Maxillofacial Soft-tissue Healing Efficacy between Nano-chitosan and Collagen-Chitosan Membrane - A Comparative Study.

Introduction: Routine wound management in maxillofacial trauma with soft-tissue injury needs to be addressed in a systematic way to prevent untoward complications. In this study, we examined the effects of a novel surgical dressing material on pain, wound healing and scar and its feasibility to common people. Our aim is to compare the efficacy and potency of the nano-chitosan membrane and collagen-chitosan membrane as surgical dressing materials for soft-tissue wounds in the maxillofacial region. Materials and Methods: Thirty participants who sustained soft-tissue injury in the maxillofacial region were included in the study. Post-suturing, Group A participants were treated with nano-chitosan membrane impregnated with chlorhexidine, Group B participants were treated with collagen-chitosan membrane impregnated with chlorhexidine and Group C participants had received chlorhexidine powder as conventional wound care management and recalled and evaluated for wound healing, pain and scar at seventh day, one month and three months postoperatively. Results: The wound healing efficacy of both Group A and B participants was nearly comparable and Group A had better wound healing (P = 0.043) when compared to conventional chlorhexidine dressing material. In relation to pain intensity, Group A was reported with a low intensity of pain and also with better results in scar assessment at the third-month follow-up. Discussion: This study had proven that even though the wound healing efficacy of both nano-chitosan and collagen-chitosan membranes is nearly comparable, nano-chitosan shows better results on the evaluation of parameters such as wound healing, pain and scar. Nano-chitosan membrane has better wound healing when compared to conventional chlorhexidine dressing material.

Assessment of Speech in Patients Undergoing Hemiglossectomy with Primary Closure and Radiotherapy - A Prospective Study.

Introduction: The oral cavity plays a pivotal role in the generation of speech. The treatment of oral squamous cell carcinoma of the tongue requires an aggressive approach, combining resective surgery along with radiation therapy, with long-lasting effects on the patient's ability to speak. This study was designed to assess speech in subjects with carcinoma of the tongue following hemiglossectomy with primary closure and radiotherapy. Methods: A prospective study was carried out in 20 subjects who underwent hemiglossectomy with primary closure for carcinoma of the tongue followed by radiotherapy. All subjects were evaluated for speech using 'Kannada Diagnostic Photo Articulation Test' before surgery, after surgery (on the 10th and 30th day), during radiation therapy after 15 fractions of radiation and after 1, 2 and 3 months following completion of radiotherapy. Statistical analysis was performed using SPSS software (v. 17.0). Significance levels were determined using ANOVA followed by Bonferroni correction. Results: Intelligibility of speech was noted to be affected most at the one month follow-up visit after completion of radiotherapy (P < 0.001). The Kannada Diagnostic Photo Articulation Test proves to be a useful tool in assessing changes in speech, with results that can be replicated in further studies. Discussion: The incidence of articulatory errors is increased following surgery and radiotherapy. Over time, the number of errors reduce and approach the baseline, indicating that although speech is indeed hampered by the treatment, with adequate speech therapy one can regain their preoperative articulation.

In vitro Comparison of Adipogenic Differentiation in Human Adipose-Derived Stem Cells Cultured with Collagen Gel and Platelet-Rich Fibrin.

Background: Adipose-derived stem cells (ADSCs) are the most preferred cell type, based on their phenotypic characteristics, plasticity, and favorable immunological properties for applications in soft-tissue augmentation. Hence, the present in vitro study was aimed to evaluate the adipogenic differentiation potential of human ADSCs upon culturing individually with collagen gel and platelet-rich fibrin (PRF). Materials and methods: The collected lipoaspirate was used for establishing ADSCs using enzymatic digestion method. Then, the cells were analyzed for their morphology, viability, proliferation rate, population doubling time (PDT), colony-forming ability, cell surface markers expression, and osteogenic differentiation as biological properties. Further, ADSCs were evaluated for their adipogenicity using induction media alone, and by culturing with collagen gel and PRF individually for prospective tissue augmentation. Results: ADSCs were successfully established in vitro and exhibited a fibroblast-like morphology throughout the culture period. Cells had higher viability, proliferation potential and showed their ability to form colonies. The positive expression of cell surface markers and osteogenic ability confirmed the potency of ADSCs. The ADSCs cultured on collagen gel and PRF, individually, showed higher number of differentiated adipocytes than ADSCs grown with adipogenic induction medium alone. Conclusion: The extent of lipid accumulation by ADSCs was slightly higher when cultured on collagen gel than on PRF. Additional experiments are required to confirm better suitability of scaffold materials for soft-tissue regeneration.

