Osteomyelitis and Pathologic Fracture of Mandible in Undiagnosed Osteopetrosis.

Osteopetrosis (OP) is a heterogeneous group of rare, heredity bone disorders with variable clinical features involving the bones of the body. OP is characterized by increased bone density, which is caused by aberrant osteoclast-mediated bone resorption. This syndromic disorder comes with a series of problems and, unless recognized and treated early, can lead to a multitude of further grave complications. We report a rare case of a female patient who reported chronic unhealed extraoral draining sinus present over the left submandibular region with pathologic fracture of the left mandibular angle, which, if, was diagnosed early with the identification of the osteopetrosis syndrome, could have been managed more conservatively.

Histopathological Interpretation of TMJ Osteophyte: Report and Review.

Introduction: Osteophytes are osseocartilaginous structures which are commonly found in common degenerative joint diseases. It can be free or attached to nature. There is a paucity of information in the literature regarding the histopathological interpretation of osteophytes in Temporomandibular Joint (TMJ). Purpose: To report the incidental finding of osteophytes in cases of chronic protracted TMJ dislocation. Material and Method: To present case of an elderly 72-year-old female and a 35-year-old male with chronic protracted TMJ dislocation who were treated surgically for their condition with an incidental finding of an osteophyte in TMJ intraoperatively. Result: The histopathological examination revealed fibrocartilaginous core tissue surrounded by bone formation due to dystrophic calcification. Conclusion: The microscopic examination is mandatory in order to study and understand the pathophysiology of an osteophyte. This study presents rare histopathological evidence of an osteophyte. It reflects the process of its formation and the possibilities of fate of an osteophyte in TMJ.

"Bridging the Breach": Cranioplasties Using Different Reconstruction Materials-An Institutional Experience.

Introduction: Cranioplasty is a time tested surgical procedure to restore the form and function of either congenital or acquired calvarial defects. Both autologous bone flaps and alloplastic substitutes have been surgically explored over time to achieve the pre-morbid contour and eliminate the existing and anticipated complications like the "Sinking flap Syndrome". Though autologous bone flap, if preserved, is generally considered the first choice for reconstruction, however its absence/large defect reconstruction calls for alternative options. The selection of the reconstructive material is governed by various patient factors and material-related issues. The current study is an institutional experience of calvarial reconstruction with different materials. Though the aim of the surgery is always maximum patient comfort and satisfaction, post-operative outcome may vary from case to case. Materials and Method: Patients with calvarial defects post decompressive craniectomy, referred to the Department of OMFS from the Department of Neurosurgery/Neurology at our tertiary care centre, were successfully managed for the same using autologous Bone flap, customized Titanium and PEEK patient specific implant (PSI). Post-op evaluation for aesthetics, ease of adjustment/workability, thermal conductivity and infection/exposure was done at 01 and 06 months. Results: Fifteen patients of cranial defects post decompressive craniectomy were taken up of calvarial reconstruction using autologous Bone flap (n = 5), Titanium (n = 5) and PEEK (n = 5) patient specific implant (PSI). Satisfactory restoration of cranial contour was seen in all cases immediately after surgery. One patient underwent flap necrosis in bone flap group, while thermal conductivity was reported in 2 out of 5 cases of titanium PSI. Ease of workability was relatively low in all cases of PEEK group while increased overall surgical duration was encountered in bone flap group owing to second surgical site in abdomen. Conclusion: A variety of reconstruction materials may be used for cranial contouring depending on the defect and surgeon's experience, however the results may vary from case to case thus mandating tailor-made treatment for each patient.

Correlating Nasal Patency with Obstructive Sleep Apnea in Obese Versus Non-Obese Patients: An Acoustic Rhinometry Study.

