Carotid Cavernous Fistula as a Rare and Late Complication of Maxillofacial Injury: A Brief Clinical Study.

Carotid- Cavernous Fistula (CCF) represents an aberrant vascular communication at the skull base between the high-flow carotid arterial system and the low-flow venous channels within the cavernous sinuses of the sphenoid bone. Benjamin Travers, in the year 1809, described this condition as "pulsating exophthalmos". This case is a presentation of a carotid cavernous fistula in an operated case of maxillofacial injury as a late complication. The individual presented with a nonresolving proptosis and chemosis for the past 9 weeks. This presentation enumerates how the diagnosis was made, though being a rare complication and how it was promptly managed that resulted in a remarkable resolution of signs and symptoms.

Clear Cell Odontogenic Carcinoma: A Rare JAW Tumor-A Case Report and Literature Review.

Clear cell odontogenic carcinoma (CCOC) is a rare epithelial malignant odontogenic tumor of the jaw with a distinct histology and deceptive behavior. As the clinical presentation is often misleading, the contribution of biopsy, molecular biology, immunohistochemistry and cytogenetics are essential in the diagnostic process. This article describes the presentation of an aymptomatic, painless swelling in the lower jaw of a 63 yrs old female, who was initially diagnosed as an ameloblastoma, taken up for segmental resection, subsequently histopathologically diagnosed as a case of clear cell odontogenic carcinoma and later managed with chemotherapy. Current management protocols and presentation of CCOC have also been reviewed.

Oral Plasmablastic Lymphoma: A Rare Manifestation of HIV-Related Neoplasm-A Brief Clinical Study.

Plasmablastic lymphoma (PBL) is an uncommon and aggressive large B-cell lymphoma commonly diagnosed in human immunodeficiency virus-positive patients. Though the oral cavity is a common site for PBL, this condition is not commonly reported in the literature as an oral manifestation. Most oral PBLs presented as an asymptomatic swelling, frequently associated with ulcerations and bleeding. No standard treatment is yet advocated for oral PBL. Five-year survival rate was recorded not more than 33.5%. This presentation emphasizes on oral manifestation of plasmablastic lymphoma (PBL) as a rare entity, which was provisionally diagnosed for carcinoma (CA) oral cavity. A simple presentation of ulcerated growth in the upper jaw was excised for histopathologic evaluation. Subsequently, it turned out to be a rare oral manifestation of HIV-related lymphoma. It is imperative to understand simple oral presentation as a manifestation of an underlying systemic condition. With this interest, this case presentation is published with a literature review.

Post-Covid Orofacial Mucormycosis: A Clinico-Radiological Classification System and Management Protocol.

Background: In the wake of the second wave of the COVID-19 pandemic, a substantial number of individuals were afflicted by orofacial mucormycosis post-COVID. The immunocompromised state rendered by the SARS-COV2 (Severe Acute Respiratory Syndrome Corona Virus 2) infection provides a breeding ground for the opportunistic mucor invasion. Corticosteroid and COVID-induced hyperglycemia contribute to the unhindered progress of the mucor infection in these patients. The sino-nasal region serves as the entry point and rapid progress of the disease to the oral cavity, mid-face, orbits, and ultimately the brain proves fatal. Aim and Objectives: The aim of this study was to present a definitive clinico-radiological staging/classification system for patients of post-covid mid-face mucormycosis based on combined radiographic and clinical features for subsequent convenient staging of maxillofacial mucormycosis. The objectives are being to lay down a comprehensive management protocol for these patients. Methods: This retrospective study consisted of a cohort of 31 patients presenting to a tertiary care center over a 12-month period and diagnosed as post-covid mucormycosis. Their clinical features at the time of presentation along with radiographic presentation/extent of anatomical destruction were combined to create a clinico-radiological staging system. Further, a comprehensive management protocol including cultures, surgery and chemotherapy has been laid down. Results: This included 18 males and 13 females. Average age of the patients was 53.5 years. As per the clinico-radiological system formulated by the authors, 2 patients (1 males and 1 females) displayed features of Stage 0, 12 patients (7 males and 5 females) of Stage 1-A, 8 patients (5 males and 3 females) of Stage 1-B, 6 patients (4 males and 2 females) and 3 patients (1 male and 2 females) of Stage 3. Conclusion: The lacuna of a comprehensive staging/classification system for patients of maxillofacial mucormycosis was felt by the authors while treating those affected by post-covid mucormycosis along with a detailed algorithm for management of the study population. It is to this effect that this clinic-radiological classification system has been suggested by the authors along with a management protocol.

