Fibromatosis with aggressive demeanor: Benign impersonator of malignancy.

Fibromatosis or desmoid fibromatosis is a rare benign neoplasm and develops commonly in the abdominal wall, abdominal cavity, or extra-abdominal sites. The mainstay of treatment is surgery. Chemotherapy and radiotherapy are preferred in cases of inoperable/relapse or a multifocal disease. Hereby, we report a case of fibromatosis arising in the left popliteal fossa, proven by histopathology and immunohistochemistry. Local excision of the mass was performed. The patient was asymptomatic for 6 months, after which she complained of difficulty in walking. Clinical evaluation elicited recurrence in the surgical bed. In spite of the surgical excision with tumor-free margins, recurrence was seen within a span of 6 months. 18F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) was done to rule out multifocal disease and to define the extent of relapse. Although magnetic resonance imaging provides an excellent soft-tissue resolution to delineate the disease, 18F-FDG PET/CT is an important and supplementary tool which aids in the management of fibromatosis.

Neocondyle distraction osteogenesis in the management of temporomandibular joint ankylosis: Report of five cases with review of literature.

INTRODUCTION AND OBJECTIVES: Management of temporomandibular joint (TMJ) ankylosis is a challenging and rather daunting task owing to complex abnormal anatomy and its sequel to craniofacial structures. Various autogenous grafts and alloplastic materials have been tried with variable success for creation of a near-normal joint. In recent years, neocondyle distraction has added a new dimension to the management of TMJ ankylosis. The aim of this paper is to describe the role of neocondyle distraction in TMJ ankylosis. MATERIALS AND METHODS: Neocondyle distraction was carried out in five patients with TMJ ankylosis following gap arthroplasty. Computed tomogram scans were taken before surgery and 1-year postdistraction for surgical planning and postoperative assessment, respectively. The intraoral distractors (KLS Martin, Jacksonville, FL, USA) were used in this study. RESULTS: All five patients reported with adequate mouth opening and functional jaw movements. The procedure was well tolerated by all the patients. None of the patients underwent reankylosis following neocondyle distraction. CONCLUSION: With proper surgical planning and distraction protocol, neocondyle distraction is an effective and safe technique for TMJ reconstruction and preventing reankylosis.

Distraction osteogenesis in complex facial asymmetry corrections.

This article highlights the authors' experience in the management of facial asymmetries with the use of distraction osteogenesis. It is a narrative based on the clinical experience at the Meenakshi Cleft & Craniofacial Center at Chennai.

Catheter-based donor site analgesia after rib grafting: a prospective, randomized, double-blinded clinical trial comparing ropivacaine and bupivacaine.

PURPOSE: Although ribs provide the best source of cartilage for reconstruction, its harvesting is associated with significant postoperative pain and sometimes incapacitating functional deficit. The lack of studies in the maxillofacial literature on regional analgesia for rib harvests stimulated this study design. This study compared ropivacaine with bupivacaine in providing postoperative analgesia after rib harvest. PATIENTS AND METHODS: Patients who needed rib grafting for maxillofacial reconstructive procedures were enrolled in this prospective, randomized, double-blinded clinical trial. Patients were randomly allocated to 1 of 2 groups with different modalities of anesthesia against a control group. A catheter was embedded in the rib donor site in all patients. Patients in group A received 0.75% ropivacaine, those in group B received 0.5% bupivacaine, and those in croup C patients received normal saline and served as the controls. The outcome variables were the subjective and objective pain scores, the duration of action, and the efficacy of the drugs after rib harvest. Dependent variables were the need for a rescue analgesic by the patient and the duration of hospital stay. The subjective intensity of pain at rest was calculated using the visual analog scale. The objective pain scores at function were evaluated by comparing preoperative with postoperative values of incentive spirometry, breath-holding test, maximal chest expansion, and match-blowing test. The t test and paired samples test were used to the analyze data, and a P value less than .05 was considered significant. RESULTS: Forty-two patients were enrolled in this study. Patients in groups A and B showed significant pain relief compared with group C. Patients in group A showed significantly less pain at rest (2.8±0.894) compared with those in group B (3.7±0.875; P<.05). Patients in group A also showed significantly less in pain at function (3.8±0.894) compared with those in group B (4.7±0.923; P<.05). Patients in group A showed a minimal need for a rescue bolus compared with those in group B. The duration of action for ropivacaine was longer by a mean difference of 11 hours. No noteworthy difference was seen for the duration of stay in the hospital. CONCLUSIONS: The use of catheter-based analgesia after rib harvesting provides excellent postoperative comfort, with ropivacaine providing an earlier return to normal function compared with bupivacaine. The duration of action of ropivacaine was significantly longer and, hence, decreased the need for rescue analgesics.

Specialty dentistry for the hemophiliac: is there a protocol in place?

Restorative dental care for the hemophiliac patient is of paramount importance for the fact that advanced dental conditions and subsequent treatments prove to be more complicated and risky. Quite often, dental health is neglected by hemophiliacs for fear of bleeding during procedures. Surprisingly, even dental specialists avoid these candidates and contribute to the conversion ofa simple dental patient to an oral surgical patient. The complexities involved in diagnosing a bleeding disorder and the rarity of a standardized protocol to handle such patients contribute to this problem. This article prescribes a simple protocol to diagnose bleeding disorders and a modified scheme for endodontic and periodontal therapy in a hemophiliac patient.