The reliability of cephalometric measurements in oral and maxillofacial imaging: Cone beam computed tomography versus two‑dimensional digital cephalograms.

Context: This study compared digital two‑dimensional (2D) lateral cephalograms and cone‑beam computed tomography (CBCT) total and half‑skull images for the reliability of cephalometric measurements. Aims: (1) To compare the accuracy of cephalometric measurements and reproducibility between the digital and CBCT cephalograms in the Indian population. (2) To compare interobserver variability in landmark identification through their cephalometric measurements by comparing different imaging modalities (CBCT total skull, CBCT half‑skull, and conventional lateral cephalogram). (3) To further compare half‑skull with the total skull synthesized CBCT and digital cephalograms in the same regard. Materials and Methods: Thirty patients, who had consented with orthodontic treatment, participated in the study. Informed consent was obtained from the patient before the radiographic procedures. 2D digital lateral cephalograms and their corresponding CBCT scans were taken and imported in DICOM format to OnDemand 3D software. Twenty‑three landmarks were identified by 3 observers and 9 linear and 14 angular measurements were digitally traced. The values were sent for statistical analysis using ANOVA to check the interobserver reliability between the imaging modalities. Statistical Analysis Used: ANOVA, Student’s t‑test, and post hoc test were used for the statistical analysis. Results: The interobserver reliability was high between the modalities. CBCT total skull received an overall intraclass correlation coefficient (ICC) value of 0.76. The ICC value for the CBCT half‑skull was 0.79 and for the digital cephalograms it was 0.80. The reliability for CBCT total skull was marginally less when compared to the CBCT half‑skull and digital cephalograms, but more for the mid‑sagittal measurements. Digital cephalograms showed the most variation with measurements of the mandibular plane when compared to CBCT. Conclusions: CBCT has the potential to be used for cephalometrics, especially the half‑skull images, but further studies are required to prove whether CBCT total skull images can be used. 2D cephalometry, however, still does remain as the mainstay of orthodontic diagnosis and treatment planning and cannot be easily replaced by three‑dimensional cephalometry.

Parental Pesticidal Exposure and Risk of Clefts in the Craniofacial Region: A Case-Control Study in South India.

Objective: The multifactorial etiology of cleft can be due to environmental factors or genetic factors or combination of both. Many studies were conducted to detect the epidemiology of the clefts and the genetic factors causing clefts. There is no or very less studies conducted in India to identify the risk of pesticidal exposure in occurrence of nonsyndromic clefts. The present study is to investigate the risk of parental pesticidal exposure in causing clefts in the craniofacial region. Methods: The case-control study included 179 cases of cleft in the craniofacial region and 200 healthy controls matched for age and gender. The data were collected in the proforma from the study group in the departments of plastic surgery, Obstetrics and Gynaecology, and Paediatrics of Vydehi Institute of Medical Sciences and Research Centre. Result: Majority (55.3%) of the parents from the cleft group were exposed to pesticides but only 4.5% parents of the control group were exposed which is statistically significant (p=0.001). Compared to other cleft group, more parents of cleft lip palate exposed to pesticides was also significant (p=0.041).The cleft cases which were exposed to pesticides (86%) were from the rural area and the controls which were not exposed (79%) were from the urban area and is statistically significant (p<0.001). Conclusion: Parental pesticidal exposure is a risk factor for clefts in the craniofacial region. Among all the clefts, the risk is increased for the cleft lip palate.

Study of dorsal wall of sacrum.

Background: Sacrum is a large triangular bone formed by fusion of five sacral vertebrae. The opening present at the caudal end of sacral canal is known as sacral hiatus and is formed due to the failure of fusion of lamina of fifth sacral vertebra. Objective of current study was to study the anatomical variations of dorsal wall of sacrum in order to clarify the structural variations of sacral hiatus and surrounding structures for improving the reliability of caudal epidural block Methods: The present study was done on 50 male and 50 female dry human sacra after calculating the sacral indices and sexing of sacra. The dorsal wall of sacrum was studied with respect to composition of sacrum, level of sacral hiatus, deficiencies and apertures in the bony dorsal wall and also for the presence and absence of sacral cornua. Results: The level of apex of sacral hiatus can vary from upper part of S2 to lower part of S5. The most common position was at S4 (64%). Elongated sacral hiatus at the level of S2 was present in 4% of cases. Sacrum had normal 5 segments in 70% of cases, 4 segmented sacra were observed in 4% of cases, sacralization of 5th lumbar vertebra in 7%, coccygeal ankylosis in 19% of cases. Less extensive apertures in the bony dorsal wall of sacral canal were observed in 29% of sacra. Conclusion: The dorsal wall of sacrum has anatomical variations. Understanding these variations may improve the reliability and success of caudal epidural anesthesia.