The aim of this study was to correlate nasal patency with Obstructive Sleep Apnea (OSA) in obese versus non-obese patients using Acoustic Rhinometry (AR). Eccovision® Acoustic Rhinometer equipment was used to compare nasal cross-sectional areas (CSA1,2 & 3 corresponding to nasal valve region, anterior portion of middle & inferior turbinate and posterior portion of middle & inferior turbinate respectively) and volume in age and gender matched sample divided into three groups: Group 1: Non-obese patients without OSA (25 patients, 13 males and 12 females); Group 2: Non-obese patients with OSA (25 patients, 14 males and 11 females); Group 3: Obese patients with OSA (25 patients, 13 males and 12 females). The mean nasal cross-sectional areas and volume were lower in Group 2 compared to Group 1 but statistically non-significant (P value > 0.05 for all). The mean nasal cross-sectional areas and volume were significantly lower in Group 3 as compared to Groups 1 and 2 (P value < 0.05 for all). BMI showed a statistically significant positive (direct) correlation with AHI in Groups 2 and 3 (P value < 0.05 for both). The nasal cross-sectional areas and volume showed a statistically significant negative (inverse) correlation with AHI in Groups 2 and 3 (P value < 0.05 for both). OSA diagnosed cases with high BMI may not present with an obvious nasal obstruction; the nasal patency may still be compromised due to reduced nasal lumen secondary to obesity. AR, being cost-effective and non-invasive modality; is advocated to evaluate pre-treatment nasal patency, as well as follow up evaluation to ascertain improvement after the intervention.

Rehabilitation of acquired mandibular defect with two-piece, magnet-retained salivary reservoir.

Resection of large tumors involving mandible is the most common reason for mandibulectomy in patients. Adjunct therapies complicate the clinical situation and advocates innovations in conventional design concepts and treatment protocols. Xerostomia is one of the most common complications arising post-radiotherapy. Incorporation of a salivary reservoir in the design has been frequently used in xerostomia patients using acrylic dentures. The purpose of the article is to highlight a technique and steps in rehabilitation of a large acquired mandibular defect using a two-piece, magnet-retained acrylic removable partial denture with salivary reservoir.

Long-Term Study of Relapse After Mandibular Orthognathic Surgery: Advancement Versus Setback.

Background: Relapse is a continuing process and should be evaluated on a long rather than short term. Materials and Methods: Treatment records of 46 patients who underwent mandibular orthognathic surgery were divided into two groups, i.e. Group 1: Mandibular Advancement (MA) surgery (n = 26) and Group 2: Mandibular Setback (MS) surgery (n = 20). Lateral cephalograms were traced at T0 (01 week before surgery), T1 (01 week after surgery), T2 (01 year after surgery) and T3 (minimum 05 years after surgery) to study short- and long-term skeletal and dental relapse in horizontal, vertical and angular parameters selected for the study. Relapse was correlated with gender, age, amount of surgical movement and intra-operative change in mandibular plane angle to study effect of these factors on relapse. Results: All horizontal, vertical and angular parameters studied showed significant relapse at short term (from T1 to T2) which continued significantly till long-term evaluation (T2 to T3) in both groups (P value < 0.001). Horizontal relapse in all parameters, vertical relapse in all parameters (except Pog and overbite at T1-T2) and angular relapse in all parameters (except Ramus inclination at T1-T2) was significantly higher in Group 2 compared to Group 1 (P value < 0.001 for all). Relapse showed significant and positive correlation with amount of surgical movement and intra-operative change in mandibular plane angle in both groups (P value < 0.05 for all). Conclusion: Both MA and MS surgeries show significant relapse on both short- and long-term evaluation which it is higher in MS as compared to MA surgeries.

Effect of Mandibular Setback Surgery on Tongue Length and Height and Its Correlation with Upper Airway Dimensions.

