Evaluation of treatment outcome amongst two different treatment modalities for reconstruction of carcinoma of tongue patients: The infrahyoid myocutaneous flap versus radial forearm flap.

Introduction: Oral cancer is one of the most common cancers not only in India but also in South Asia. Treatment of oral cancer is not only limited to cure but also requires good reconstruction of the surgical defects for a better quality of the life. There are many well-proven options for reconstruction purposes for the defects of the oral cavity including local regional flaps to microvascular-free flaps. After resections of mobile parts of the tongue (up to 50%) speech and swallowing are impaired significantly, however, even after sophisticated plastic reconstruction, serious swallowing and speech problems persist. Material and Methods: The pilot study was carried out after the allocation of fourteen patients with carcinoma of the tongue into two treatment test groups; the Radial forearm flap (RFF) and Infrahyoid neuromuscular flap (IHF) group to evaluate and compare the treatment outcome for reconstruction using two different treatment modalities. The pilot study was carried out after the allocation of fourteen patients with carcinoma of the tongue into two treatment test groups. the clinical parameters likewise swallowing reflex, speech analysis, donor site complication, time taken for the surgery, and cost-effectiveness of the flap was evaluated using IBM SPSS Statistics for Windows software, 20.0 (IBM Corp., Armonk, USA). The data were numerically coded and entered into the program. Both the descriptive statistics and the inferential statistics involving one-way ANOVA and Tukey's Post Hoc test were analyzed to compare both intergroup and intragroup comparisons at different time intervals. Results: The swallowing and aspiration analysis showed a highly statistically significant difference at 3 months and 6 months by Post Hoc test between the groups. The speech analysis scores at all intervals were not statistically significant while for tongue movements the results were significant. The time taken and expenditure for surgery by IHF were less in comparison to RFF. Conclusion: The infrahyoid flap is a quick, easy, and reliable reconstructive method, which is cost-effective when used with knowledge of its clinical utility and limitations, the functional results are excellent with great patient satisfaction.

Study of myths and beliefs among the parents of a child with cleft lip and palate.

Aim: The aim of the study was the identification of predictors of psychology and beliefs among parents of children affected by cleft lip and cleft palate. Methods: The study included a sample of 157 parents of children having cleft lips and cleft palates. Parents were given a questionnaire related to their beliefs and reasons behind deformity. Results: Out of 157 participants, 90 were fathers, and 67 were mothers. The children with deformities included 105 boys and 52 girls. The majority of parents (43) believed that the eclipse was one of the reasons for the deformity and the other was God's wrath for the mother's sins. The time of birth was considered a factor for cleft lip and palate by 27 parents. The study revealed that the self-esteem of fathers was higher than mothers and they were more concerned of being undesirably judged by others due to deformity of their children than the mothers. Conclusion: It can be inferred that the parents of a child with cleft lip and palate differ in their psychosocial adjustments. Also, mothers experience more psychosocial problems than fathers. The superstitious beliefs still prevail in rural areas despite advanced medical facilities and awareness.

Three-dimensional printing in maxillofacial surgery: A quantum leap in future.

Although application of three-dimensional (3D) printing in oral and maxillofacial surgery (OMFS) was first reported almost 30 years back, reduction in its manufacturing cost and availability of affordable 3D printing devices have popularized its use over the past few years. The 3D-printed objects include anatomical models, occlusal splints, drilling, or cutting guides and patient-specific implants (custom made plates and reconstruction devices). The anatomical model not only assists the surgeon in better understanding of the deformity or pathology but also aids in explaining the same to the patient and relatives. Mock surgery carried out on these models improve precision and thereby reduce the operating time. The guiding splints provide an exact design and fit for the graft, thus replicating form and function of the jawbone. The patient specific implants manufactured through computer-assisted designing help in superior replication of original anatomical form. This paper intends to highlight the current applications of 3D printing in field of maxillofacial surgery in the management of facial deformity, esthetic disturbances, and jaw pathologies. Cases of condylar hyperplasia, jaw tumor, facial asymmetry secondary to joint deformity, apertognathia, and chin augmentation managed with the application of 3D printing have been described in this paper. It also discusses the history, techniques, advantages, limitations, and future scope of 3D printing technology in OMFS.

