Comparative Evaluation of the Local Anesthetic Action of Tramadol Hydrochloride With Adrenaline Versus Lidocaine Hydrochloride With Adrenaline for Maxillary Exodontia: A Randomized Control Trial.

BACKGROUND: Tramadol hydrochloride (T-HCl) has demonstrated to have a local anesthetic effect similar to lidocaine hydrochloride (L-HCl) when administered locally for minor oral surgical procedures. PURPOSE: Our study aimed to compare the anesthetic effect of T-HCl versus L-HCl in maxillary premolar extraction. STUDY DESIGN, SETTING AND SAMPLE: The study is a split-mouth, double-blind randomized clinical trial at the Faculty of Dental Sciences, Ramaiah University of Applied Sciences, Bengaluru, India. The study sample was composed of patients referred for maxillary bicuspid extraction. Patients were excluded from the sample if, allergic to the study drugs, pregnant or lactating females, and smokers. EXPOSURE VARIABLE: The variable is an anesthetic drug administered for local anesthesia and it is grouped into 2 categories, T-HCl and L-HCl. A supraperiosteal infiltration of T-HCl with adrenaline on one side and L-HCl with adrenaline on the contralateral side was injected. MAIN OUTCOME VARIABLE: The primary outcome variable was profound anesthesia of T-HCl, where the patient sensed the loss of sensation of touch, temperature, and pain. Secondary outcomes were onset and duration of anesthesia, intraoperative pain, postoperative analgesia, and adverse reactions, were recorded. ANALYSES: Inferential statistics, the χ2 Test, the Mann-Whitney Test, and the Wilcoxon signed-rank test were used to compare the parameters. The level of significance was set at ≤ 0.05. RESULTS: A total of 40 patients were included, and 80 teeth were extracted. Profound anesthesia was achieved in all the cases. The mean subjective duration of anesthesia in the T-HCl and L-HCl groups was 130.80 ± 20.01 minutes and 111.40 ± 14.87 minutes, respectively, with a P value of .001. The mean Visual Analogue Scale (VAS) score for pain during the procedure in the T-HCl and L-HCl groups was 0.60 ± 0.67 and 1.10 ± 0.71, respectively, with a P value of .002. The mean Visual Analogue Scale score for pain postoperatively in the T-HCl and L-HCl groups was 0.70 ± 0.72 and 1.40 ± 0.67, respectively, with a P value of .001. Six patients in T-HCl required postoperative analgesia when compared to 18 patients in L-HCl (P value < .003). CONCLUSIONS AND RELEVANCE: T-HCl provides similar anesthetic outcomes in the extraction of maxillary bicuspids as L-HCl.

Maxillary Leiomyosarcoma with Lymph Node Metastasis: Report of an Unusual Case.

Leiomyosarcoma is an unusual, malignant, mesenchymal neoplasm that is extremely rare in head and neck region. It clinically presents as a well-defined, painless mass which could easily be misdiagnosed as a benign lesion, posing a diagnostic challenge to the clinician. Head and neck leiomyosarcomas are very aggressive and have a poor prognosis. Hence, early diagnosis plays a vital role in its appropriate management.

Micrometastasis detection using modified papanicolaou stain in nodal tissues of oral squamous cell carcinoma - A histological study.

CONTEXT: Cervical lymph node metastasis is the most important prognostic factor in Squamous Cell Carcinoma of Head and Neck (SCCHN). Detection and evaluation of micro-metastasis forms the basis for diagnosis, staging, treatment options and prognosis. Lymph node prognostic factors are extremely important for the survival and recurrence in the patient. Assessing lymph node metastasis in the absence of clinical enlargement is challenging. AIM: To evaluate micrometastasis and individual tumor cells (ITC) in regional lymph nodes of oral squamous cell carcinoma (OSCC) by modified papanicolaou (PAP) stain and re-evaluate the tumor staging. SETTINGS AND DESIGN: The retrospective study was executed at MS Ramaiah University of Applied Sciences. METHODS AND MATERIALS: The current study constituted a total of 40 lymph nodes from OSCC patients, metastatic (n=20) and non-metastatic lymph nodes (n=20). All sections were stained with H & E followed by modified PAP stain. Modified PAP was used for identification of micrometastasis deposits. STATISTICAL ANALYSIS USED: The Chi square test was employed to analyze significance. RESULTS: Modified PAP stain proved to be more accurate (p = 0.006) than H and E stain in detecting micrometastasis which accounted for 15% of non-metastatic lymph node sections used in our study. CONCLUSION: Special stain like modified PAP stain is valuable and sensitive in detecting micro-metastasis over H and E stain. Detection of micrometastasis in OSCC patients is advantageous for the patient as it influences staging, it modifies the treatment plan in terms of both radiotherapy and chemotherapy.