INTRODUCTION: The changes in length and height of tongue following mandibular setback (MS) surgery may affect pharyngeal airway dimensions. There is limited literature correlating tongue dimensional changes with linear and volumetric airway changes following MS with bilateral sagittal split ramus osteotomy (BSSRO) in skeletal class III patients. MATERIALS AND METHODS: Treatment records of 18 patients who underwent MS with BSSRO were evaluated for changes in tongue and linear airway dimensions, mean airway volume and area at T1 (1-week pre-surgery), T2 (6-month post-surgery) and T3 (2-year post-surgery). Amount of MS was recorded from case sheets of patients. Mean tongue length reduced, whereas mean tongue height increased at T2 compared to T1 (P value = 0.001 for both). Linear, area and volumetric airway parameters at T2 were significantly reduced (P value = 0.001). All parameters showed statistically nonsignificant increase from T2 to T3 (P value > 0.05). Correlation analysis showed that change in tongue length at T3 did not show statistically significant correlation with amount of MS, changes in linear, area and volumetric airway parameters (P value > 0.05). However, the change in tongue height at T3 showed a significant (P value < 0.05) negative correlation (r value = - 0.742) with change in posterior airway space (PAS). CONCLUSIONS: The appraisal of tongue length and height after MS surgery should be an integral part of diagnosis and treatment planning. The retro-positioning of tongue and increase in its height after MS surgery may compromise pharyngeal airway especially PAS. Additional options such as bi-jaw surgery, debulking of tongue volume and genioplasty should be explored to minimize adverse effects post-surgically.

Evaluation of Airway Dimensions Following Mandibular Setback with Surgery-First Orthognathic Versus Conventional Orthognathic Approach.

BACKGROUND: To evaluate changes in airway dimensions following mandibular setback with conventional orthognathic approach (COA) and surgery-first orthognathic approach (SFOA). MATERIALS AND METHODS: Treatment records of 20 patients who underwent mandibular setback with SFOA/COA were divided into two groups (COA and SFOA, ten patients in each group). Acoustic pharyngometry values were obtained at T0 (01 week prior to surgery), T1 (01-month post-surgery) and T2 (01-year post-surgery). Percentage change in mean volume and area was obtained at T1 (T1-T0) to evaluate airway changes and at T2 (T2-T1) to compare relapse of airway changes in both groups. Changes in airway per mm setback at T1 (T1-T0) and T2 (T2-T1) were also obtained in both groups. RESULTS: For both parameters, SFOA showed greater reduction at T1 and greater relapse at T2 as compared to COA. The reduction in airway volume at T1 was 0.56 mm/mm setback in COA compared to 1.06 mm/mm setback in SFOA (P-value > 0.05). The relapse in airway volume at T2 was 0.15 mm/mm setback in COA compared to 0.25 mm/mm setback in SFOA (P-value > 0.05). The reduction in area at T1 was 0.062 mm/mm setback in COA compared to 0.110 mm/mm setback in SFOA (P-value > 0.05). The relapse in area at T2 was 0.016 mm/mm setback in COA compared to 0.034/mm setback in SFOA (P-value < 0.05). CONCLUSION: In setback cases, SFOA has greater airway reduction immediate post-surgically and greater relapse at 01-year follow-up. Predicting these changes at diagnostic and treatment planning stage may prevent potential adverse events on airway.

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.

Neonatal vascular malformation of parietal bone.

Vascular malformations (VaMs) are congenital lesions and are present at birth. They grow commensurately with age. These lesions often affect the soft tissues with intraosseous involvement of the scalp being rare. Here, we discuss a case of intraosseous VaM in a 2-month-old infant which was involving the parietal bone.

Effect of Mandibular Advancement Surgery on Tongue Length and Height and Its Correlation with Upper Airway Dimensions.

