Clinical diagnostic criteria versus advanced imaging in prediction of cervical lymph node metastasis in oral squamous cell carcinomas: A magnetic resonance imaging based study.

CONTEXT AND AIM: The inaccuracies in clinical examination have been well documented, while advanced imaging modalities, including computed tomography and magnetic resonance imaging (MRI), have been shown to have superior diagnostic accuracy in detecting occult and nodal metastasis. The aim of the present study was to identify as well as evaluate the inaccuracies in clinical examination and of clinical diagnostic criteria in known cases of oral squamous cell carcinomas (OSCCs) with the help of MRI. MATERIALS AND METHODS: A total of 24 patients attending as outpatients were included in the study, while clinically diagnosed and histopathologically proven cases of OSCC were examined clinically and then subjected to advanced imaging with the help of MRI. STATISTICAL ANALYSIS USED: Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 17.0 (SPSS Inc., Chicago, IL, USA), while paired t-test was performed for evaluating the size of tumor and lymph node recorded on clinical and imaging findings. A P < 0.05 was considered statistically significant. RESULTS: Detection of tumor size and lymph node metastasis was found to be higher in case of MRI than when accomplished by clinical staging alone, while paired t-test values for difference in results were found to be statistically significant (P < 0.05). CONCLUSIONS: The present study showed that clinical diagnostic criteria alone were not sufficient and reliable for detecting metastatic lymphadenopathy, highlighting the significance of advanced imaging modalities such as MRI for an efficient preoperative diagnostic workup, as well a tool for planning treatment in patients with OSCCs.

A Modification of the Classical Dautrey's Procedure - A Case Report.

Rationale: The rationale was to establish a permanent surgical solution for nonreducing dislocations of the temporomandibular joint (TMJ). Patient Concerns: The patient presents with a long-standing history of chronic subluxation of the TMJ bilaterally, with the need to forcibly manipulate and reduce the dislocated jaw. Diagnosis: Chronic recurrent dislocation of the TMJ. Treatment: A modified Dautrey's procedure was performed on the right side, with the osteotomized segment being transferred medially and inferiorly. Outcome: After 5 years of follow-up, there was no incidence of recurrent dislocation. Take-away Lesson: This modification is a viable option in both unilateral and bilateral reducing and nonreducing dislocations.