Management of Sialoceles Using an Indigenous Salivary Stent.

Background: A Sialocele is a subcutaneous extravasation of saliva from the salivary gland secondary to traumatic disruption of its duct or parenchyma. It is observed after ablative head and neck surgery or due to trauma. Though there are several techniques described, there is no universal consensus on how to treat postoperative sialoceles. Purpose: This paper describes a simple technique which was used to successfully treat 11 patients with postoperative sialoceles. Methods: In this paper we have described the use of an indigenously designed tapered stent used to decompress the sialocele. The decompression allows natural healing and fibrosis to occur over 4-6 days thereby resolving the sialocele. Results: 11 patients with postoperative sialoceles were successfully treated using our technique. Conclusion: The technique described by the authors is a simple, easy to perform procedure that can be managed in the outpatient office under local anesthesia with minimal equipment.

COVID-associated rhinocerebral mucormycosis: a retrospective analysis of presentation and outcomes.

OBJECTIVES: To comprehensively analyse the disease presentation and mortality of COVID-associated rhino-orbito-cerebral mucormycosis. METHODS: A retrospective analysis of the demographics, clinical and radiographic findings was performed. A binary logistic regression analysis was performed to examine the survival of patients with mucormycosis from hypothesised predictors. RESULTS: A total of 202 patients were included in this study. Statistical significance was demonstrated in the predilection to the male gender, recent history of SARS-COV-2, history of use of corticosteroid and hyperglycemia in this cohort of CAM. The mortality rate was 18.31%. Advanced age, raised HbA1c and intra-orbital extension were found to be predictors adversely affecting survival. CONCLUSION: Early diagnosis, aggressive surgical therapy, early and appropriate medical therapy can help improve outcomes. LEVEL OF EVIDENCE: Level 4.

Long-Term Comparison of the Aesthetic Outcomes between Nasoalveolar Molding- and Non-Nasoalveolar Molding-Treated Patients with Unilateral Cleft Lip and Palate.

BACKGROUND: The cleft lip-nose deformity in unilateral cleft lip and palate is one of the most challenging problem for surgeons to correct. Although nasoalveolar molding has been shown to be effective in improving presurgical symmetry in patients with complete unilateral cleft lip and palate, there is need for better evidence regarding the long-term nasolabial aesthetics of patients who have received this therapy. METHODS: Thirty-eight patients treated with nasoalveolar molding and 48 patients not treated with nasoalveolar molding (but otherwise treated similarly) with unilateral cleft lip and palate were studied to assess and compare the nasolabial aesthetics. The objective evaluation of the nasal symmetry was performed on the basal view of two-dimensional photographs and the subjective nasolabial aesthetic evaluation was performed using the Asher-McDade scale. RESULTS: At 5-year postoperative follow-up, nasoalveolar molding group patients had better mean values on the objective scores; however, these were not statically significant. The nasoalveolar molding group of patients had a statistically significant improvement in the subjective evaluation in comparison to the non-nasoalveolar molding-treated patients. The number of lip revisions was also statistically higher in the non-nasoalveolar molding-treated group of patients. CONCLUSIONS: In this retrospective, single-center study, the authors found that at 5-year postoperative follow-up, nasoalveolar molding-treated patients had improved nasolabial aesthetics and fewer revision operations. These are, however, preliminary results and the patients will be followed up until the end of growth to assess the longer term effects of nasoalveolar molding on the nasolabial aesthetics in unilateral cleft lip and palate. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

An Assessment of the Osteogenic Potential of Cissus quadrangularis in Mandibular Fractures: A Pilot Study.