INTRODUCTION: The spatial position and dimensions of oral and pharyngeal soft tissues change post-mandibular advancement (MA) surgery which involves changes in position of soft palate, tongue and associated musculature. There is no study which simultaneously evaluates changes in tongue length and height post-MA surgery and correlates these changes with changes in upper airway dimensions and the amount of MA. MATERIALS AND METHODS: Treatment records of 18 patients that underwent MA with bilateral sagittal split ramus osteotomy were evaluated at T1 (01 week before surgery) and T2 (06 months post-surgery). Linear airway and tongue measurements were done on lateral cephalogram. Mean volume and mean pharyngeal area values were recorded from the acoustic pharyngometry (AP) records of patients. RESULTS: A statistically significant increase in tongue length (P value < 0.001) and nonsignificant change in tongue height were observed at T2 (P value > 0.05). A statistically significant increase in airway parameters recorded on both lateral cephalogram and AP was observed at T2 (P value < 0.001). Correlation analysis did not show a statistically significant correlation of change in tongue length and tongue height at T2 with the amount of MA, change in airway parameters on lateral cephalogram and AP (P value > 0.05). CONCLUSIONS: Mandibular advancement surgery is a viable option for improvement in pharyngeal airway in skeletal Class II patients with retrognathic mandible. Changes in tongue length observed in our study may correspond to the stretch of protruders of tongue, especially genioglossus, and may point toward possible relapse on a long-term follow-up.

Transverse Changes in Mandible Following Bilateral Sagittal Split Ramus Osteotomy Advancement.

BACKGROUND: BSSRO is the most frequently performed surgical procedure for mandibular advancement. However, the effect of advancement on proximal segment is not clearly understood. AIM AND OBJECTIVES: The aim of the study was to evaluate the radiographic transverse changes in mandible following BSSRO advancement and to compare the amount of transverse displacement of the proximal segment with the amount of surgical advancement. MATERIALS AND METHODS: Twelve cases of skeletal class II deformity undergoing fixed orthodontic mechanotherapy and requiring mandibular advancement were selected for the study. Pre-operative (T0) PA ceph and OPG were used to measure the linear distances from right to left Co-Go, Go-Me, Go-Go, Co-Co, Rp-Rp and Co-Me points. The cases were operated for BSSRO mandibular advancement. Post-operative (T1) PA ceph and OPG were used to compare the changes in linear measurements. RESULT: There were six male and six female patients with an average age of 19.5 years. The average mandibular advancement was 6.5 mm. Post-operative radiographic changes in transverse measurements of Go-Me, Go-Go, Co-Co, Rp-Rp and Co-Me were statistical significant. The changes in Co-Go measurements were statistically not significant. We could not establish any correlation between mandibular advancement and amount of transverse changes. CONCLUSION: Significant changes were noticed in transverse dimensions of mandible following BSSRO advancement in both PA ceph and OPG. The transverse changes had no clinical implication during the post-operative follow-up.

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.

Tension Pneumocephalus-A Rare Complication of Craniofacial Fracture: Report and Review.

The term tension pneumocephalus (TP) means raised intracranial pressure due to air in the cranial cavity. This presentation is a rare case report and review on TP. Decompressing this raising intracranial pressure is a surgical emergency. Therefore, this presentation emphasises the importance of timely identification and management of TP in saving life. In this case, the acute signs of raising intracranial pressure were identified and promptly addressed surgically along with the maxillofacial injury management. This restored the deteriorating neurological status as well as his facial form and function. The etiological factors, pathophysiology and various treatment options are reviewed.

Instrumentation and signal processing for the detection of heavy water using off axis-integrated cavity output spectroscopy technique.

An experimental setup is developed for the trace level detection of heavy water (HDO) using the off axis-integrated cavity output spectroscopy technique. The absorption spectrum of water samples is recorded in the spectral range of 7190.7 cm-1-7191.5 cm-1 with the diode laser as the light source. From the recorded water vapor absorption spectrum, the heavy water concentration is determined from the HDO and water line. The effect of cavity gain nonlinearity with per pass absorption is studied. The signal processing and data fitting procedure is devised to obtain linear calibration curves by including nonlinear cavity gain effects into the calculation. Initial calibration of mirror reflectivity is performed by measurements on the natural water sample. The signal processing and data fitting method has been validated by the measurement of the HDO concentration in water samples over a wide range from 20 ppm to 2280 ppm showing a linear calibration curve. The average measurement time is about 30 s. The experimental technique presented in this paper could be applied for the development of a portable instrument for the fast measurement of water isotopic composition in heavy water plants and for the detection of heavy water leak in pressurized heavy water reactors.