Surgical Challenges in the Management of Post COVID-19 Midface Mucormycosis (PCoMM): An Institutional Protocol.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has posed another serious threat, mucormycosis infection, affecting the maxilla and orbitocerebral region. This condition has not spared world population from its merciless claws. This article addresses the challenges faced by the maxillofacial surgeons in setting the protocols from preoperative diagnosis, surgical management to postoperative care, including short-term and long-term rehabilitation. To manage this relentlessly progressing condition, a multispecialty team approach is to be activated in diagnosing, managing, and rehabilitating the patients. PURPOSE: The purpose of this clinical study is to document and analyze the clinical and demographic data, presentation of the lesion, the diagnostic methods followed for early clinical detection, and management of post COVID-19 midface mucormycosis. The article also discusses postoperative medical management and prosthetic rehabilitation. RESULTS: Most of the mucormycosis cases reporting to our center were treated and recovered patients of Severe Acute Respiratory Syndrome Coronavirus 2 infection. Thirty-four (n=34) case were operated for post COVID-19 midface mucormycosis between October 2020 and December 2021. Male to Female ratio is 1:42. The average age of the patients was 57.5 years. Maximum patients were in fifth and sixth decade of life. Maxilla was the involved bone. Treatment was primarily surgical debridement to extended or radical maxillectomy. All patients were treated with Liposomal Amphotericin B and tab posaconazole for 3 to 4 weeks depending upon the age, weight, and physiological state of the patients to attain an optimal cumulative load. Three patients succumbed to illness postoperatively (n=3, 1.02%). Average duration of hospital stay was 47 days. The average review period was 5.1 months.

Congenital Granular Cell Tumour - Case Report and Review of Literature.

Rationale: Congenital orofacial swellings in neonates are mainly limited to vascular malformations and neuroectodermal benign tumours. Congenital granular cell tumour (CGCT) is a rare condition affecting neonates with a prevalence rate of 6 in 1 million. Our report provides a brief review of diagnosis and management. Patient Concern: A 4-day-old female neonate was brought in with the chief complaint of a single, lobulated mass protruding from the right side of the oral cavity. The inability to achieve lip seal and suckling resulting in feeding problems was the primary concern. Diagnosis and Treatment: Surgical excision of the lesion was carried out under general anaesthesia. Resected mass was confirmed to be a CGCT upon histopathological evaluation. Outcome: One-year follow-up showed satisfactory healing with no evidence of recurrence. Take-away Lesson: Ultrasonography and other imaging modalities help in differentiating it from vascular malformations. Simple surgical excision suffices to treat the condition.

Time versus tissue: Timely identification of Scedosporium Rhinosinusitis in a post-COVID-19 case by MALDI-TOF MS leading to successful management.

COVID-19 (Coronavirus Disease 2019), illness with associated comorbidities and corticosteroid therapy makes the host immunocompromised and prone to opportunistic microbial infections. As the world continues to struggle with the pandemic of COVID-19, an increase in cases of opportunistic fungal infections have been reported from all over the world during the second wave of COVID-19 like aspergillosis, mucormycosis, and candidiasis. Scedosporium apiospermum is an emerging pathogen that is usually associated with mycetoma, pulmonary infection, and central nervous infections. It has been rarely associated with fungal rhinosinusitis (FRS). In this study, a rare case of FRS caused by S.apiospermum in an immunocompromised post-Covid-19 diabetic woman is reported.

Comparative Evaluation of Success in Cases of Synovial Chondromatosis of Temporomandibular Joint Treated with Temporomandibular Joint Arthroscopy: A Case Series.

Introduction: Synovial chondromatosis of the temporomandibular joint (TMJ) is characterized by the formation of multiple nodules of cartilage with varying sizes due to metaplastic development of the synovial membrane. Aetiology revolves with primary lesion, and pathogenesis is still unknown with multiple factors, which includes low-grade trauma or internal derangement. This condition remains undiagnosed and leads to therapeutic challenges from clinical manifestations which are non-specific and needs various tools to diagnose with combination of radiologic and histopathological examination. Materials and Method: We report a case series of five cases which were diagnosed as cases of TMD of the temporomandibular joint. Diagnostic arthroscopy including lysis and lavage with Ringers lactate, hyaluronic acid was carried out. Intra-operative findings were suggestive of synovial chondromatosis. Sample taken for histopathological examination confirmed the diagnosis of synovial chondromatosis of TMJ. Postoperative status of mouth opening and pain was assessed at 15 days, one month, 3 months, 6 months and one year during the review to evaluate the success of arthroscopy of TMJ. Results: All patients reported success with the modality of arthroscopy lysis and lavage at 12 months of follow-up with improvement at every follow-up visit in terms of range of motion and reduction of pain score on VAS. Hence, arthroscopy with lysis and lavage came out to be a promising alternative for open joint surgery in cases of synovial chondromatosis of the TMJ with same outcomes in relieving patients who complain of reduced maximum inter-incisal opening and pain. Conclusion: Thus, arthroscopic procedures can be considered an alternative and effective modality for successful management of cases of synovial chondromatosis of temporomandibular joint.

