. Histopathology alone is insufficient for arriving at a definitive diagnosis. Immunohistochemistry plays an important role in such cases for correctly establishing and confirming the diagnosis. Here, we present a rare case of intraosseous schwanomma (neurilemmoma) of the mandible.

Analysis of Variation in Anatomy of Lower Limb Vasculature and Implications for Free Fibula Flap by Color Doppler Imaging.

Background: The free fibula flap (FFF) has proved to be an adequate adjunct tool in the reconstruction of defects following cancer ablation. Although various investigation tools in the past have been proved to be adequate to study the blood supply of the various trunks of arteries, for the survival of graft, the color Doppler flow study (CDF) can be done for the accurate examination of various perforators for the same in the lower limbs prior to its harvest. Materials and Methods: 40 patients were included in the study and were examined for free fibula flap tissue transfer via color Doppler study for the lower limb perforators. Results: In the study, the perforators that are musculocutaneous, septocutaneous and septomusculocutaneous were detected in 80 legs that were examined and all of them had adequate diameter to justify the fact that the graft can be taken for harvesting, except for only two cases where it was found that they were hypoplastic. Conclusion: CDF can be a reliable and informative tool in patients planned for free fibula tissue transfer. Also, the skin perforators can be mapped, so as to determine skin paddle inclusion.

Comparative Evaluation of Reconstructive Methods in Oral Submucous Fibrosis.

BACKGROUND: Oral submucous fibrosis is a chronic, progressive, scarring, precancerous condition of oral mucosa which on progression causes severe trismus. AIM AND OBJECTIVES: To compare and evaluate the efficiency of buccal fat pad, platysmal mucocutaneous flap, nasolabial flap, collagen membrane graft, split thickness skin graft and temporoparietal fascia in reconstruction of surgical defect created by excision of fibrous bands in oral submucous fibrosis. RESULTS: After 6 months of follow-up, the interincisal mouth opening was 40.0 mm in case of buccal pad fat, 24.5 mm in temporoparietal fascia flap group, 33.8 in collagen membrane graft group, 34.5 mm in platysma flap group, 34.7 mm in nasolabial flap group, 29.3 mm in split thickness skin graft. ANOVA statistical analysis for postoperative interincisal distance at various time intervals and between pre-, intra- and postoperative interincisal distances were carried out which showed the results were significant at p value < 0.05 in all groups. No postoperative complications were noted in buccal fat pad group, split thickness skin graft group and collagen membrane group. However, platysmal group had flap necrosis and temporoparietal flap group patients had to undergo a second debulking procedure after one month. CONCLUSION: From our study, we concluded buccal fat pad yields superior results with respect to postoperative mouth opening and related complications.

Autotaxin-LPA-LPP3 Axis in Energy Metabolism and Metabolic Disease.

Besides serving as a structural membrane component and intermediate of the glycerolipid metabolism, lysophosphatidic acid (LPA) has a prominent role as a signaling molecule through its binding to LPA receptors at the cell surface. Extracellular LPA is primarily produced from lysophosphatidylcholine (LPC) through the activity of secreted lysophospholipase D, autotaxin (ATX). The degradation of extracellular LPA to monoacylglycerol is mediated by lipid phosphate phosphatases (LPPs) at the cell membrane. This review summarizes and interprets current literature on the role of the ATX-LPA-LPP3 axis in the regulation of energy homeostasis, insulin function, and adiposity at baseline and under conditions of obesity. We also discuss how the ATX-LPA-LPP3 axis influences obesity-related metabolic complications, including insulin resistance, fatty liver disease, and cardiomyopathy.

Evaluation of Postoperative Sensory and Motor Deficit Following Craniomaxillofacial Reconstruction Using Bicoronal Flap: An Evaluative Study.

INTRODUCTION: The ideal surgical approach to treat craniomaxillofacial skeleton should provide maximum exposure of the facial skeleton, ensure less potential for injury to facial structures and allow for good cosmetic result. Several designs have been described such as hemicoronal, preauricular, lateral eyebrow, and bicoronal approach. Although the bicoronal flap gives superior long-term cosmetic results, it has a few disadvantages. We conducted this study to assess neurosensory disturbances and motor deficit following craniomaxillofacial reconstruction using bicoronal flap. MATERIALS AND METHODS: A prospective study was carried out in the Department of Oral and Maxillofacial Surgery, North Karnataka, India. Forty patients with craniomaxillofacial trauma requiring fixation of fracture or reconstruction were included in the study. Postoperative neurosensory evaluation is carried out at intervals of 1 week, 1 month, 3 months, and 6 months clinically using mechanoreceptive and nociceptive testing. RESULTS: Among 40 cases, 11 (27.5%) had postoperative paraesthesia affecting the supraorbital region; 9 (22.5%) of them had return of normal sensation within 6 months and 2 (5%) patients became normal after one year. Four patients had unilateral frontalis weakness on the right side for a period of 6 months. DISCUSSION: The bicoronal flap is a preferred approach for access to the craniofacial skeleton and orbit with minimal sensory and motor complications. However, before choosing the same, the advantage of raising such a wide flap should be weighted comparing the benefits and complications.

