Heterotopic Ossification After Reconstruction with Free Fibula Flap - an Ambiguous Mishap.

Heterotopic ossifications (HO) are rare, yet, well reported complications after free flap transfer. We present a case of HO that occurred within a month, and has not been previously described in the literature. This serves as a reminder that bony hard swellings proximal to the free flap within a month should raise the suspicion of HO.

Chyle leak after head and neck surgeries: a comprehensive review of diagnosis and management strategies.

Chyle leaks are uncommon complications after head and neck surgeries. Although uncommon, such a complication is noteworthy mention due to its perplexing diagnosis and management strategies. This scoping review aims to highlight and emphasize the diagnosis and management options proposed in the literature. A comprehensive search was performed in PubMed, Google Scholar, Cochrane Library, and Scopus databases and identified 617 articles that were reduced to 40 studies and reports after applying the eligibility criteria. Although numerous treatment options ranging from simple, conservative measures to invasive surgical procedures have been mentioned for low-output, high-output, and massive leaks, there is no concrete evidence on the best method. Thus, a combination of management options must be customized by case for optimum results.

Transverse Cervical Artery Based Free Flap in Reconstruction of a Tongue Defect: A Case Report.

In the era of reconstructive surgery, new and revolutionary options are being explored in oro-facial defect reconstruction. As free flaps are presently front runners for reconstruction of defects resulting from resection of benign and malignant lesions, there is a need for devising newer options to serve the need of covering defects following oncological resection. The availability of promising pedicles in the supraclavicular region makes it a potential donor site for harvesting regional flaps, and going forward, free flaps. Transverse cervical artery flap has been a useful regional flap for head and neck reconstruction but there are limited literature pertaining to transverse cervical artery free flap. We report a case of successful reconstruction of tongue defect with transverse cervical artery free flap.

Minimal clinically important difference in maxillofacial trauma patients: a prospective cohort study.

The present study estimated the minimal clinically important difference (MCID) for pain on a visual analogue scale - numerical rating scale (VAS-NRS) and mean bite force (MBF) in patients treated for maxillofacial trauma (MFT). This cohort study included 120 MFT patients treated according to AO principles. Preoperative and four-week postoperative pain on the VAS-NRS, and MBF were measured to calculate MCIDs as indicators of functional rehabilitation. The patient's perspective of the treatment was assessed using a four-item anchor question. The MCID was determined by two anchor-based approaches, namely, the change difference (CD) method and receiver operating characteristic (ROC) curve method. According to the CD method, the MCID for pain was 2.4 and the MBF was 147.9 N. Based on the ROC curve, the MCID for pain was 2.5 (sensitivity 91.7%, specificity 47.2%) and MBF was 159.1 N (sensitivity 71.4%, specificity 61.1%). This study demonstrated a high sensitivity (>70%) for MCID, which implies that pain reduction of 2.4-2.5 points on the VAS-NRS and a gain in MBF of 147.9-159.1N are clinically relevant for patients treated for MFT.

A Surgical Experience of Oral Squamous Cell Carcinoma Co-Existing with Post Burn Contractures of Neck.

A female patient in her early 60s was diagnosed with squamous cell carcinoma of right buccal mucosa. Interestingly, the patient also presented with post-burn contractures of face, neck and chest which posed significant anaesthetic and surgical challenges, thus making this case report unique. Through this case report, we highlight the reflections in management of such a case.

Safety and Efficacy of Resveratrol in Healing of Maxillofacial Fractures: A Randomized Controlled Study.

Objectives: To assess the efficacy of resveratrol in improving functional outcomes following open reduction and internal fixation of maxillofacial fractures. Study Design: A single-center, randomized, parallel group, prospective, double-blind clinical trial was conducted on 40 patients between the age 20 and 60 years, requiring open reduction and internal fixation of maxillofacial fractures. The selected patients were randomly divided into two groups, Group 1 (placebo) and Group 2 (resveratrol) where tablets resveratrol 500 mg were given twice daily for 1 month following open reduction and internal fixation of fractured segments. Bite force was calculated pre-operatively and on the 1st, 4th, 8th and 12th week postoperatively. Serum markers osteocalcin and alkaline phosphate were calculated pre-operatively and at 4th and 12th week postoperatively. Results: Bite force (690.55 ± 262.00) in the resveratrol group was higher than the placebo group (553.27 ± 300.08) at 12th week postoperatively. However, the difference was non-significant statistically (p = 0.132). Resveratrol group (116.80 ± 55.25) showed better maintenance of serum ALP level as compared to placebo group (107.90 ± 42.99) at 12th week postoperatively, but again it lacked statistical significance (p = 0.573). Resveratrol group after initial reduction at 4th week showed serum osteocalcin levels nearly equal to the preoperative values at 12th week, while the placebo group showed a decline both at 4th and 12th week postoperatively. However, these results were not statistically significant (p = 0.065). Conclusion: There was no statistically significant difference in bite force, serum ALP level and serum osteocalcin levels between placebo group and resveratrol group. Though not statistically significant but early increased level of serum osteogenic markers, better restoration of bite force in group 2 (tab. Resveratrol) indicates toward its possible optimistic role in maxillofacial fracture healing. More studies with larger sample sizes are needed in order to confirm the efficacy of this drug in maxillofacial fracture.

