A rare differential diagnosis of aortic stenosis with a black aortic valve: A case report.

BACKGROUND: Cardiac ochronosis, presenting as a rare manifestation of alkaptonuria, an autosomal recessive disorder, is characterised by black pigmentation of calcified cardiac valves and atherosclerotic plaques. We report an intraoperative dilemma on the discovery on the black aortic valve in a case of an old lady with degenerative calcific aortic stenosis. CASE PRESENTATION: A 60-year-old lady was electively admitted for valve replacement with a bioprosthetic valve for severe aortic stenosis. She was symptomatic with complaints of headache and giddiness and had a pressure gradient of 113/17mmhg across the aortic valve. Intraoperatively, she was found to have cardiac ochronosis on the discovery of pigmented aortic intima extending to the valve leaflets and underwent valve replacement with a mechanical prosthetic valve. She was post-operatively evaluated for the same and diagnosed with alkaptonuria. Though the surgery went uneventful and the patient was discharged without any complication, she was advised to be on regular follow-up to assess valve gradients, paravalvular leaks and to monitor the disease progression. CONCLUSION: The presented case sheds light on the rare cardiac manifestation of alkaptonuria. In the absence of definitive pre-operative diagnosis, intraoperative findings played a pivotal role in guiding the surgical approach and choice of prosthetic valve. The decision to use a mechanical valve was influenced by the potential risks associated with bioprosthetic valves in the setting of ochronosis. Ongoing follow-up and monitoring are essential to assess the durability of the chosen prosthetic valve and to manage any long-term consequences of the underlying metabolic condition.

Developing and Validating Quantitative Food Frequency Questionnaire to Assess Dietary Vitamin D Intake among Adults in Indian Population.

ABSTRACT: The objective of this study is to create and validate a quantitative food frequency questionnaire (FFQ) for the assessment of Vitamin D intake among adults in Indian population. A quantitative FFQ was developed consisting of Vitamin D dietary-rich sources selected from IFCT, 2017. Further, the FFQ was validated against 24-h dietary recall from randomly selected 385 adults, both men and women above 25 years of age. The mean dietary Vitamin D intake estimated using quantitative FFQ was 402.61 ± 101.21 IU/day and that from 24-h dietary recall was 392.83 ± 120.86 IU/day. The coefficient of correlation between these two methods was 0.86 (P < 0.001) suggestive of high correlation between the two dietary assessment tools. This indicates that Vitamin D intake from FFQ and 24-h recall was similar. This efficient FFQ can assess adult Vitamin D intake in epidemiological studies, offering convenience, and ease of evaluation.

Characterization of a novel root-associated diazotrophic rare PGPR taxa, Aquabacter pokkalii sp. nov., isolated from pokkali rice: new insights into the plant-associated lifestyle and brackish adaptation.

Salinity impacts crop growth and productivity and lowers the activities of rhizosphere microbiota. The identification and utilization of habitat-specific salinity-adapted plant growth-promoting rhizobacteria (PGPR) are considered alternative strategies to improve the growth and yields of crops in salinity-affected coastal agricultural fields. In this study, we characterize strain L1I39T, the first Aquabacter species with PGPR traits isolated from a salt-tolerant pokkali rice cultivated in brackish environments. L1I39T is positive for 1-aminocyclopropane-1-carboxylate deaminase activity and nitrogen fixation and can promote pokkali rice growth by supplying fixed nitrogen under a nitrogen-deficient seawater condition. Importantly, enhanced plant growth and efficient root colonization were evident in L1I39T-inoculated plants grown under 20% seawater but not in zero-seawater conditions, identifying brackish conditions as a key local environmental factor critical for L1I39T-pokkali rice symbiosis. Detailed physiological studies revealed that L1I39T is well-adapted to brackish environments. In-depth genome analysis of L1I39T identified multiple gene systems contributing to its plant-associated lifestyle and brackish adaptations. The 16S rRNA-based metagenomic study identified L1I39T as an important rare PGPR taxon. Based on the polyphasic taxonomy analysis, we established strain L1I39T as a novel Aquabacter species and proposed Aquabacter pokkalii sp nov. Overall, this study provides a better understanding of a marine-adapted PGPR strain L1I39T that may perform a substantial role in host growth and health in nitrogen-poor brackish environments.

Evaluation of platelet derived growth factor-BB levels in injectable platelet rich fibrin coated graft using gingival pedicle split thickness tunnel technique for isolated gingival recession: A randomized controlled trial.