Comparative Assessment of Microplates with Miniplates in the Fixation of Midface Fractures: A Prospective Study.

Aim: The aim of this study was to compare the treatment outcome following fixation of midface fractures with microplates to that of miniplates. Materials and Methods: The prospective study included 30 patients with confirmed diagnosis of midface fractures (Le Fort I, II, III, ZMC fractures or combination) and who gave written informed consent. The patients were categorized into microplate (1.2 mm) group and miniplate (2.0 mm) group with 15 patients in each group using computer-generated randomization. The clinical parameters like occlusion, stability of fixation, chewing efficiency, pain, infection, paresthesia, plate exposure, palpability, aesthetic outcomes and patient's perspective were assessed on postoperative day 1, day 3, after 1 week, 1 month and after 3 months. Results: There was no statistically significant difference between the two groups in terms of occlusion, stability of fixation, chewing efficiency, pain, infection, paresthesia, plate exposure, aesthetic outcomes and patient's perspective. One patient in microplate group and five patients in miniplate group complained of plate palpability (P = 0.16), suggesting clinically significant difference but statistically no significant difference. Conclusion: Microplate osteosynthesis gives equivalent results compared to miniplate osteosynthesis, in the fixation of midface fractures in terms of stability and function and clinically superior in terms of aesthetics.

P-Cadherin and WNT5A expression in assessment of lymph node metastasis in oral squamous cell carcinoma.

BACKGROUND: Oral cancer progression is a multi-step process in which adhesion molecules play a pivotal role in the development of recurrent, invasive, and distant metastasis. The aim of this study was to adopt prognostic biomarkers to assess the lymph node metastasis of OSCC that will facilitate in deciding the treatment modality by the surgeons. OBJECTIVES: The objectives of the study were to assess the biological behaviour of OSCC by correlating the expression levels of P-Cadherin and WNT5A immunohistochemically. METHODS: A total of 60 selected OSCCs cases (lymph node metastasis n = 30, non-metastatic n = 30) and 10 normal healthy controls were quantitatively and qualitatively analysed by immunohistochemistry for P-Cadherin and WNT5A. A survival analysis was also performed. RESULTS: The expression levels of P-Cadherin and WNT5A in OSCC groups were statistically significant between metastatic and non-metastatic groups (p < 0.001). P-Cadherin and WNT5A expression in metastatic (lymph node metastasis) and non-metastatic cases showed a significant correlation coefficient of 0.753 at (p < 0.01). The present study also found that the aberrant expression (high) of P-Cadherin was associated with diminished survival of patients with metastatic OSCC. CONCLUSION: The present study demonstrated the aberrant expression of P-Cadherin and WNT5A could serve as important prognosticator in OSCC. CLINICAL RELEVANCE: P-Cadherin and WNT5A could be used as significant predictors of disease outcome.

Postural Disharmony Causing Myofacial Pain: A Case Report and Review of Literature of the Treatment.

Myofacial pain, a chronic painful condition of muscle origin, has numerous precipitating factors, if undiagnosed or left untreated could lead to compromised function and poor quality of life. In this case report, a female patient giving a history of 10 years of pain in the head and neck region was eventually diagnosed with myofacial pain secondary to bowing posture. The patient was successfully treated with combination of treatment modalities (TENS therapy, exercises, occlusal splint, etc.), which resulted in relief from chronic pain and improvement in quality of life.