Carcinoma of Mandible Involving The Floor of The Mouth - A Case Report.

Carcinoma of the floor of mouth represents 8% to 12% of all head and neck cancers. 85 to 95% of patients are males; the mean age is 58 years for men and 65 years for women. Oral carcinoma of the mandibular region has been defined as carcinoma of the mandibular alveolar ridge, lower buccal sulcus, sublingual sulcus and mandibular retro molar trigone . Lesions occurring in this area often involve mandible mostly by direct extension and seldom by other routes . The prevalence of mandibular bone involvement ranges from 12 to 56%.Classical clinical symptoms can be discomfort or pain under the mobile tongue, difficulty with protraction or swallowing, speech impairment, but more frequently, the dentist or the family physician discovers the disease

Pre-operative contrast enhanced computer tomographic evaluation of cervical nodal metastatic disease in oral squamous cell carcinoma.

Aims: This prospective study was undertaken to evaluate the contrast enhanced computed tomography (CECT) criteria in detecting cervical lymph node metastasis in 50 patients with an oral squamous cell carcinoma (OSQCC). Materials and Methods: A total of 50 patients with OSQCC who underwent clinical assessment, routine CECT scanning of cervical lymph node and radical neck dissection were analyzed. Radiologic criteria for diagnosing nodal metastasis in this imaging study were: A nodal size of 1 cm, the presence of central lucency despite the size of the lymph node and grouping of lymph nodes. These criteria were based on modified American Joint Committee on Cancer Radiological Nodal Staging Guidelines. Statistical Analysis: Chi-square test/Fisher Exact test has been used to find the significant association of findings. Diagnostic statistics viz.: Sensitivity, specificity, positive predictive value (PPV), negative predictive value, and diagnostic accuracy were obtained. The results were considered significant when P value was less than 0.05. Results: On using a nodal size of 1 cm and the presence of central nodal necrosis (CNN) as radiological criteria for nodal metastasis CT scanning staged 23 of the 27 histopathologically positive necks, providing accuracy of 88%, sensitivity of 92%, and specificity of 84% in detection of nodal metastasis. A significant relationship between the incidence of CNN, different nodal densities, and primary tumor differentiation was observed. Conclusions: The nodal size cut-off of 1-1.5 cm had a maximal sensitivity of 90.91% and PPV of 86.96%. Furthermore, observation of nodal densities in the absence of frank CNN on the CT scan may be necessary especially in low grade primary tumor. CT assessment of cervical node metastasis was found acceptable, although adjuncts like ultrasound guided fine needle aspiration may further increase efficacy of CT scan in nodes lesser than 1 cm in size.

Paraneoplastic Syndromes In Patients With Oral Cancer.

Paraneoplastic syndromes (PNS) include a series of disorders that accompany benign and malignant tumors. PNS occurs in one to seven percent of all cancer patients, however the evidences seem to be increasing. PNS associated with head and neck cancer can be divided into six main groups : endocrine, cutaneous or dermatologic, hematologic, osteoarticular or rheumatologic, neurologic and ocular syndromes. PNS can precede, follow or be concurrent with the malignant tumours. The following review thus aims to highlight various aspects of different Paraneoplastic syndromes and how important is awareness of these conditions for clinicians dealing with cancer.

Long QT syndrome in children with congenital deafness.

The Jervell and Lange-Nielson syndrome(JLN) is an infrequent form of long QT syndrome (LQTS) in which prolonged QT interval and congenital deafness exist together. We attempted to identify patients with LQTS among 127 children (age 1.2-10 years) with congenital hearing loss. The corrected QT interval was measured from 12 lead electrocardiogram(ECG) , using Bazette’s and Friedricia formulae.The QT interval was considered prolonged when it exceeded the upper limit of 440ms and 450ms, respectively. Ten children with congenital deafness had a corrected QT interval longer than 440ms. Although these children did not meet the definite criteria according to Schwartz parameters, all the 10 children could be defined as having intermediate probability of LQTS according to revised criteria. We advise that children with congenital deafness be screened for long QT syndrome .