Failures in cranioplasty - A clinical audit & review.

INTRODUCTION: Cranioplasty, like any other surgical procedure also comes with risk of complications and failure. Failure of cranioplasty may be early or delayed and further can be attributed to the surgical procedure itself or to the reconstruction material used for the procedure. The aim of this clinical audit is to analyze the causes of failure of 14 cases of cranioplasty procedure. MATERIALS AND METHODS: This retrospective study analyses the causes of failure of 14 cases of cranioplasty over 8 â€‹years â€‹at a tertiary care centre and identifies major etiological factors for failure including local and systemic. Further, a correlation between the reconstruction material used for cranioplasty and failure was studied along with other attributable factors such as systemic status of the patient and other local factors. RESULTS: The study established that there exists a correlation between failure and the biomaterial used for reconstruction. Various etiological factors like infection, flap break down, fixation protocol and foreign body were identified along with time frame of failure. After failure of cranioplasty, feasibility of a secondary cranioplasty has also been factored into this study, with 8 out of the 14 cases being successfully re-operated. CONCLUSION: Cranioplasty is a technically demanding and demands certain levels of operator skill levels. While formulating a treatment plan for reconstruction of cranial defects, one has to tailor make a strategy considering several factors such as systemic condition of the patient, status of the cranial surgical site, etiology behind craniectomy, choice of reconstruction material, duration from craniectomy and age of the patient. Inspite of best efforts and ideal reconstruction attempts, failures remain a nagging reality.

Cost-Effective Realization of Multimode Exciton-Polaritons in Single-Crystalline Microplates of a Layered Metal-Organic Framework.

We report the observation of multimode exciton-polaritons in single-crystalline microplates of a two-dimensional (2D) layered metal-organic framework (MOF), which can be synthesized through a facile solvothermal approach, thereby eliminating all fabrication complexities usually involved in the construction of polariton cavities. With a combination of experiments and theoretical modeling, we have found that the exciton-polaritons are formed at room temperature as a result of a strong coupling between Fabry-Perot cavity modes formed inherently by two parallel surfaces of a microplate and Frenkel excitons provided by the 2D layers of dye molecular linkers in the MOF. Flexibility in rational selection of dye linkers for synthesizing such MOFs renders a large-scale, low-cost production of solid-state, micro-exciton-polaritonic devices operating in the visible and near-infrared range. Our work introduces MOFs as a new class of potential materials to explore polariton-related quantum phenomena in a cost-effective manner.

Nanosized Bispyrazole-Based Cryptand-Stabilized Palladium(0) Nanoparticles: A Reusable Heterogeneous Catalyst for the Suzuki-Miyaura Coupling Reaction in Water.

A macrobicyclic cryptand with a long rigid cavity incorporating a chelating bispyrazole moiety in each of the three bridges was synthesized. The multiple chelating metal binding sites were utilized for the controlled synthesis and stabilization of ultrafine palladium nanoparticles (Pd NPs) of nearly ∼2 nm size. The as-synthesized Pd NPs were characterized by X-ray photoelectron spectroscopy, transmission electron microscopy, and powder X-ray diffraction. The well-dispersed cryptand-stabilized nanoparticles are found to catalyze the C-C bond-forming Suzuki-Miyaura reaction heterogeneously using water as a green solvent.

Regioisomeric cryptand stabilized gold supraspheres and elongated dodecahedron supraparticles for reversible host-guest chemistry.

Addition of bis-pyrazole based cryptand regioisomers (1 and 2) to citrate stabilized gold nanoparticles (AuNPs) led to gold supraspheres (AuSSL) and elongated dodecahedron (AuEDL) supraparticles, respectively. These supraparticles as heterogenous hosts show a high uptake of a small fluorophore SEA-SC1 in an aqueous medium and reversible release in organic solvents.