Role of cancer stem cells in head-and-neck squamous cell carcinoma - A systematic review.

Targeting cancer stem cell (CSC) subpopulation within the tumor remains an obstacle for specific therapy in head-and-neck squamous cell carcinoma (HNSCC). Few studies in the literature describe a panel of stem cell makers, however a distinct panel has not been put forth. This systematic review aims to enhance the knowledge of additional markers to accurately relate their expression to tumorigenesis, metastasis, and therapy resistance. Databases, including PubMed, Google Scholar, Ebsco, and Science Direct, were searched from 2010 to 2017 using various combinations of the following keywords: "Stem cell markers in HNSCC" and "chemoresistance and radioresistence in HNSCC." Original experimental studies (both in vitro and in vivo) published in English considering stem cell markers in HNSCC, were considered and included. We excluded articles on tumors other than HNSCC, reviews, editorial letters, book chapters, opinions, and abstracts from the analyses. Forty-two articles were included, in which 13 types of stem cell markers were identified. The most commonly expressed CSC markers were CD44, aldehyde dehydrogenase, and CD133, which were responsible for tumorigenesis, self-renewal, and therapy resistance, whereas NANOG, SOX-2, and OCT-4 were involved in metastasis and invasion. Identification of an accurate panel of CSC markers is the need of the hour as nonspecificity of the current markers poses a problem. Further studies with a large sample size would help validate the role of these CSC markers in HNSCC. These CSC proteins can be developed as therapeutic targets for HNSCC therapy, making future treatment modality more specific and effective.

Lipid metabolism in cancer: A systematic review.

Preclinical studies and clinical trials have emphasized the decisive role of lipid metabolism in tumor proliferation and metastasis. This systematic review aimed to explore the existing literature to evaluate the role and significance of the genes and pathways most commonly involved in the regulation of lipid metabolism in cancer. The literature search was performed as per Preferred Reporting Items for Systematic Reviews and Meta-analyses. Approximately 2396 research articles were initially selected, of which 215 were identified as potentially relevant for abstract review. Upon further scrutiny, 62 of the 215 studies were reviews, seminars, or presentations, and 44 were original study articles and were thus included in the systematic review. The predominant gene involved in lipid metabolism in cancer was stearoyl-coenzyme A desaturase 1 (SCD1), followed by fatty acid synthase (FASN). The pathway most commonly involved in lipid metabolism in cancer was the phosphoinositide 3-kinase/protein kinase B (PI3K/Akt) signaling pathway, followed by the mitogen activated protein kinase (MAPK) pathway. SCD1 and FASN play significant roles in the initiation and progression of cancer and represent attractive targets for potentially effective anti-cancer treatment strategies. The regulation of cancer metabolism by the Akt kinases will be an interesting topic of future study.

Sub-epithelial hyalinization, incomplete cystic lining, and corrugated surface could be a predictor of recurrence in Odontogenic Keratocysts.

BACKGROUND: Odontogenic Keratocysts (OKCs) are known for their rapid growth and tendency to invade the adjacent tissues. Its high recurrence rate (2.5%-62%) has attracted many kinds of research to identify new parameters to predict recurrence that would enable better treatment outcomes for such patients. The present study aims to correlate Sub-Epithelial Hyalinization (SEH) that has not been explored in an Asian population to date and other histopathologic features of OKC to its recurrence propensity. MATERIALS & METHODS: A total of 60 OKCs were analyzed for histopathologic correlation of thickness of lining, complete/incomplete lining, corrugated surface, ortho/para keratinization, intercellular edema, reversed polarity, basilar hyperplasia, the palisading arrangement of basal cells, presence/absence of rete pegs, folding of the epithelium, epithelial/connective tissue separation, SEH, basal offshoots, daughter cysts and inflammation with recurrence to arrive at the most significant histologic feature predicting recurrence. RESULTS: The most significant histologic parameter differentiating recurrent and non-recurrent OKCs was the presence of SEH (p = 0.004), incomplete lining epithelium (p â€‹= â€‹0.023), and a corrugated surface (p â€‹= â€‹0.049). Several other histologic parameters evaluated did not statistically correlate with recurrence, this can be attributed to the smaller sample size considered in the present study. CONCLUSION: SEH is a reliable histologic parameter to predict recurrence in OKCs. The presence of SEH is indicative of a higher recurrence potential in OKCs. Evaluation of histological parameters and their correlation with recurrence in OKCs on a larger sample size could validate the results of the current study undertaken and potentially unravel more insights on predicting recurrence. KEY MESSAGES: Sub-epithelial hyalinization is a significant feature for predicting recurrence in OKC.