Background: Use of injectable-platelet rich fibrin (i-PRF) in the field of periodontal regeneration is quite well known due to its efficacy. The study was aimed to evaluate the platelet derived growth factor-BB (PDGF-BB) levels in cases of isolated gingival recession using gingival pedicle split thickness tunnel technique (GPST) and de-epithelialized gingival graft (DGG) with or without coating it with i-PRF. Methodology: 20 patients exhibiting Miller's class I/II isolated gingival recession were selected for this parallel arm randomized controlled trial. Recipient site was prepared using GPST technique, free gingival graft was harvested and de-epithelialized, further graft was coated with i-PRF and wound fluid samples from surgical site were collected at baseline, 3rd day and 7th day for group A. The same procedure without coating the graft in i-PRF was carried out for group B. Clinical parameters like probing depth, recession depth, recession width, width of keratinized gingiva, wound healing index (WHI), complete root coverage was recorded at baseline and after 4 months. Results: Significant intergroup difference was seen in WHI and the levels of PDGF-BB from baseline to the last estimated time point (p < 0.05). Conclusion: The study emphasizes on the use of novel GPST technique in conjunction with DGG coated with liquid PRF, which has shown sustained release of PDGF-BB resulting in better wound healing.

The comprehensive characterization of Prosopis juliflora pods as a potential bioenergy feedstock.

The production of renewable and sustainable biofuels using inevitable wastes is a promising alternative to the alarming depletion of fossil fuels. Significantly, the sustainable biorefinery of lignocellulosic waste, as an alternative fuel source, is a prognosticating approach to tackle many agricultural/forestry residues and offers a circular economy as well as environmental benefits. But, the heterogeneity of lignocellulosic biomass is one of the major bottlenecks in lignocellulosic biorefinery. Thus the characterization of lignocellulosic biomass is essential to understanding the feedstock's nature, composition and suitability for biofuel production. The present study taps evergreen spiny non-edible pods of Prosopis juliflora (Pj) as an energy feedstock. Proximate, ultimate and biochemical characterization of Pj pods were conducted, and thermal behaviour and calorific values were determined. Cellulose and hemicellulose were isolated and characterized by reliable methods. The overall characterization has revealed the Pj pods as a potential feedstock for bioenergy. The collected Pj pods contain (% w/w) moisture 7.89 ± 0.002, volatile matter 87.67 ± 0.002, ash 0.21 ± 0.002, fixed carbon 4.23 ± 0.002 with a calorific value of 17.62 kg/MJ. The CHNS content was (w/w %) carbon 41.77, nitrogen 3.58, sulfur 26.3 and hydrogen 6.55. The biochemical composition analysis yields (% w/w) on a dry basis; cellulose 26.6 ± 0.18, hemicellulose 30.86 ± 0.27, lignin 4.71 ± 0.12, protein 11.63 ± 0.12 and starch 1.1 ± 0.06 and extractives 30.56 ± 0.008. The isolated cellulose and hemicellulose were analyzed and confirmed by CP/MAS &1H NMR, FTIR, TG-DSC, SEM, XRD, and TGA. The present results revealed that the tested biomass, Prosopis juliflora, could be used as a feedstock in biorefinery for bioenergy.

ROS Dependent Antifungal and Anticancer Modulations of Piper colubrinum Osmotin.

Osmotin, a plant defense protein, has functional similarity to adiponectin, an insulin sensitizingsensitising hormone secreted by adipocytes. We speculated that Piper colubrinum Osmotin (PcOSM) could have functional roles in obesity-related cancers, especially breast cancer. Immunofluorescence assays, flow cytometry, cell cycle analysis and a senescence assay were employed to delineate the activity in MDAMB231 breast cancer cell line. PcOSM pre-treated P. nigrum leaves showed significant reduction in disease symptoms correlated with high ROS production. In silico analysis predicted that PcOSM has higher binding efficiency with adiponectin receptor compared to adiponectin. PcOSM was effectively taken up by MDAMB231 cancer cells which resulted in marked increase in intracellular ROS levels leading to senescence and cell cycle arrest in G2/M stage. This study provides evidence on the ROS mediated direct inhibitory activity of the plant derived osmotin protein on the phytopathogen Phytophthora capsici, and the additional functional roles of this plant defense protein on cancer cells through inducing ROS associated senescence. The strong leads produced from this study could be pursued further to obtain more insights into the therapeutic potential of osmotin in human cancers.