Efficacy and safety of tenecteplase in Indian patients with st-segment elevation myocardial infarction.

OBJECTIVE: To assess the efficacy and safety of tenecteplase in Indian patients with ST-segment elevation MI (STEMI). METHODS: Cardiologists/physicians who had used tenecteplase for management of STEMI, recorded safety and efficacy parameters from consecutively treated patients. Tenecteplase was administered as per the prescribing information. Adjunctive therapy which included clopidogrel and UFH/LMWH was administered as routinely practiced and indicated by guidelines. RESULTS: Five hundred and seven patients (male = 415, females = 92; mean age = 58.28 +/- 12.23 yrs; weight (kg) = 70.12 +/- 11.06) with STEMI were treated with weight-adjusted tenecteplase within median chest pain to drug interval of 120 minutes. Resolution of chest pain within median interval of 45 minutes occurred in 436 patients with median duration required for > or = 50% resolution of ST segment of 75 minutes. Clinically successful thrombolysis was reported in 80.67% patients. Five patients suffered intra-cranial hemorrhage (ICH), of which 3 patients had received Gp IIb/IIIa inhibitors. Incidence of intra-cranial hemorrhage attributable to tenecteplase was 0.39% (2 out of 507 patients). Incidence of myocardial re-infarction was 2.96% (15 out of 507 patients). There were 12 deaths (2.36%). CONCLUSION , This data shows that tenecteplase is safe and effective in Indian patients with STEMI and conforms to the international ASSENT-2 trial data.

Salmonella myocarditis presenting as acute myocardial infarction: a case report.

Cardiac involvement with Salmonella infection is well known and electrocardiographic changes bear a direct relationship to prognosis. We present here a case with ECG changes mimicking an acute myocardial infarction in salmonella infection.

Surgical repair of left ventricular aneurysms: a comparative evaluation of linear versus Dor's repair.

BACKGROUND: Resection and linear repair of aneurysms of the left ventricle alter its geometry and thereby reduce its performance over the long term. Hence, Dor's circular patch repair was advocated to maintain the geometry of the left ventricle. However, the superiority of this procedure over linear repair is debatable. METHODS AND RESULTS: We retrospectively analyzed 95 cases of left ventricular aneurysm repair--28 cases by Dor's procedure and 67 by linear repair. The age group, symptoms, risk-factor profile and severity of coronary artery disease were comparable in both the groups, but the cardiopulmonary bypass and mean aortic cross-clamp time were longer in those treated with Dor's procedure. The left internal mammary artery could be grafted to the left anterior descending artery or diagonal branch in 13 cases in the group undergoing Dor's procedure (group I) versus 14 cases in the group undergoing linear repair (group II). There was no mortality in group I while there were 7 deaths in group II. Patients in group I were followed up for up to 2 years and those in group II for up to 13 years. During follow-up, 16/2 8 remained in NYHA functional class I or II in group I versus 24/67 in group II. The mean preoperative left ventricular ejection fraction was 34.9% in group I which improved to 39.7% during follow-up. In group II, the mean preoperative left ventricular ejection fraction was 37.2% which improved to 41.5% during follow-up. This difference was not statistically significant. CONCLUSIONS: In our retrospective study, we did not observe any superiority of Dor's repair over linear repair for left ventricular aneurysm as regards NYHA functional class and left ventricular ejection fraction. However, follow-up with Dor's repair was short (up to 2 years). Hence, no definite conclusions can be drawn.

Hemangioma of the pericardium: a case report.

A 52-year-old male presented with dyspnoea on exertion. He was found to have a clinically normal cardiac status and a mass lesion in the anterior mediastinum, probably arising from the pericardium near the right atrium, as shown by both echocardiography and a computerized tomographic scan of the chest. He was successfully operated. The histopathology of the mass revealed it to be a hemangioma of the pericardium. This is one of the rare tumors of the pericardium and only a few cases have been reported in the literature.