Self-Drilling Versus Self-Tapping Screws: A 3D Finite Element Analysis.

STUDY DESIGN: Self-tapping and self-drilling screws are two modalities available for plate fixation. When compared to self-drilling, self-tapping screws have a few drawbacks like screw loosening, thermal osteolysis, equipment dependent, and time-consuming. AIM: The aim of this study was to compare the efficacy of self-tapping and self-drilling screws with relation to plate retention and stability in internal fixation of mandibular fractures using 3D finite element analysis (FEA). OBJECTIVES: The objective of this study was to determine the influence of screw placement technique on stress concentration and deformation occurring at the screw-bone interface in self-drilling and self-tapping screws. MATERIALS AND METHODS: A 3D computer-aided design modeling system was used to build a trilaminate mandibular bone, self-tapping screw and self-drilling screw, and a 2-holed miniplate with gap that were converted into finite element models using Hypermesh 13.0 software. Material properties and boundary conditions were assigned to these models. Pullout, torque, and torsional forces were applied to evaluate the stress concentration and deformation at the screw-bone interface. RESULTS: The comparison of stress concentration and deformation values between the two types of screws was interpreted using ANSYS software version 14.5. Results of torque test, pullout test, and torsional test showed maximum Von Mises stress, and deformation around the screw-bone interface was higher in self-tapping screw than in self-drilling screw. CONCLUSION: Within the limitations of the 3D FEA, the findings provided significant evidence to suggest that self-tapping screws have a greater incidence of fatigue when compared to self-drilling screws as there was more stress distribution and deformation at their screw-bone interface.

Clinical Profile of Adolescent Onset Anorexia Nervosa at a Tertiary Care Center.

OBJECTIVE: To study the clinical profile and outcome of adolescent onset anorexia nervosa at a tertiary care center in Southern India. METHOD: Review of hospital records of adolescents diagnosed with anorexia nervosa. Outcome was assessed for those with a follow-up of atleast one year, by outpatient visit or by a telephonic interview. FINDINGS: Data of 43 patients (28% males) with mean (SD) age at presentation of 13.4 (1.7) years were included. The mean (SD) BMI at presentation was 13.8 (3.2) kg/m2, the lowest being 8.3 kg/m2. 33 (76%) patients were hospitalized for nutritional rehabilitation. Of the 15 patients followed up 1-5 years later, one had died and 11 had achieved normal weight for age. CONCLUSIONS: As compared to other studies, this study showed a higher proportion of boys with anorexia nervosa. Further research is necessary to understand factors affecting long-term outcome.

Prediction of metastasis in oral squamous cell carcinoma through phenotypic evaluation and gene expression of E-cadherin, ß-catenin, matrix metalloproteinase-2, and matrix metalloproteinase-9 biomarkers with clinical correlation.