Spirometric indices in primary ciliary dyskinesia: systematic review and meta-analysis.

Primary ciliary dyskinesia (PCD) is a genetic, heterogeneous disease caused by dysfunction of cilia. Evidence is sparse and reports of lung function in PCD patients range from normal to severe impairment. This systematic review and meta-analysis of studies of lung function in PCD patients examines the spirometric indices of PCD patients and differences by age group and sex. We searched PubMed, Embase and Scopus for studies that described lung function in 10 or more patients with PCD. We performed meta-analyses and meta-regression to explain heterogeneity. We included 24 studies, ranging from 13 to 158 patients per study. The most commonly reported spirometric indices were forced expiratory volume in 1 s (FEV1) and forced vital capacity presented as mean and standard deviation of percent predicted values. We found considerable heterogeneity for both parameters (I 2=94-96%). The heterogeneity remained when we stratified the analysis by age; however, FEV1 in adult patients was lower. Even after taking into account explanatory factors, the largest part of the between-studies variance remained unexplained. Heterogeneity could be explained by genetic differences between study populations, methodological factors related to the variability of study inclusion criteria or details on the performance and evaluation of lung function measurements that we could not account for. Prospective studies therefore need to use standardised protocols and international reference values. These results underline the possibility of distinct PCD phenotypes as in other chronic respiratory diseases. Detailed characterisation of these phenotypes and related genotypes is needed in order to better understand the natural history of PCD.

Phosphine-mediated reaction of 3-methyl allenoate and isatins: a protocol for the synthesis of spirofuran oxindoles.

A facile synthesis of spirofuran oxindoles via phosphine-mediated reaction of 3-alkyl allenoate with isatins is presented.

A phosphine-mediated reaction of cyclic 1,2-diones and 3-alkyl allenoates: an efficient protocol for benzannulation applicable to the synthesis of polycyclic aromatic hydrocarbons.

A facile one-pot benzannulation strategy involving phosphine-3-alkyl allenoate zwitterions and cyclic 1,2-diones is described. The strategy is effectively utilized in the synthesis of fluoranthenes and benzo[a]aceanthrylenes with impressive photophysical properties. This is the first report on an intermolecular benzannulation using a 3-alkyl allenoate as a four carbon synthon.

Phosphine-mediated reaction of 3-alkyl allenoates and diaryl 1,2-diones: efficient diastereoselective synthesis of fully substituted cyclopentenones.

An efficient phosphine-mediated diastereoselective synthesis of substituted cyclopentenones from 3-alkyl allenoates and diaryl 1,2-diones is described.

A facile four component protocol for the synthesis of dihydropyridine derivatives.

An efficient one pot synthesis of dihydropyridine derivatives employing the transient zwitterions generated from aniline and allenoates is described.

Employing homoenolates generated by NHC catalysis in carbon-carbon bond-forming reactions: state of the art.

Homoenolate is a reactive intermediate that possesses an anionic or nucleophilic carbon ß to a carbonyl group or its synthetic equivalent. The recent discovery that homoenolates can be generated from α,ß-unsaturated aldehydes via N-Heterocyclic Carbene (NHC) catalysis has led to the development of a number of new reactions. A majority of such reactions include the use of carbon-based electrophiles, such as aldehydes, imines, enones, dienones etc. resulting in the formation of a variety of annulated as well as acyclic products. The easy availability of chiral NHCs has allowed the development of very efficient enantioselective variants of these reactions also. The tolerance showed by NHCs towards magnesium and titanium based Lewis acids has been exploited in the invention of cooperative catalytic processes. This tutorial review focuses on these and other types of homoenolate reactions reported recently, and in the process, updates the previous account published in 2008 in this journal.

NHC catalyzed transformation of aromatic aldehydes to acids by carbon dioxide: an unexpected reaction.

A facile NHC-mediated reaction of aromatic aldehydes with carbon dioxide leading to carboxylic acids is described. The present protocol is mechanistically important, and it can serve as a tool for the sequestration of carbon dioxide.

Novel nucleophilic heterocyclic carbene mediated stereoselective conjugate addition of enals to nitrostyrenes via homoenolate.

A stereoselective Michael addition of homoenolate, generated from enals by nucleophilic heterocyclic carbene (NHC) catalysis, to beta-nitrostyrenes is reported for the first time. The products of this reaction obtained in good yields are of potential value in the synthesis of a variety of acyclic and heterocyclic compounds.