Evaluation of graft uptake from the iliac crest in secondary alveolar bone grafting: Bergland's criteria revisited.

BACK GROUND: The secondary alveolar grafting is an integral part in the management of alveolar cleft defect. Particulate cancellous bone and marrow (PCBM) graft obtained from iliac crest are considered as the gold standard. AIM: Aim of the study was to evaluate the graft uptake clinically and radiologically using the Bergland's radiographic scale. MATERIAL AND METHODS: A longitudinal descriptive study was conducted on twenty patients of unilateral CLP in the age group of 6-13 years, presenting with residual/secondary alveolar cleft defect with unerupted maxillary lateral incisor/canine adjacent to the defect. Autologous PCBM graft obtained from iliac crest was used in all cases. Post operative clinical and radiological evaluation was carried out using the Bergland's radiographic scale at intervals of 1 week, 1 month and 6 months. DATA COLLECTION AND RESULT: Clinical evaluation consisted of assessment for infection, exposure of graft, rejection of graft, wound dehiscence and status of oronasal communication. A four-point Bergland's radiographic scale was used to compare the interdental height of the bone graft with unaffected side and categorized from grade I to IV. After six months, 6 cases were graded as grade I, 11 cases as grade II and 2 cases were grade III. Only one case deteriorated to grade IV which is considered as failure. SUMMARY AND CONCLUSION: Satisfactory results were obtained in 95% cases. Bergland's radiographic assessment scale is a valuable, easily available and inexpensive diagnostic tool to assess the condition of the grafted bone in SABG.

Efficacy of the Retroparotid Trans-Masseteric Approach via Retromandibular Incision in ORIF of Subcondylar Fractures: Our Institution Experience.

BACKGROUND: Fractures of the mandible subcondyle have always presented a challenge to the maxillofacial surgeon, with a myriad of treatment options existing ranging from conservative management to open reduction and internal fixation (ORIF) to condylotomy. The complex anatomy of the region poses a challenge, with injury to the facial nerve branches being the primary concern. OBJECTIVE: This study evaluated the efficacy of a modified retromandibular approach, with retroparotid trans-masseteric dissection for ORIF of subcondylar fractures. METHODOLOGY: Twenty-five patients with subcondylar fractures at varying levels were treated surgically by ORIF using this approach. RESULTS: All patients managed by this modified retromandibular approach had satisfactory results with restoration of vertical ramal height, satisfactory mouth opening, stable occlusion and no facial nerve damage post-op. CONCLUSION: In our study, the modified retromandibular approach, with retroparotid trans-masseteric approach was effective in surgical management of subcondylar fractures by ORIF with minimal complications.

Complications of Cranioplasty.

Cranioplasty is a time-honoured surgical procedure to restore the calvarial form and function that is associated with a relatively high complication rate. The present article analyzed various complications and reviewed the complications based on study of the relevant research in the craniofacial literature. Complications were broadly divided into 2 groups, intraoperative and postoperative, for ease of understanding. The etiological factors, local and systemic condition of the patient, prevention, and management of various complications were widely discussed. The article also highlighted problems and complications associated with various reconstructive materials. Insights into various complications of cranioplasty enable surgeon to understand them better, minimize the chances of occurrence, and improve surgical outcome. In spite of reported high rate of complications, serious complications like meningitis, air embolism, and death are rare.

A Cu(ii) metal-organic framework with significant H2 and CO2 storage capacity and heterogeneous catalysis for the aerobic oxidative amination of C(sp3)-H bonds and Biginelli reactions.

A Cu(ii) metal-organic framework, {[Cu2(L)(H2O)2]·(5DMF)(4H2O)}n (1), has been synthesized using an angular tetracarboxylic acid ligand (H4L) incorporating both trifluoromethyl (-CF3) and amine (-NH2) groups. Notably, the framework possesses high water and thermal stability. At atmospheric pressure, the activated framework 1' exhibits substantially high amounts of CO2 (35.5 and 20.8 wt% at 273 and 298 K respectively) and H2 (1.72 wt% at 77 K) adsorption. Also, 1' exhibits excellent catalytic activity for the condensation-cyclization reaction between 2-benzoyl pyridine and different benzylamines via oxidative amination of the C(sp3)-H bond to form 1,3-diarylated imidazo[1,5-a]pyridines under mild aerobic conditions. In addition to this, 1' shows excellent heterogeneous catalytic activity in Biginelli reactions. The solid catalyst could be recycled several times without significant loss in the catalytic activities.