Effect of oxygen partial pressure in deposition ambient on the properties of RF magnetron sputter deposited Gd2O3 thin films.

Gadolinium oxide is an excellent optical material that offers high transmission in a wide wavelength range of 200-1600 nm and exhibits a high bulk refractive index of ∼1.80 at 550 nm. In the present study, a set of Gd2O3 thin films has been deposited on fused silica substrates by RF sputtering of a Gd2O3 target under various O2 to Ar flow ratios. The samples have been characterized by grazing incidence x-ray diffraction (GIXRD) to study the long range structural behavior, by GIXR to study density and surface roughness of the films, by atomic force microscopy measurements to study morphological properties, by Rutherford backscattering measurements for compositional studies, and by transmission spectrophotometry and spectroscopic ellipsometry techniques to study their optical properties. It has been observed that the films deposited with 10% oxygen partial pressure have low density, high surface roughness, and high void content, which results in a low value of refractive index of this film, and film quality improves as oxygen partial pressure is further increased. Extended x-ray absorption fine structure measurement with synchrotron radiation has also been employed to extract local structural information around Gd sites, which has in turn been used to explain some of the observed macroscopic properties of the films.

Insight into growth of Au-Pt bimetallic nanoparticles: an in situ XAS study.

Au-Pt bimetallic nanoparticles have been synthesized through a one-pot synthesis route from their respective chloride precursors using block copolymer as a stabilizer. Growth of the nanoparticles has been studied by simultaneous in situ measurement of X-ray absorption spectroscopy (XAS) and UV-Vis spectroscopy at the energy-dispersive EXAFS beamline (BL-08) at Indus-2 SRS at RRCAT, Indore, India. In situ XAS spectra, comprising both X-ray near-edge structure (XANES) and extended X-ray absorption fine-structure (EXAFS) parts, have been measured simultaneously at the Au and Pt L3-edges. While the XANES spectra of the precursors provide real-time information on the reduction process, the EXAFS spectra reveal the structure of the clusters formed in the intermediate stages of growth. This insight into the formation process throws light on how the difference in the reduction potential of the two precursors could be used to obtain the core-shell-type configuration of a bimetallic alloy in a one-pot synthesis method. The core-shell-type structure of the nanoparticles has also been confirmed by ex situ energy-dispersive spectroscopy line-scan and X-ray photoelectron spectroscopy measurements with in situ ion etching on fully formed nanoparticles.

Early Postoperative Malignant Subcutaneous Emphysema: Report and Review.

BACKGROUND: Subcutaneous emphysema is defined as presence of air or gas in subcutaneous tissue layer. It may be localized or generalized due to various aetiological factors. Although SE and pneumomediastinum are self-limiting conditions, life-threatening complications may develop. Escape of air into both pleural cavity causing bilateral pneumothorax and tension pneumothorax can be termed as malignant emphysema. PURPOSE: To report a case of malignant generalized subcutaneous emphysema in early postoperative phase following palatoplasty. CASE REPORT: A 25 year old female patient was operated for closure of residual oronasal communication using an anteriorly based tongue flap. The patient was reversed from general anesthesia and shifted to the post-operative room with the endotracheal tube in situ. Sudden swelling of the face and periorbital area was noticed which spread all over the body. A diagnosis of malignant post-operative subcutaneous emphysema was made and the patient was shifted back to the operation theatre. She was managed successfully by bilateral tube thoracotomy and tracheostomy. CONCLUSION: Close observation of the patient in early postoperative stage having endotracheal tube in situ is crucial to avoid such complication. Regardless of aetiology, early recognition of the clinical features of tension pneumothorax and timely intervention are necessary for the survival of the patient.