Maxillofacial Injuries in Motorcyclists Following the Implementation of Helmet.

BACKGROUND: It has been reported that 20%-60% of all people injured in road traffic accidents (RTAs) tend to have some form of maxillofacial injury. Mangalore city, Karnataka State, India, traffic police has enforced the law to wear helmets to tackle the problem. The outcome of the initiative till date was not measured. Therefore, the objective of the study was to assess the prevalence of maxillofacial injuries among the victims of motorized two-wheeler RTAs, following the passing of the helmet law. MATERIALS AND METHODS: The study was conducted at the Accident and Emergency Department of K.S. Hegde Medical College and Hospital and at the Department of Oral and Maxillofacial Surgery, A.B. Shetty Memorial Institute of Dental Sciences, Nitte (Deemed to be University), Mangalore, Karnataka, India. The inclusion criteria were the patients who had two-wheeler accidents during the time period of 2016-2017 was collected. The data related to age, gender, helmet wearing, diagnosis, and type of orthopedic injuries was included. A descriptive statistics was calculated along with 95% confidence interval; correlation coefficient and odds ratio using STATA software. RESULTS: A total of N = 347 individuals were included in the study. The mean age of the individuals was 33.7 (2-85) years, and the median age was 32 years. 81.55% (N = 283) were male and 18.44% (N = 64) were female. Among the individuals, 51.5% (N = 179) were not wearing helmets and 44.38% (N = 154) of them were males. A total of 25.07 (N = 87) individuals had orthopedic injuries and 16.42% (N = 57) individuals had orthopedic injuries who were not wearing helmets. CONCLUSION: Under the limitations of the study, we conclude that majority of the two-wheelers are not wearing helmets. This study has demonstrated that the impact of wearing helmet on occurrence of craniofacial and orthopedic injuries is less.

Unicystic ameloblastoma with mural proliferation: conservative or surgical approach?

Ameloblastoma occurs in a wide variety of forms. Various forms of ameloblastomas have various treatment modalities ranging from a conservative approach to surgical resection with reconstruction. We report a case of unicystic ameloblastoma with mural proliferation in a 17-year-old girl, who presented with a swelling in the lower left jaw associated with dull aching pain and was managed initially by a conservative approach followed by surgical enucleation on recurrence.

Spindle cell carcinoma in maxilla.

Spindle cell carcinomas (sarcomatoid carcinomas) are rare tumours. It is a variant of squamous cell carcinoma which has spindled tumour cells, which simulate a true sarcoma, but are epithelial in origin. They are extremely uncommon in the head and neck region. Only five cases with maxillary origin have been discussed in the literature. As compared to squamous cell carcinoma of maxilla, this variant is associated with poor diagnosis and advanced disease at presentation, as is demonstrated in the case presented. There are no standard recommendations for management owing to the rarity of this histology. Surgery and radiotherapy form the mainstays of treatment. We report a rare case of spindle cell carcinoma involving the maxilla.

Ameloblastomatous calcifying odontogenic cyst: a rare histological variant.

The calcifying odontogenic cyst (COC) occurs mainly as an intraosseous lesion in mandible or maxilla, but the peripheral variation of COC has also been reported. The confusion regarding its nature as cyst or tumour has not been resolved and a vast diversity has been noted in clinicopathological aspects of COC. We report a case of COCs with minimal mural ameloblastomatous proliferation in a 13-year-old girl, who presented with a painless swelling in the left jaw causing mild facial asymmetry.