Customized cost-effective polymethylmethacrylate cranioplasty: a cosmetic comparison with other low-cost methods of cranioplasty.

BACKGROUND: Intraoperative hand-moulded cranioplasty and polymethylmethacrylate (PMMA) prostheses made from bone impressions are economical but the cosmetic results are less than satisfactory. Commercially available customized prostheses perform better but are prohibitively expensive. We evaluate the performance of a locally developed, low-cost customized PMMA cranioplasty prosthesis. OBJECTIVE: To compare the cosmetic outcome of 3 types of PMMA cranioplasty as well as with objective measurements on postoperative CT scans METHODS: This study includes 70 patients who underwent cranioplasty between March 2016 and June 2020. In this period, patients had their cranioplasty prostheses made by intra-operative hand moulding (HM), by using the removed bone as a template and making a bone impression (BI) or by 3D printing the prosthesis based on a CT scan. Cosmetic outcomes were assessed by the patient and the operating surgeon on an 8-point scale. The degree of measured anthropometric asymmetry was measured on a postoperative CT scan and correlated with the cosmetic outcome. RESULTS: Our locally produced 3D-printed cranioplasty prostheses showed a statistically better performance in cosmetic scores when compared to the HM and BI (p value < 0.001). CT anthropometric measurements significantly correlated with cosmetic outcome (p value 0.01) CONCLUSION: Our 3D cranioplasty prostheses had better cosmetic outcomes than HM and BI prostheses, and our technique is able to produce them at 10% of the cost of the currently available commercial customized prostheses.

Bony tumour in an unusual location on the mandible.

Osteomas are benign osteogenic tumors that are seen in the facial bones, but uncommonly in the mandible. In the facial bones, both central and peripheral osteomas have been described. Peripheral osteomas have been described to occur in the frontal, ethmoid, and maxillary sinuses but are not common in jawbones. When in the mandible, they are usually found over the angle and inferior border of the mandible. We report on a solitary peripheral osteoma located unusually in the sigmoid notch of the left mandible causing facial asymmetry.

Extended osteoplastic maxillotomy for total excision of giant multicompartmental juvenile nasopharyngeal angiofibroma.

Juvenile nasopharyngeal angiofibroma (JNA) is a rare vascular neoplasm occurring almost exclusively in adolescent males. Although benign, it is often locally aggressive and can erode into surrounding tissues and structures resulting in significant morbidity and mortality. In 20% of cases, there is intracranial extension. In this paper, we report on the total excision of a large, recurrent JNA with intracranial extension into the middle cranial fossa encroaching into the cavernous sinus, by right temporal craniotomy and extended osteoplastic maxillotomy.

Tooth Ache to Leprosy! Importance of Revisiting Diagnosis.

Atypical facial pain can be dreadful for the patient, and treating it can be an arduous task for the clinician, unless the diagnosis is constantly revisited.

Natal and Neonatal Teeth: A Tertiary Care Experience.

BACKGROUND: Presence of teeth in a neonate is a rare occurrence due to the disturbance in the biological chronology of teeth. Although uncommon, these teeth if present are found to have several clinical implications. AIMS: This study aimed to describe the clinical characteristics and the treatment outcome of natal and neonatal teeth from a hospital setting. MATERIALS AND METHODS: This retrospective study was carried out by reviewing the hospital records of babies with natal or neonatal teeth in a tertiary hospital in Tamil Nadu between January 1, 2012, and December 31, 2014. Babies with complete clinical data along with their follow-up records were selected and results were analyzed. RESULTS: Complete clinical data of 33 babies with a total of 52 teeth were included, of which 28 teeth were natal and 24 teeth were neonatal. All the teeth were located in the mandibular primary incisor region and majority were in pairs. A positive family history was present in eight cases. Extractions were carried out only in cases where the teeth were found to be extremely loose or interfering with feeding. The only local complication noted in this study was Riga-Fede disease. CONCLUSIONS: The findings of this study suggest that natal and neonatal teeth may have a possible hereditary basis. All the teeth were noted to be prematurely erupted primary teeth rather than supernumerary teeth. Both dentists and pediatricians need to be aware of the clinical implications of these teeth and that they should be retained unless they are symptomatic.

Nature and pattern of primary teeth extractions in a tertiary care hospital setting in South India.

BACKGROUND: Many studies have been carried out on the prevalence of dental diseases in children although not much information is available regarding its outcome among Indian children. AIM: The aim of the present study was to analyze the type of primary tooth extracted and the reasons for the extraction among children attending a tertiary care hospital in the Southern part of India. MATERIALS AND METHODS: The dental records of pediatric patients who had visited the dental clinic of a tertiary care hospital located in Tamil Nadu, South India from December 2013 to November 2016 were reviewed. Patients who underwent extraction of at least one primary tooth under local or general anesthesia were included in the study. RESULTS: A total of 943 primary teeth were extracted from 447 patients over 3 years. The most commonly extracted tooth type was the first primary molar followed by the primary central incisor. Grouping by age, the most frequently extracted tooth type between 2 and 5 years was the primary central incisor, the first primary molar among the 6-9-year-old and the second primary molar among 10-15-year-old. The majority of primary teeth extractions were performed in the age group of 6-9 years. No significant gender differences were noted. The most common reason for extraction of primary teeth in children was dental caries. CONCLUSIONS: This study demonstrates a high prevalence of untimely primary teeth extractions in young children and dental caries continues to be the leading cause. It clearly reflects on the lack of infant oral health care, the inadequacy of awareness and underutilization of oral health services among children in India.