Chiral Cadmium(II) Metal-Organic Framework from an Achiral Ligand by Spontaneous Resolution: An Efficient Heterogeneous Catalyst for the Strecker Reaction of Ketones.

A thermally stable cadmium-based chiral metal-organic framework (MOF), {[Cd2(L)(H2O)(DMF)]·3DMF·2H2O}n (1; DMF = N,N-dimethylformamide), has been synthesized from an achiral ligand by spontaneous resolution. The MOF features 1D open channels with a large density of active metal sites and has a 3,6-c binodal net with a rare sit 3,6-conn topology. The metal-bound water and DMF solvents could be easily removed along with the guest molecules in the lattice upon activation to afford the desolvated framework 1'. It exhibits microporous nature, as confirmed by the gas-sorption measurements with carbon dioxide uptake of 43.2 cm3 g-1 at 273 K. The open metal sites in the framework make it an outstanding heterogeneous catalyst in the Strecker reaction for the synthesis of α-aminonitriles in a solvent-free state at room temperature with excellent conversion yields.

From Zn(II)-Carboxylate to Double-Walled Zn(II)-Carboxylato Phosphate MOF: Change in the Framework Topology, Capture and Conversion of CO2, and Catalysis of Strecker Reaction.

The ligand H2L has been built by linking an imidazole moiety to the 5-position of isophthalic acid. It forms two types of porous frameworks, {[Zn(L)]·2DMF·2H2O}n (1) and {[(CH3)2NH2][Zn2(L)(H2O)PO4]·2DMF}n (2). 1 is a porous neutral framework and has rtl rutile 3,6-conn topology, while 2 is an organo-metallophosphate anionic porous framework with double-walled hexagonal channels. Framework 1' (desolvated) exhibits moderate CO2 adsorption (58 cc g-1 at 273 K, 1 bar), whereas 2' (desolvated) shows a microporous nature with a high adsorption of CO2 (111.7 cc g-1 or 22 wt % at 273 K, 1 bar). Interestingly, this adsorbed CO2 could be converted very efficiently to cyclic carbonates under mild conditions using 2' as the catalyst in the presence of tetrabutylammonium bromide as the cocatalyst. The presence of open metal sites in 2' makes it an efficient heterogeneous catalyst for solvent-free three-component Strecker reaction using various aldehydes/ketones together with amines and trimethylsilyl cyanide in high yields at room temperature. The straightforward experimental and product isolation procedure along with easy recovery and reusability of the catalyst provided an attractive route for the synthesis of α-amino nitriles.

An Amine Functionalized Metal-Organic Framework as an Effective Catalyst for Conversion of CO2 and Biginelli Reactions.

A highly porous and thermally stable anionic Zn(II)-framework, {[(CH3)2NH2+]2[Zn3((µ3-O))(L)2(H2O)]·4DMF·2H2O}n (1), having exposed metal sites and pendant amine groups has been synthesized adopting the solvothermal technique. This anionic 3D framework showed two-fold interpenetration with 45.1% void volume. It has a 3,6-c binodal net with rare sit 3,6-conn topology. The metal bound aqua ligand could be easily removed along with the guest molecules in the lattice upon activation to afford the desolvated framework 1'. This produced exposed metal sites that, along with the pendant amine groups incorporated in the ligand, generated a coordination space in the framework to make it an outstanding heterogeneous catalyst for the chemical fixation of CO2 with various epoxides under atmospheric pressure and in the three-component Biginelli reaction with different aldehydes, ethyl acetoacetate, and urea to afford dihydropyrimidinones.

Classification of the Residual Cranial Defects and Selection of Reconstruction Materials.

The cranial defects are complex in nature and are due to various causes. Therefore, there is a need for a common term of reference to these defects. This requirement stood as a prime reason for proposing a classification system for cranial defects. The classification is based on 2 decades of experience in cranioplasty. This efficient and simple way of representation would fill the existing lacunae for a systematic communication on cranial defects. Over the ages the evolution of reconstruction and grafting had undergone a massive progress. Therefore, it is essential to enumerate all available graft and bio-materials for restoring the cranial defects. The aetiology for these defects, age and sex of the patient, site and size of the defect, associated systemic conditions, cost factor, and operator's choice are the factors that play key role in the selection of the reconstructive material. This article discusses on these factors in cranioplasty. High success rate with excellent function and cosmetic outcome in using a variety of materials, as shared in this article. The advantages of autografts cannot be matched by any existing alloplast. However, in case of larger defects, for a better cosmetic outcome and to reduce the donor site morbidity, alloplasts are the most widely preferred material of choice.