BACKGROUND: A routine mandibular fracture matures in about 12 weeks and hence hinders normal function significantly. Alternatives are being researched to hasten the healing and allow early function. This prospective study aimed to assess the osteogenic potential of the drug Cissus quadrangularis (CQ) on the mandibular fracture healing. DESIGN: Prospective randomized study. RESULTS: The study between the groups revealed a statistically significant increase in the alkaline phosphatase levels in CQ group in comparison with control group. The radiographic findings (increment in density and rate of change of density), clinical findings (mobility, swelling, reduction in pain) and other biochemical findings (serum calcium, serum phosphorous) did not differ statistically between the CQ and control groups. CONCLUSION: Based on the lack of a statistically significant improvement in almost all parameters except for the alkaline phosphatase levels, we believe that a larger sample size is required to ascertain the absolute value of CQ before adding it to the mandibular fracture regimen.

A Longitudinal Study of The Nasal Symmetry in Unilateral Cleft Lip And Palate Patients Treated With Nasoalveolar Molding.

Background Nasoalveolar molding (NAM) has been extensively used as a presurgical technique in the treatment of unilateral cleft lip and palate (UCLP) over the last two decades. It has proven to be a useful tool to reduce the cleft size, improve nasal symmetry, and increase the columellar length. The long-term stability of these findings has not been conclusively proven. Methods In this longitudinal study, the nasal symmetry of 24 NAM treated UCLP patients was evaluated to assess the 5-year stability of NAM. The basal photographs were shot postcheiloplasty (T1), at 1-year follow-up (T2), at 3-year follow-up (T3), and 5-year follow-up (T4) appointments. Results In this study, we found that NAM was a useful adjuvant in achieving nasal symmetry in patients with UCLP in the immediate postoperative period. However, as the patients aged, there was a gradual loss of mean nasal height (by 22.83%) and columella length (by 24.89%), a mean gain in nasal width (by 40.25%) and alar base width (by 40.69%), and an increase in the columella deviation (by 3.46%) from the T1 to the T4 follow-up. Conclusion Although there is no conclusive evidence, the loss of symmetry may be due to the unequal growth on the cleft and noncleft sides. These patients will be followed-up till end of growth for a definite conclusion on the long-term effect of NAM.

A Comparative Cephalometric Study of Nasoalveolar Molding- and Non-Nasoalveolar Molding-Treated Bilateral Cleft Patients at Early Mixed Dentition Period.

OBJECTIVE: To evaluate and compare early maxillary growth in 2 groups of patients with repaired bilateral cleft lip and palate (BCLP) who had and had not received nasoalveolar molding (NAM) therapy in infancy. HYPOTHESIS: Nasoalveolar molding does not have any effect on maxillomandibular growth at the early mixed dentition period. DESIGN: Retrospective study. PATIENTS: The study group consisted of forty-two 7-year-old patients with BCLP-20 in the NAM group and 22 in the no-NAM group. The control group consisted of nineteen 7-year-old noncleft, normal patients. INTERVENTIONS: Nasoalveolar molding was carried out prior to surgeries in those children who were brought in within 8 weeks of birth. Children brought in later were treated without a presurgical intervention. All patients were treated with a single-stage modified Millard cheiloplasty without gingivoperiosteoplasty. Palatoplasty was done by single-stage Bardach palatoplasty with muscle repositioning. MEAN OUTCOME MEASURES: Hard tissue and dental cephalometric values measured on lateral cephalograms, recorded at 7 years of age. RESULTS: A comparison of the mean sagittal values showed a statistically significant maxillomandibular retrusion and incisor retroclination of both BCLP groups in comparison to the control group. None of the cephalometric parameters varied statistically between NAM and no-NAM groups. The maxillomandibular relation, lower face height ratio, mandibular plane, and mandibular axis angles did not show statistically significant difference between all 3 groups. CONCLUSIONS: On the basis of this study, NAM does not have any effect on maxillomandibular growth at the early mixed dentition period.

Hemifacial hypertrophy: Exploring new avenues of treatment modalities.

Congenital hemihyperplasia is a rare developmental disorder characterized by unilateral overgrowth of one or more body parts resulting in marked asymmetry. We are reporting here, a case of true hemifacial hypertrophy in a young female adult highlighting the clinical features and possible treatment options.