Diabetic Maxillary Osteomyelitis: A Worrisome Vulnerability-Our Experience.

Background: Osteomyelitis is inflammation of medullary cavities, haversian system and adjacent cortex of bone. It is devastating to patients when invasive. Aim: The purpose of this study is to retrospectively review patients diagnosed with diabetic maxillary osteomyelitis and evaluate factors relating infection & diabetes. Methodology: Case records of patients diagnosed with diabetic maxillary osteomyelitis were studied. Patient's demographic data, predisposing factors, etiology, clinical features, culture sensitivity reports, microbiology, treatment and complications were studied. Diabetic status was confirmed by glycosylated hemoglobin (HbA1c) test. Duration of diabetes and anti-diabetic medication adherence was also studied. Results: There were 28 patients diagnosed with diabetic maxillary osteomyelitis, (23-male; 5-female). Majority of the patients (60.7%) belonged to fourth & fifth decades. Twenty (71.4%) patients had poorly controlled diabetes (HbA1c > 8%). All patients reported with random blood sugar > 200 mg/dl. Thirteen patients (46.4%) were diagnosed for diabetes on admission and 11 patients (39.3%) had poor anti-diabetic medication adherence. Predominant etiology was odontogenic infection (50%). Cases of bacterial osteomyelitis (50%) were more frequent than those of fungal osteomyelitis (32.1%). Recurrence was observed in three cases. Conclusion: Non-cognizance about diabetes mellitus can prove devastating for maxillofacial region and may prove fatal for the patient.

Lipoxins in inflammation.

Lipoxins and ATL appear to be the first recognized members of a new class of endogenous mediator that are anti-inflammatory or serve for the "pro-resolution" of inflammation. PGE2 can and may display anti-inflammatory properties in certain settings, but in most cases, it enhances inflammation in vivo. This is likely the result of numerous receptor isoforms and differential coupled mechanisms for PGE2 and its diverse role in human physiology. Since the integrated response of the host is essential to health and disease, it is important to achieve a more complete understanding of the molecular and cellular events governing the formation and actions of endogenous mediators of resolution that appear to control the magnitude and duration of inflammation. In view of the present body of evidence, it is not surprising that a protective action for inhibition of COX-2 was found in cardiovascular disease. Characterizing useful experimental systems with clinically relevant endpoints will also take a multidisciplinary approach and require a shift in our current thinking about inflammation and the role of lipid mediators.

Cognizance, adverse effects and motivation regarding COVID-19 vaccination amongst health care professionals: A cross-sectional study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) vaccines are currently at the forefront of India's fight against the pandemic. They have been shown to prevent the disease or reduce its severity, following 2 doses given at an interval of 6-8 weeks. OBJECTIVES: The present cross-sectional survey was carried out on 1,145 health care practitioners in order to recognize and evaluate the adverse effects of vaccination as well as knowledge, motivation and attitudes with regard to vaccines amongst the respondents after the 1st dose of vaccination. MATERIAL AND METHODS: An anonymous survey was carried out among different age and gender groups in the medical colleges situated in the state of Maharashtra, India. The participants' responses were collected with the use of the Google Forms platform through sending a URL link to the questionnaire. The validity of the questionnaire was pilot-tested and the obtained Cronbach's alpha value was 0.80. Amongst the 1,145 participants, 92.2% of the respondents received COVISHIELD™ and 7.8% received COVAXIN®. The subjects were further scrutinized in 4 different age groups:18-27 years (73.0%); 28-37 years (14.8%); 38-47 years (9.6%); and above 47 years (2.5%). RESULTS: Adverse effects were common in the age group of 18-27 years and were observed significantly more frequently in females than males. A very common symptom was pain at the site of injection with an occurrence of 85.2%. Fever was present in 62.6% of the respondents, with 39.1% having low-grade fever and very few having high-grade fever. CONCLUSIONS: Knowledge about adverse effects and what to expect after vaccination would help to educate people, dispel misinformation and reduce vaccination hesitancy. It can also help to promote awareness about the incidence of adverse effects and the safety of COVID-19 vaccines.

Aesthetic root coverage with acellular dermal matrix allograft: a shield for gingival recession.