Biologically synthesized ZnS quantum dots as fluorescent probes for lead (II) sensing.

This manuscript presents a robust strategy for selective Pb(II) sensing based on a fluorescence turn-off mechanism using ZnS quantum dots (QDs) biosynthesized using Aspergillus sp. The biogenic nanoprobe displayed marked sensing efficiency in the presence of Pb ions over concentration ranges from 5 to 100 µM with limits of detection of around 2.45 µM. Performance optimization studies revealed that the maximum fluorescence quenching efficiency was obtained in the presence of [ZnS NPs] at 4 mg/ml, and alkaline pH of 10 recorded under stable ambient temperature for approximately 5 min for the quenching process. Advanced morphological analysis indicated that the bio-sensing mechanism was essentially a surface-based phenomenon in which the Pb ions were in very close proximity to the QDs and formed stable ground-state Pb-ZnS complexes, resulting in a quenched fluorescence of the QDs. Simultaneously, a larger fraction of Pb ions interacted via collisions with the excited ZnS QDs and resulted in an effective energy transfer from the excited QDs to the Pb ions, therefore resulting in an obvious decrease in QD fluorescence. These insights were well supported by theoretical analysis using Stern-Volmer plots and sphere-of-action models.

Maximizing the direct recovery and stabilization of cellulolytic enzymes from Trichoderma harzanium BPGF1 fermented broth using carboxymethyl inulin nanoparticles.

The carboxymethylated inulin (CMI) nanoparticles prepared by the salt out method was demonstrated to harvest cellulolytic enzymes (Ez) directly from the clarified fermented broth of Trichoderma harzanium BPGF1. The formation of CMI nanoparticles and entrapment of Ez in CMI was confirmed by scanning electron microscopy and Fourier transform infrared spectroscopy, respectively. A factorial design was developed to maximize enzymes recovery directly from the fermented broth. A maximum of 71.68 ± 8.61% cellulolytic enzymes was recovered using 20 mg/L inulin, 2 M sodium chloroacetate at 80 °C for 2 h. The resultant CMIEz nanohybrid displayed excellent activity in broad pH and temperature. Moreover, CMIEz was reusable for >30 cycles without losing efficiency. The real-time application of CMIEz was demonstrated by hydrolyzing acid pretreated corncob. High-pressure liquid chromatography revealed that the hydrolyzed corncob contained cellobiose, glucose, galactose, xylose, mannose, and arabinose. The results highlight that carbohydrate nanoparticles was useful in engulfing enzymes directly from the fermentation broth.

Immediate Ridge Augmentation Using Autogenous Tooth Root as a Block Graft in a Periodontally Hopeless Extraction Site: A Pilot Study.

The aim of the our study was to assess the efficacy of autogenous tooth root as a block bone graft in reconstructing the vertical and horizontal dimensions at periodontally hopeless extraction sites both clinically and radiographically. A total of 13 patients having a tooth with periodontally hopeless prognosis and indicated for extraction were included in the study. Following atraumatic extraction, the tooth was processed to create a decoronated cementum-free dentin block which was used to augment the extraction socket. The augmentation of periodontally hopeless socket with tooth block autograft resulted in a gain of clinical ridge width of 5.9 mm radiographically, the apico-coronal defect depth reduced up to 8.2 mm (P = .001), and a gain in ridge width of 5.8 mm postoperatively after 6 months (P = .001). The present study demonstrated the effectiveness of using tooth root as a block graft for ridge augmentation in the periodontally hopeless extraction site making it suitable for implant placement in future.

Bacterial Cellulose production by K. saccharivorans BC1 strain using crude distillery effluent as cheap and cost effective nutrient medium.

Bacterial Cellulose (BC), a valuable biopolymer gaining importance over the past few decades due to its remarkable properties and applications. In this study, crude distillery effluent having a high COD value of 87,433 mg/L was used to produce Bacterial Cellulose under static fermentation by Komagataeibacter saccharivorans, a novel isolated bacterial strain. 1.24 g/L of cellulose production was noted after eight days along with 23.6% reduction in COD value. The BC pellicle was purified, lyophilized and stored. Further, the lyophilized BC pellicle was subjected to characterization techniques such as SEM, ATR-FTIR, XRD, NMR and TLC. Morphological analysis revealed that cellulose fibers were dense with higher porosity and an average fiber width of 60 nm. FTIR depicted similar functional groups as that of BC-HS medium. TLC of the biopolymer was performed to evaluate its purity. X-ray diffraction and 13C NMR studies gave more insights about the crystalline and the amorphous regions; the synthesized polymer exhibited 80.2% as crystallinity and crystallite size of 8.36. Hence, the present study demonstrates that distillery effluent waters could be effectively reused as production medium fulfilling two objectives namely one reducing COD and making the effluent safe for disposal and two to produce a value-added product.