CONTEXT: Controversies prevail regarding the true predictive role of epithelial-mesenchymal transition (EMT) biomarkers in metastasis of oral squamous cell carcinoma (OSCC). There is also limited research carried on till date wherein the protein and gene expression of EMT biomarkers have been investigated simultaneously in the Indian population. AIM: The aim of this study was to assess the gene expression and quantitative protein expression of EMT biomarkers using conventional method and MATLAB software and to determine if there is any difference in the expression between metastatic and nonmetastatic OSCCs with clinicopathologic correlation. SETTINGS AND DESIGN: Twenty metastatic and nonmetastatic OSCC tissue sections each were obtained from department archives. Gene expression and quantified protein expression of EMT markers were done and correlated with clinical parameters. SUBJECTS AND METHODS: Sections immunostained for EMT biomarkers were evaluated using semi-quantitative and quantitative (MATLAB) methods. Gene expression using semi-quantitative reverse transcriptase-polymerase chain reaction was done. These findings were correlated with clinical parameters. STATISTICAL ANALYSIS USED: Pearson's Chi-square test, Student's t-test, and univariate logistic regression analysis were performed using SPSS software. RESULTS: The low immunoexpression of E-cadherin and ß-catenin and the high expression of matrix metalloproteinase (MMP)-2 and MMP-9 correlate with Stages III and IV showing high metastatic risk. Furthermore, the upregulated MMP-2 and MMP-9 gene expressions in advanced clinical stages of OSCC have high metastatic potential. CONCLUSIONS: This study is the first of its kind to employ texture and color segmentation in MATLAB to objectively assess the protein expression of EMT biomarkers. This research is instrumental in studying the protein and gene expressions of EMT markers with clinical correlation.

Development of clinico-histopathological predictive model for the assessment of metastatic risk of oral squamous cell carcinoma.

CONTEXT: Oral cancer metastasis is the leading cause of death globally. The decision-making on the mode of surgical treatment in clinically negative lymph nodes is challenging. AIM: The aim of this study was to develop a predictive model using clinical and histopathologic parameters that may help in the assessment of the metastatic risk of oral squamous cell carcinoma (OSCC). SETTINGS AND DESIGN: Clinical data of histopathologically confirmed primary OSCC from 2014 to 2017 were retrieved from the archives. Histopathological parameters for metastasis that were considered for evaluation in the study were tumor buds, cytoplasmic pseudofragments, tumor grade, depth of invasion, invasive tumor front (ITF) pattern, and lymphovascular invasion (LVI). METHODS: Hematoxylin and eosin and pan-cytokeratin immunostained sections of metastatic and nonmetastatic OSCC were assessed for histopathological features and correlated with clinical parameters. STATISTICAL ANALYSIS USED: SPSS software (Statistical Package for Social Sciences for Windows, Version 22.0 (2013) (IBM Corp., Armonk, NY, USA)) was used for the statistical analysis. Pearson's Chi-square test was done to assess the grades of histopathological and clinical parameters between the study groups. Univariate analysis was performed to develop a clinicopathologic predictive model. RESULTS: The clinicopathologic model signifies that OSCC with clinical Stage IV, high grades of tumor buds and cytoplasmic pseudofragments, Type V ITF pattern, positive LVI, deeply invasive tumors, and poorly differentiated grades of OSCC have a high risk of developing nodal metastasis. These parameters may be used as early predictors for metastasis of OSCC both in incisional and excisional biopsy specimens. CONCLUSIONS: The proposed predictive model is simple, cost-effective, and user-friendly for the early assessment of nodal metastatic risk in clinically negative lymph nodes.

Procedures and pitfalls in incisional biopsies of oral squamous cell carcinoma with respect to histopathological diagnosis.

This review has addressed the issues faced by a diagnostic pathologist during routine assessment of haematoxylin and eosin stained incisional biopsies from oral squamous cell carcinoma patients. Herein, the pragmatic means undertaken, has highlighted routinely faced problems & encounters determined at various levels as clinical, laboratory and diagnostic pitfalls, when possible, tips offered towards procedures and guidance. Also, dealt with subtypes of oral squamous cell carcinoma, differential diagnosis, and relevant prognostic indicators that can navigate the surgeon to take quick decisions. It speaks of the journey of biopsied material from the clinician to the laboratory until the generation of the final report. Although histopathological evaluation is a confirmatory tool for any clinically suspected lesion it mandates the co-operation of faculty from varied disciplines. The onus lies on a pathologist to establish standard protocols to oversee, audit the laboratory operating procedures from time and again. Technical errors and faults at the office desk doesn't come under the purview of this review.