Awareness about root coverage is increasing in day-to-day clinical practice. Patients are more motivated and concerned about aesthetics nowadays along with the issues of sensitivity of teeth. The conventional flap designs and techniques including lateral sliding flaps, coronally advanced flap, subepithelial connective tissue grafts and free gingival grafts are being adopted for root coverage. The newer material including resorbable and non-resorbable guided tissue regenerative membranes, amniotic membrane, platelet-rich fibrin membrane, enamel matrix derivative protein, xenogenic collagen matrix graft along with the soft tissue substitute like acellular dermal matrix allograft are also being used for recession coverage. The present case report describes a case of 22-year-old female patient with the chief complaint of denudation of gums exposing the root surface over the mandibular left central incisor. The soft tissue substitute acellular dermal matrix allograft was used for root coverage as the patient was not willing to procure an autogenous palatal graft. The results were satisfactory with complete root coverage.

Unusual presentation of mucormycosis mimicking a localised sino-orbital pathology.

Mucormycosis is an aggressive and deadly fungal infection, which is invariably associated with an immunocompromised patient. Mucormycosis in the head and neck region presents as skeletal necrosis, with or without soft tissue involvement. Early identification and treatment with combination of surgical debridement and parenteral antifungal therapy is critical for a favourable outcome. This paper reports an unusual presentation of mucormycosis, mimicking a localised sino-orbital pathology involving the infraorbital subcutaneous tissue and the maxillary sinus, in a 35 years old immunocompetent man. Despite aggressive antifungal therapy and surgical management, the course of disease was fatal, reiterating the high mortality associated with mucormycosis.

Retrieval of foreign body from maxillary sinus through extraction socket.

Dry socket or alveolar osteitis is one of the most common complication following tooth extraction. Patients usually reports of pain, which typically starts on third or fourth postoperative day and responds to simple irrigation and placement of zinc oxide eugenol (ZOE) pack, which provides an obtundent effect. The pack should be loosely kept in the extraction socket and should be changed periodically to allow healing. This report presents a case of retrieval of foreign body, which actually was a ZOE pack from maxillary sinus, 6 months after the patient underwent extraction of upper left maxillary first molar.

Novel technique for esthetic root coverage with titanium prepared platelet-rich fibrin.

Leukocyte- and platelet-rich fibrin (L-PRF) can be defined as an autologous leukocyte and platelet-rich biomaterial. Unlike other platelet-rich products, this technique does not require an anticoagulant or bovine thrombin. However, it is simply centrifuged blood without any additives, which makes it possible to avoid all of the legal restrictions related to the reimplantation of blood-derived products. L-PRF is composed of a fibrin matrix polymerized in a tetramolecular structure and is involved in the joining of platelets, leukocytes, cytokines, and circulating stem cells. The use of silica- coated test tubes is arising a lot of queries about the safety of L-PRF prepared within these test tubes. So, to avoid the use of silicacoated test tubes, titanium prepared PRF has come in practice now, as titanium is biocompatible metal and has property of histoconduction. The present case report is about successful esthetic root coverage around mandibular anterior teeth with clinical attachment loss of 4-5 mm at baseline. The patient had reduced sensitivity, CAL was 1 mm, and attached gingiva covered denuded root surface after 15 days and after 3-month recall appointment.

Zenker's diverticulum: a rare clinical condition with unusual oral manifestation.

Oral mucosa exhibit clinical manifestations of a variety of systemic conditions and can serve as an indicator of overall health of an individual. Various systemic conditions like autoimmune, endocrine and haematological disorders can present with oral mucosal lesions, which can serve as an important diagnostic feature. These oral lesions can vary from oral ulceration, bleeding gums, xerostomia, chronic glossitis, to erosion and sensitivity of teeth. It is important that a clinician must be aware of the oral presentations of systemic conditions, so that timely diagnosis can be made and the necessary treatment is executed. This paper presents an unusual case of severe oral mucosal ulcerations and dysphagia in an elderly patient diagnosed with Zenker's diverticulum. Patient was relieved of all oral symptoms once the underlying gastrointestinal tract pathology was diagnosed and surgically corrected.

Incidence and Distribution of Jaw Pathologies among 0-15 Years Age Group at a Tertiary Rural Health-Care Center of Maharashtra: A Retrospective Study of 10 Years.