Transcriptome- Assisted Label-Free Quantitative Proteomics Analysis Reveals Novel Insights into Piper nigrum-Phytophthora capsici Phytopathosystem.

Black pepper (Piper nigrum L.), a tropical spice crop of global acclaim, is susceptible to Phytophthora capsici, an oomycete pathogen which causes the highly destructive foot rot disease. A systematic understanding of this phytopathosystem has not been possible owing to lack of genome or proteome information. In this study, we explain an integrated transcriptome-assisted label-free quantitative proteomics pipeline to study the basal immune components of black pepper when challenged with P. capsici. We report a global identification of 532 novel leaf proteins from black pepper, of which 518 proteins were functionally annotated using BLAST2GO tool. A label-free quantitation of the protein datasets revealed 194 proteins common to diseased and control protein datasets of which 22 proteins showed significant up-regulation and 134 showed significant down-regulation. Ninety-three proteins were identified exclusively on P. capsici infected leaf tissues and 245 were expressed only in mock (control) infected samples. In-depth analysis of our data gives novel insights into the regulatory pathways of black pepper which are compromised during the infection. Differential down-regulation was observed in a number of critical pathways like carbon fixation in photosynthetic organism, cyano-amino acid metabolism, fructose, and mannose metabolism, glutathione metabolism, and phenylpropanoid biosynthesis. The proteomics results were validated with real-time qRT-PCR analysis. We were also able to identify the complete coding sequences for all the proteins of which few selected genes were cloned and sequence characterized for further confirmation. Our study is the first report of a quantitative proteomics dataset in black pepper which provides convincing evidence on the effectiveness of a transcriptome-based label-free proteomics approach for elucidating the host response to biotic stress in a non-model spice crop like P. nigrum, for which genome information is unavailable. Our dataset will serve as a useful resource for future studies in this plant. Data are available via ProteomeXchange with identifier PXD003887.

Effect of various capping agents on photocatalytic, antibacterial and antibiofilm activities of ZnO nanoparticles.

Zinc oxide nanoparticles (ZnO NPs) are extensively used in a wide variety of commercial products including sunscreens, textiles and paints It is a known fact that ZnO NPs are not stable when dispersed in water, therefore manufacturers use several surface modifying agents to increase the stability of ZnO NPs. In the present study, ZnO NPs were synthesized via chemical co-precipitation with and without the use of surface modifying agents including ethylene glycol (EG), gelatin, polyvinyl alcohol (PVA) and polyvinylpyrrolidone (PVP). Preliminary characterization was done by UV-Visible spectroscopy. Electron microscopic analysis showed that the particles were hexagonal in shape. The hydrodynamic size distribution was analyzed by using dynamic light scattering method and crystalline nature was determined by X-ray diffraction method. The study evaluated the photocatalytic, antibacterial and antibiofilm activities of the particles with and without the addition of surface modifying agents. The capping of the particle was confirmed by FT-IR spectroscopy. The photocatalytic activity was checked against methylene blue. Capping of the particles reduced the photocatalytic activity of the particles. The antibacterial and antibiofilm activities were checked against Staphylococcus aureus (MTCC 3160) and Pseudomonas aeruginosa (MTCC 1688). Antibacterial activity was analyzed by simple plate count method both under dark as well as light condition. Antibiofilm activity was checked in both pre- and post-biofilm formation period under both dark as well as light condition. The activity was evaluated via crystal violet staining method. All the particles showed good antibacterial and antibiofilm activities.

'Stylo-mandibular complex' fracture from a maxillofacial surgeon's perspective--review of the literature and proposal of a management algorithm.

The incidence of fractures of styloid process, either in isolation or association with mandibular fractures, is rare, and frequently overlooked. When present, they pose clinical dilemma in diagnosis and management. Proper management of styloid fractures is essential, not just to alleviate the patients' symptoms, but also to prevent potential complications like post-traumatic styloid syndrome and injury to adjacent vital structures. This article features a review of literature on 'styloid fracture concomitant with mandibular fracture' along with a case report. The article explores the biomechanics resulting in styloid fracture especially when co-existing with mandibular fractures. The article also enumerates the clinical features of this unusual clinical phenomenon and aims at rationalizing the need for its medical or surgical management. A simple protocol for the management of 'stylo-mandibular complex' fracture has been proposed.