Assessment of Pretreatment Neutrophil/Lymphocyte Ratio and Platelet/Lymphocyte Ratio in Prognosis of Oral Squamous Cell Carcinoma.

PURPOSE: Recent data have provided evidence of systemic inflammatory markers playing an important role in determining the disease-free survival (DFS) and overall survival (OS) of patients with oral squamous cell carcinoma (OSCC). The aim of the present study was to determine the prognosis of OSCC using the preoperative neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR). PATIENTS AND METHODS: We enrolled 130 patients with OSCC who received treatment in the present retrospective study. Both PLR and NLR correlated with the demographic data, tumor characteristics, and prognosis. The optimal cutoff for PLR and NLR was determined by receiver operating characteristic curve analysis and was 142 and 3.1 for PLR and NLR, respectively. The prognostic significance of both markers was determined by univariate and multivariate analysis. Survival curves were plotted using the Kaplan-Meier method. RESULTS: The clinicopathologic variables correlated with cumulative survival on univariate analysis. Advanced clinical lymph node stage (P = .001), pathologic lymph node stage (P = .001), pathologic tumor stage (P = .049), pathologic TNM stage (P = .006), receipt of multimodality treatment (P = .013), and high PLRs (P = .001) and NLRs (P = .002) showed a statistically significant association with shorter DFS. A multivariate Cox proportional hazard regression model demonstrated that a high PLR (hazard ratio [HR], 2.998; 95% confidence interval [CI], 1.128 to 7.968; P = .028) and patient age (HR, 1.100; 95% CI, 0.750 to 1.613; P = .025) were independent factors for determining DFS and OS. CONCLUSIONS: We observed that high PLRs and NLRs were significant in determining the prognosis. The PLR was superior to the NLR in determining DFS and OS and can be used as an independent prognostic indicator in patients with OSCC.

Pancytokeratin immunostained tumor buds and cytoplasmic pseudofragments are reliable early predictive variables for regional lymph node metastatic risk assessment of oral squamous cell carcinoma.

CONTEXT: The 5-year survival rate in patients with cervical lymph node metastasis is reported to be 20-36% post surgery as compared to 63-86% in patients without nodal involvement. This necessitates assessing the metastatic potential of OSCC patients. OBJECTIVES: To evaluate the role of Pancytokeratin immunostained tumour buds and cytoplasmic pseudofragments with other histopathological and immunohistochemical variables in predicting metastatic risk of Oral Squamous Cell Carcinoma (OSCC). SETTINGS AND DESIGN: Retrospective study on archival tissues of OSCC available from the Department of Oral Pathology and Microbiology. METHODOLOGY: Totally.40 samples of 117 histopathologically diagnosed OSCC samples were selected that displayed metastatic risk variables like invasive tumour front pattern, lymphovascular invasion, tumour buds and cytoplasmic pseudofragmentation and were grouped into 20 each of metastatic and non-metastatic OSCC. 5 normal oral mucosa samples were included in the control group. The 45 tissues were stained with congo red to assess tumour - associated tissue eosinophilia (TATE) and immunohistochemically evaluated for tumour budding and cytoplasmic pseudofragmentation using pancytokeratin, proliferation (Ki-67), microvessel density (MVD)(CD31) and lymphatic vessel density (LVD)( LYVE-1). STATISTICAL ANALYSIS: Pearson's Chi square test and Man Whitney U test were used and analysed by Statistical Package for the Social Sciences (SPSS) software version 20.0. RESULTS: Metastatic OSCC showed significantly high number of tumour buds (p = 0.001), cytoplasmic pseudofragments (p = 0.008), higher tumour grade (p = 0.038), lymphovascular invasion (p = 0.008) and LVD (p = 0.013), aggressive invasive tumour front pattern (p = 0.001) compared to non-metastatic OSCC. CONCLUSION: Pancytokeratin immunostained tumour buds, cytoplasmic pseudofragments and higher LYVE-1 expression may be used as independent predictors for OSCC metastasis.This study highlights the importance of recognizing the early metastatic risk variables that navigates the surgeon in planning appropriate therapy for OSCC.