OBJECTIVE: This study was undertaken to investigate the prevalence of intraosseous jaw lesions among pediatrics (0-15 years of age) in a rural health-care center of Maharashtra and to determine the most common types of lesions and their distribution according to gender and anatomical site involved. STUDY DESIGN: Histopathological data were collected from a database of lesions classified as intraosseous jaw lesions dated between January 1, 2005, and December 31, 2015, from the archives of the Department of Oral and Maxillofacial Surgery, Rural Dental College, Maharashtra, India. All the cases of jaw cysts and tumors among children under 16 years of age group were segregated and scrutinized further under the headings of type of pathologies, anatomical locations where they are most commonly seen, and the age/gender most pertinent to these pathologies. RESULTS: The present study revealed that 114/3896 jaw lesions were pediatric jaw pathologies, of which odontogenic cysts were 67/114 and jaw tumors were 47/114. Among the cysts, 70% were developmental cysts and 30% were inflammatory cysts. The majority (71.6%) of the jaw cysts were found in the mixed dentition phase (7-15 years). Among the jaw tumors, 55% of them were categorized under odontogenic tumors and 45% were under fibro-osseous lesions. Similar to intraosseous jaw cysts, tumors of jaws were more prevalent under the age of mixed dentition, which was found to be 87%. Male predominance was seen and the overall male:female ratio was calculated as 1:0.52 and 1:0.5 for cysts and tumors, respectively. Mandibular posterior segment was found to be the most commonly encountered anatomical site in both the groups of cases. CONCLUSION: A large number of cases were recorded, which led us to a path of interrogation through which the reason for increased incidence was extracted, and it was agreed that though the pathogenesis remains the same in every individual, routine health checkups and early diagnosis may reduce the incidence and aggressiveness of pathologies, respectively, which was lacking at the rural area.

Catheterization of post infection parotid duct sialocele with paediatric Ryles tube: A case report.

Sialocele is a cavity filled with saliva, usually as a result of trauma, complication of surgery, sialolithiasis or bacterial infection residing inside the duct. Many cases of parotid sialocele have been reported in the literature, but only very few cases of parotid duct sialocele have been reported. We report a case of an unusual facial swelling over buccal mucosa at the route of Stenson's duct with poor oral hygiene, a case of parotid duct sialocele with secondary infection and describe its diagnosis and management.

Karapandzic Flap for Esthetic and Functional Reconstruction of Large Defect of Lower Lip.

Squamous cell carcinoma is the most common cancer occurring in the oral cavity. The lips are one of the most common sites of occurrence with involvement, lower lip being more common than upper. Reconstruction of large defects of lower lip with good functional and esthetic outcome is the biggest challenge faced by the surgeon. Karapandzic flap is one the most commonly used technique for reconstruction of large defects of the lower lip.

The prevalence of squamous cell carcinoma in different sites of oral cavity at our Rural Health Care Centre in Loni, Maharashtra - a retrospective 10-year study.

AIM OF THE STUDY: Oral cancer ranks in the top three of all cancers in India and is quickly becoming a global health priority. More than 90% of oral and oropharyngeal cancers are squamous cell carcinoma. The purpose of this study was to document its incidence depending upon the involvement of different sites of oral cavity, and its variation with age and gender. MATERIAL AND METHODS: Histopathologically proven oral squamous cell carcinoma cases were collected from the department of oral and maxillofacial surgery RDC, PIMS. The cases were systematically grouped under three headings: anatomical sub-site of oral cavity, age group, and gender, which were analysed to calculate the prevalence of oral cancer. The study was undertaken after obtaining approval from the institutional Ethical Committee board. RESULTS: Among the different sites of oral cavity, the highest incidence (31.47%) of oral squamous cell carcinoma was seen for buccal mucosa in our study. The most affected age group (39.50%) were patients above 50 years old, predominantly involving males. CONCLUSIONS: The population in this study were mostly from remote areas, among which a high rate of occurrence of oral cancer was encountered because the people were of low socio-economic class, had a casual attitude towards their health, high rate of tobacco consumption, and limited health care facilities. This study provides valuable data of the prevalence of oral cancer among the rural population.

Retrieval of foreign body from a postoperative defect in the mandible during the follow-up period: A bizarre occurrence.