Down-regulation of osmotin (PR5) gene by virus-induced gene silencing (VIGS) leads to susceptibility of resistant Piper colubrinum Link. to the oomycete pathogen Phytophthora capsici Leonian.

Piper colubrinum Link., a distant relative of Piper nigrum L., is immune to the oomycete pathogen Phytophthora capsici Leonian that causes 'quick wilt' in cultivated black pepper (P. nigrum). The osmotin, PR5 gene homologue, earlier identified from P. colubrinum, showed significant overexpression in response to pathogen and defense signalling molecules. The present study focuses on the functional validation of P. colubrinum osmotin (PcOSM) by virus induced gene silencing (VIGS) using Tobacco Rattle Virus (TRV)-based vector. P. colubrinum plants maintained under controlled growth conditions in a growth chamber were infiltrated with Agrobacterium carrying TRV empty vector (control) and TRV vector carrying PcOSM. Three weeks post infiltration, viral movement was confirmed in newly emerged leaves of infiltrated plants by RT-PCR using TRV RNA1 and TRV RNA2 primers. Semi-quantitative RT-PCR confirmed significant down-regulation of PcOSM gene in TRV-PcOSM infiltrated plant compared with the control plants. The control and silenced plants were challenged with Phytophthora capsici which demonstrated that knock-down of PcOSM in P. colubrinum leads to increased fungal mycelial growth in silenced plants compared to control plants, which was accompanied by decreased accumulation of H2O2 as indicated by 3,3'-diaminobenzidine (DAB) staining. Thus, in this study, we demonstrated that Piper colubrinum osmotin gene is required for resisting P. capsici infection and has possible role in hypersensitive cell death response and oxidative burst signaling during infection.

Immunolocalization of heme oxygenase-1 in periodontal diseases.

CONTEXT: Chronic periodontitis is an inflammatory condition of supporting tissues initiated by organisms in dental plaque. The reactive oxygen species and free radicals mediate connective tissue destruction in periodontitis. In order to counteract the free radical mediated tissue damage, numerous antioxidant mechanisms exist within the host. One such system is heme oxygenase enzymes. Heme oxygenase is the key enzyme involved in catabolism of heme. It cleaves the heme molecule to yield equimolar amounts of biliverdin, carbon monoxide, and iron. These end products act as important scavengers of reactive oxygen metabolites. Increased heme oxygenase expression has been identified in inflammatory condition, such as pancreatitis, diabetes, nephritis, and atherosclerosis. Since chronic periodontitis is one such inflammatory condition, we assessed the expression of heme oxygenase-1, in smokers and periodontitis group using immunohistochemistry technique. AIMS: The aim of this study is to compare the expression of heme oxygenase-1 in patients with healthy periodontium, periodontitis and smokers. MATERIALS AND METHODS: Gingival tissue samples were taken from 30 patients, who were divided into three groups healthy controls (n = 10), chronic periodontitis (n = 10), and smokers with chronic periodontitis (n = 10). All the samples were subjected to immunohistochemical staining using the antiheme oxygenase-1 antibody and were tested for efficiency by staining a positive control (prostate cancer tissue sections) and a negative control. The results were tabulated and analyzed. RESULTS: Our results showed increased expression of heme oxygenase-1 in the gingival tissue samples taken from smokers compared with periodontitis and healthy tissue. CONCLUSION: The results of our study is an increasing evidence of involvement of antioxidant enzymes like heme oxygenase-1 in periodontal inflammation and their implication for treatment of chronic periodontitis.

An innovative technique for root coverage using pedicled buccal fat pad.

Various etiological factors are associated with gingival recession which may be anatomical, physiologic, or pathologic factors. Several root coverage procedures have been described to manage the gingival recession. However, it has been found that root coverage procedures in Miller's Class III and IV gingival recession have a poor prognosis with current techniques. A newer predictable technique, pedicled buccal fat pad (PBFP) has been introduced in cases of severe gingival recession. The buccal fat pad (BFP) is a specialized capsulated fat tissue that has the property of maintaining its volume and structure over a long period of time. It can also serve as a well vascularized, readily obtainable local flap for reconstructive purposes and increasing the dimensions of keratinized mucosa. The aim of this case report is to establish a new technique for root coverage using pedicled BFP in Miller Class IV recession on the maxillary right first molar.