Treatment Outcomes for Isolated Maxillary Complex Fractures with Maxillomandibular Screws.

Intermaxillary fixation (IMF) is a basic and fundamental principle in the management of patients with fractures of the maxillomandibular complex. There are several shortcomings related to the conventionally recommended tooth-mounted devices that are used to achieve IMF. To circumvent these, the use of bone-borne screws has been advocated. We present a series of maxillary fractures treated with IMF screws. Over a 12-month period, 15 cases of maxillary fracture were managed with open reduction and bone plate fixation. IMF screws were used to achieve IMF intraoperatively and for a short duration postoperatively. Eight cortical titanium screws were inserted transmucosally, two for each quadrant at the junction of the attached and mobile mucosa. Satisfactory occlusion was achieved in all the patients with few complications. IMF screw fixation was observed to be a safe and quick method for open reduction of maxillary fractures. Tooth-borne devices are associated with problems such as poor oral hygiene and periodontal health, extrusion of teeth, loss of tooth vitality, traumatic ulcers of buccal and labial mucosa, and needle stick injury to the operator. These procedures are also time consuming. The use of cortical bone screws is a quicker and safe alternative for achieving satisfactory IMF.

Primary oral tuberculosis: report of two cases.

Oral lesions of tuberculosis though uncommon, are seen in both the primary and secondary stages of the disease. In secondary tuberculosis, the oral manifestations may be accompanied by lesions in the lungs, lymph nodes, or in any other part of the body and can be detected by a systemic examination. Primary oral tuberculosis may present as a diagnostic challenge for the clinician. Here we report two patients with primary tuberculosis in the oral cavity who presented to the dental department, were diagnosed and referred for medical management.

Hajdu Cheney Syndrome.

Hajdu-Cheney Syndrome is a rare genetic disorder characterised by progressive focal bone destruction. It is known to be an autosomal dominant disorder but there have been reports of sporadic cases as well. Although the disease manifestation is found to begin from birth, it is most often not diagnosed until adolescence or adulthood. It could be due to the rarity of the condition and the variation of the disease manifestation at different age groups. We report a case of Hajdu-Cheney Syndrome in a 26-year-old male who presented with severe periodontitis and premature loss of teeth. The other characteristic features included craniofacial dysmorphism, abnormalities of the digits and dental anomalies. Patients with craniofacial dysmorphism along with dental abnormalities should be thoroughly examined for any underlying systemic disorder. A team of specialists may be able to diagnose this condition before the disease is advanced.

Pseudotumour of the Mandible Associated with von Willebrand's Disease.

Patients with bleeding disorders may occasionally present with pseudotumours. Most commonly these occur in the soft tissues and long bones, and are very rare in the maxillofacial region. We present the clinical details and management of a pseudotumour of the mandible in a 12-year-old girl with von Willebrand's disease.

Congenital epulides: a rare case report.

Congenital epulis (CE) or "Granular cell epulis" also previously termed as "Neumann's tumor" is a benign growth arising from the mucosa of the gingiva, typically seen as a mass protruding from the infant's mouth, often interfering with respiration and feeding. These tumors generally present as a single mass arising from the upper alveolus. We report a rare case of two congenital epulides arising from the maxillary and mandibular alveolus in a day old female infant, which was surgically excised, allowing for early initiation of breast feeding. The tumor cells stained negative for S100 protein hence differentiating from other granular cell tumors. The clinical presentation, differential diagnosis in regard to the various neonatal oral swellings and the management of CE has been discussed.

Evidence of Germline Mosaicism for a Novel BCOR Mutation in Two Indian Sisters with Oculo-Facio-Cardio-Dental Syndrome.

In this study, we report on 2 sisters from India with oculo-facio-cardio-dental (OFCD) syndrome caused by a novel heterozygous mutation c.3490C>T (p.R1164*) in the BCOR gene. OFCD syndrome is an X-linked inherited disorder which is lethal in males. Interestingly, both parents of the sisters were phenotypically normal, and DNA analysis from blood and buccal or saliva cells failed to detect the BCOR mutation found in their 2 daughters. To the best of our knowledge, for the first time, we provide indirect evidence of germline mosaicism for the BCOR mutation in one of the parents of the 2 sisters affected by OFCD syndrome. Although this condition is lethal in males, gonadal mosaicism could also be present in the father. The relevance of clinical diagnosis and mutation analysis required for genetic counseling is described in this family.

Prasugrel: newest antiplatelet agent and its emerging role in management of acute coronary syndrome and percutaneous coronary intervention.

Oral antiplatelet therapy has been very effective in reducing vascular events. Currently available oral antiplatelet agents are aspirin and the thienopyridine P2Y(12)-receptor antagonists. These agents are used frequently in combination among patients with coronary artery disease, and also following percutaneous coronary intervention to reduce major adverse cardiovascular events. Emergence of resistance to either aspirin or clopidogrel, or both the agents, is a major concern as antiplatelet resistance is likely to increase thrombotic events, thus resulting in a worse clinical outcome. Development of new agents has therefore become imperative. Prasugrel is the newest thienopyridine with the most robust clinical data, and appears to be superior to clopidogrel, the most extensively used agent besides aspirin in contemporary cardiovascular practice. Possible advantages of prasugrel over clopidogrel are its faster onset of action, reduced inter-patient variability, and more potent and persistent platelet inhibition. This article summarizes the available clinical data on prasugrel in the treatment of coronary artery disease.