Though reported cases of foreign bodies left intraoperatively in the oral cavity are very few, there is no case mentioned in the literature where foreign body was left behind during follow-up visits. Here, we present an operated case of unicystic ameloblastoma of mandibular ramus region, in which a needle hub was left at the operated site (cavity created because of wound dehiscence) during some of the follow-up visits, which was detected accidently by radiograph and later on retrieved. The case reported was because of negligence of trainee surgeons, might be because of overburden or because of minimal interest in these repeated follow ups. But, a trainee should understand that their work also has similar importance as that of surgeon's work.

Malignant fibrous histiocytoma of maxillary alveolar ridge extending to the hard palate.

Malignant fibrous histiocytoma (MFH) is the most common soft-tissue sarcoma occurring in adults. This entity was first described by O'Brian and Stout in 1964. Apart from the soft-tissues, this tumor has been reported to occur in all other parts of the body including bone. It has male predilection and is usually noticed in the fifth to seventh decades of life. It commonly affects extremities and retroperitoneum, whereas involvement of the head and neck region is comparatively rare. However, when the head and neck region is affected, the most common sites are the maxillary sinus and the nasal cavity, in which case, later involvement of the maxillary alveolar bone can happen. The oral cavity is a relatively less common site for MFH. This article describes clinical, computed tomographic and microscopic features of a MFH of the maxillary alveolar ridge extending to the hard palate in a 46-year-old female patient. Histogenesis, advanced imaging features, differential diagnosis, and management of MFH are also discussed.

Benign fibrous histiocytoma of the maxilla: a case report and review of literature.

Benign fibrous histiocytoma (BFH) is a mesenchymal tumor which commonly affects the skin of extremities. Histologically, BFH of soft tissues and bone shows similar features, but BFH of the bone is rare with less than 100 cases reported worldwide and usually it involves tibia, femur, and pelvic bone. As far as the oral cavity is concerned, majority of the BFHs are found in the soft tissues of the buccal mucosa, gingiva, lower and upper lips, soft palate, and floor of the mouth. Occurrence of this tumor in the jaw bones is extremely rare as only one case of the maxilla and six cases of the mandible have been reported so far . Hence, the purpose of this article is to report the second case of BFH of the maxilla in a 23-year-old female patient and to review the literature of this entity affecting the jaws.

Coexistence of two talon cusps and two dens invaginatus in a single tooth with associated radicular cyst-a case report and review of literature.

Talon cusp (TC) and dens invaginatus (DI) are relatively rare developmental anomalies which affect the shape of teeth. TC is an additional cusp that projects predominately from the lingual surface of anterior teeth. DI is a deep surface invagination of the crown or root which is commonly detected on routine radiographic examination. Both of these anomalies are observed more frequently in permanent maxillary lateral incisor. Isolated cases of single TC and DI are extensively reported in dental literature. Occasionally two talon cusps (TCs) in the same tooth as well as double and triple invaginations in one tooth are reported separately. Coexistence of these two anomalies in a single tooth is considered extremely rare, but still there are few reported cases. However, coexistence of two TCs and double DI in a single tooth is not reported till date. We hereby report the first case of coexistence of two TCs and double DI in a single tooth of a 23 year old female and use of platelet-rich fibrin (PRF) in the management of associated radicular cyst. Also, literature on coexistence of these two anomalies in a single tooth is reviewed. Key words:Coexistence, dens invaginatus, radicular cyst, talon cusp.

Transcutaneous electric nerve stimulation (TENS) in dentistry- A review.

Transcutaneous electric nerve stimulation (TENS) is a non-pharmacological method which is widely used by medical and paramedical professionals for the management of acute and chronic pain in a variety of conditions. Similarly, it can be utilized for the management of pain during various dental procedures as well as pain due to various conditions affecting maxillofacial region. This review aims to provide an insight into clinical research evidence available for the analgesic and non analgesic uses of TENS in pediatric as well as adult patients related to the field of dentistry. Also, an attempt is made to briefly discuss history of therapeutic electricity, mechanism of action of TENS, components of TENs equipment, types, techniques of administration, advantages and contradictions of TENS. With this we hope to raise awareness among dental fraternity regarding its dental applications thereby increasing its use in dentistry. Key words:Dentistry, pain, TENS.