In silico molecular docking and in vitro antidiabetic studies of dihydropyrimido[4,5-a]acridin-2-amines.

An in vitro antidiabetic activity on α -amylase and α -glucosidase activity of novel 10-chloro-4-(2-chlorophenyl)-12-phenyl-5,6-dihydropyrimido[4,5-a]acridin-2-amines (3a-3f) were evaluated. Structures of the synthesized molecules were studied by FT-IR, (1)H NMR, (13)C NMR, EI-MS, and single crystal X-ray structural analysis data. An in silico molecular docking was performed on synthesized molecules (3a-3f). Overall studies indicate that compound 3e is a promising compound leading to the development of selective inhibition of α -amylase and α -glucosidase.

Treatment of an early failing implant by guided bone regeneration using resorbable collagen membrane and bioactive glass.

Implant failure can be divided into early (prior to prosthetic treatment) or late (after prosthetic rehabilitation). Early failure is generally due to interference in the healing process after implant placement. Implants undergoing early failure will show progressive bone loss on radiographs during the healing period (4 to 6 weeks). In the present case report, early progressive bone loss was seen at 6 weeks, after placement of a non-submerged single piece mini implant. Clinical examination revealed peri-implant bleeding on probing and pocket and grade-1 mobility. Treatment protocol included mechanical debridement (plastic curettes), chemical detoxification with supersaturated solution of citric acid, antibiotics and guided bone regeneration therapy using the collagen membrane as guided bone regeneration barrier in combination with bioactive glass as bone grafting material. The 6 month postoperative examination showed complete resolution of the osseous defect, thus suggesting that this technique may hold promise in the treatment of implants undergoing early failure.

Evaluation of chemical composition and efficacy of Chinese propolis extract on Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans: An in vitro study.

BACKGROUND: Propolis as a natural remedy has maintained its popularity over long periods of time. The aim of this study was to determine the chemical composition in terms of total phenolic compounds and flavonoids present in Chinese propolis and to carry out an in vitro evaluation of its antimicrobial activity and the minimal inhibitory concentrations for Porphyromonas gingivalis (Pg) and Aggregatibacter actinomycetemcomitans (Aa). MATERIALS AND METHODS: From the ethanolic extract of propolis (EEP), total phenol content was determined by the Folin-Ciocalteau method, flavones and flavonols by the modified aluminum chloride colorimetric method, and flavanones by the 2.4-dinitrophenylhydrazine (2,4-DNP) method. Agar well diffusion assay was used to evaluate the antimicrobial potential of propolis against Pg and Aa. The minimum inhibitory concentration of propolis against the two bacteria was determined using serial tube dilution technique. RESULTS: The total concentration of phenol in the EEP was 19.44%, flavones and flavonols 2.616%, and flavanones 16.176%. The inhibitory zone depicting antimicrobial activity ranged from 18 to 25 mm for Pg and from 12 to 14 mm for Aa. The concentration range of Chinese propolis that is sensitive to inhibit the growth of Pg was 0.1-0.0125 µg/ml and for Aa it was 0.1-0.025 µg/ml. CONCLUSION: These data suggest that Chinese propolis has potent antimicrobial activity against the two periodontopathogens, suggesting its possible use as a natural alternative to the widely used synthetic antibiotics for periodontal therapy.

Embedded toothbrush foreign body in cheek - report of an unusual case.

BACKGROUND: Toothbrush injuries are common in children, and those of impalement and embedded injuries are the more serious. CASE REPORT: A five-year-old girl presented with a complaint of a swelling affecting the left side of her face and with difficulty in opening her mouth for the previous 15 days. She gave a history of a fall while brushing her teeth. A foreign body (head of a toothbrush) located adjacent to the mandibular ramus was identified with the help of a CT scan. TREATMENT: The foreign body was located by surgical exploration and retrieved. An extra-oral sinus that was present was excised and the resulting defect was reconstructed using a Limberg flap. FOLLOW-UP: Healing was uneventful during the follow-up period. After 18 months the child's mouth had completely healed although some extra-oral scarring was present. CONCLUSION: When dealing with children reporting for evaluation following trauma while tooth brushing, a thorough evaluation is essential for embedded foreign bodies.