Venolymphatic malformation of tongue: a prompt life saving intervention.

Venolymphatic malformations (VLMs) of the head and neck can have varied clinical presentation with associated complications. Timely diagnosis and treatment is warranted to curb the morbidity and obtain satisfactory outcomes. We present the case of a male patient in his early 20s with VLM of the tongue who received precise interventions which were executed with active contributions from a team of anaesthesiologists, interventional radiologists, oral and maxillofacial surgeons and intensivists. We highlight the importance of an immediate, comprehensive and multimodal treatment approach for VLMs of the maxillofacial region.

Minimal clinically important difference of mouth opening in oral submucous fibrosis patients: a retrospective study.

Objectives: The purpose of this study was to estimate the minimal clinically important difference (MCID) of mouth opening (MO) and patient satisfaction in surgically treated oral submucous fibrosis (OSMF) patients. Materials and Methods: The status of MO was collected preoperatively (T0), postoperatively at 3 months (T1), and at a minimum of 6 months postoperatively (T2). MCID was determined through the anchor-based approach with the change difference method, mean change method, and receiver operator characteristic curve (ROC) method. Results: In this study, 35 patients enrolled and completed postoperative follow-up (T2) averaging a duration of 18.1 months. At T1, using the change difference method, MO was 14.89 mm and the ROC curve exhibited a 11.5 gain in MO (sensitivity 81.8% and specificity 100%, area under the curve [AUC] of 0.902) and was classified as MCID as reported by patients. At T2, MCID of MO was 9.75 mm using the change difference method and 11.75 mm by the mean change method. The ROC curve revealed that the MCID of MO at T2 was 10.5 mm with 73.9% sensitivity and 83.3% specificity (AUC of 0.873). The kappa value was 0.91, confirming reliability of the data. Conclusion: This study demonstrated MCID values that indicate the clinical relevance of surgical treatment of OSMF if the minimum possible gain in MO is approximately 10 mm.

Oral Manifestations of COVID-19 Infection: An Analytical Cross-Sectional Study.

Objectives: The current COVID-19 pandemic has created a huge impact across the globe. Recent literature has reported the occurrence of varied oral lesions in COVID-19 patients in the form of sporadic case reports. This analytical cross-sectional study was carried out to gauge and understand the pattern of oral lesions in qualitative RT-PCR-confirmed COVID-19 patients. Methods: A cross-sectional study involves a total of 500 qualitative RT-PCR confirmed, hospitalized COVID-19 patients who were meticulously scanned for any hard and soft tissue lesions developing concomitantly with the disease occurrence. Results: This study included a total of 367 (73.4%) males and 133 (26.6%) female patients with a mean age of 53.46 ± 17.50 years. Almost 51.2% of patients presented with gustatory disturbance, 28% with xerostomia and 15.4% of patients were found to have oral findings like erythema, ulcers, depapillation of tongue. There was a statistically significant correlation between oral manifestations and disease severity (p ≤ 0.001). Conclusion: COVID-19 is found to effect oral health with greater probability in patients with severe diseases (SARI) which may be due to disease itself, immune response and lack of motivation for personal hygiene measures. Supplementary Information: The online version contains supplementary material available at 10.1007/s12663-021-01679-x.

15-hydroxyprostaglandin dehydrogenase is down-regulated in gastric cancer.

PURPOSE: We have investigated the expression and regulation of 15-hydroxyprostaglandin dehydrogenase (15-PGDH) in gastric cancer. EXPERIMENTAL DESIGN: Clinical gastric adenocarcinoma samples were analyzed by immunohistochemistry and quantitative real-time PCR for protein and mRNA expression of 15-PGDH and for methylation status of 15-PGDH promoter. The effects of interleukin-1beta (IL-1beta) and epigenetic mechanisms on 15-PGDH regulation were assessed in gastric cancer cell lines. RESULTS: In a gastric cancer cell line with a very low 15-PGDH expression (TMK-1), the 15-PGDH promoter was methylated and treatment with a demethylating agent 5-aza-2'-deoxycytidine restored 15-PGDH expression. In a cell line with a relatively high basal level of 15-PGDH (MKN-28), IL-1beta repressed expression of 15-PGDH mRNA and protein. This effect of IL-1beta was at least in part attributed to inhibition of 15-PGDH promoter activity. SiRNA-mediated knockdown of 15-PGDH resulted in strong increase of prostaglandin E(2) production in MKN-28 cells and increased cell growth of these cells by 31% in anchorage-independent conditions. In clinical gastric adenocarcinoma specimens, 15-PGDH mRNA levels were 5-fold lower in gastric cancer samples when compared with paired nonneoplastic tissues (n = 26) and 15-PGDH protein was lost in 65% of gastric adenocarcinomas (n = 210). CONCLUSIONS: 15-PGDH is down-regulated in gastric cancer, which could potentially lead to accelerated tumor progression. Importantly, our data indicate that a proinflammatory cytokine linked to gastric carcinogenesis, IL-1beta, suppresses 15-PGDH expression at least partially by inhibiting promoter activity of the 15-PGDH gene.