Does microbiome shift play a role in carcinogenesis? A systematic review.

Recent scientific advances have presented substantial evidence that there is a multifaceted relationship between the microbiome and cancer. Humans are hosts to multifarious microbial communities, and these resident microbes contribute to both health and disease. Circulating toxic metabolites from these resident microbes may contribute to the development and progression of cancer. The aim of this systematic review was to evaluate microbiome and microbial shift contribution to the development and progression of cancer. This systematic review provides an analytical presentation of the evidence linking various parts of the microbiota to cancer. Searches were performed in databases such as PubMed, Google Scholar, Scopus, EBSCO, E-Journals and Science Direct from the time of their establishment until May 2018 with the following search terms: cancer or human microbe or cancer and human microbiome AND shift in microbes in cancer. The merged data were assessed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Cochrane's Risk of Bias Tool was used to assess the bias. Initially, 2,691 articles were identified, out of which 60 full-text articles were screened and re-evaluated. Among them, 14 were excluded based on inclusion/exclusion criteria; eventually, 46 articles were included in the systematic review. The reports of 46 articles revealed that microbial shift involving Candida species, Fusobacterium nucleatum, Porphyromonas gingivalis, Helicobacter pylori and Human papilloma virus (HPV) 16 & 18 were most commonly involved in various human cancers. In particular, organisms, such as Candida albicans, Fusobacterium nucleatum, Porphyromonas gingivalis and HPV-16 were found to be more prevalent in oral cancer. The present systematic review emphasizes that the role and diverse contributions of the microbiome in carcinogenesis will provide opportunities for the development of effective diagnostic and preventive methods.

The Role of Helmet Fastening in Motorcycle Road Traffic Accidents.

Road traffic accidents are the leading cause of death among the Indian population. Motorcycle accidents are the most prominent type of injuries among road traffic accidents in India. In this prospective cross-sectional study, all the patients attending three centers in north Bangalore, with facial injuries occurring from a motorcycle accident, were included. The subjects were analyzed for the type of collision, helmet use, type of helmet use, and fastening status of the helmets. A total of 311 motorcyclists were included in this study for a period of 18 months (December 2015 to June 2017). There were 79.7% males and 20.3% females. The most prominent age group was 21 to 30 years. The percentage of riders sustaining facial injuries was significantly more in the non-helmeted group. The most common injuries in open face helmets were in the middle and lower third of the face, whereas in closed face helmets it was in the middle third of the face. The numbers of injuries were significantly higher in the nonfastened helmet group as compared with fastened helmet group. Helmet fixation is an important characteristic along with helmet type for the better effectiveness and safety of the helmets for the motorcyclists.

Soft Tissue Injuries of the Maxillofacial Region Occurring from Motorcycle Accidents.

INTRODUCTION: Soft tissue injuries are the most common type of injury occurring from a motorcycle accident. Not many studies have been conducted to determine the incidence and pattern of soft tissue injuries and the effectiveness of helmet to prevent them. METHODS: In this prospective cross-sectional study, all the patients attending three centres in North Bangalore, with facial injuries occurring from a motorcycle accident, were included. The subjects were analysed for the type of collision, helmet use, type of helmet use and incidence and pattern of extra-oral and intra-oral soft tissue injuries. RESULTS: A total number of 311 motorcyclists were included in this study for a period of 18 months (December 2015-June 2017). The most prominent age group was 21-30 years. Abrasions were the most common type of injury followed by the lacerations, contusions and communication. Injuries to the middle third and lower third of the face were significantly higher in non-helmeted and open-face-helmeted patients. Middle third injuries were most common in the full-face helmet group. CONCLUSION: Abrasions are the most common type of soft tissue injury, and most common site was the nose, followed by the forehead, orbit and chin. Full-face helmets are more effective and protective as compared to open-face helmets. Open-face helmets offer minimal protection against facial injuries occurring from road traffic accidents.