Survival Outcomes and Patterns of Failure in Maxillary Alveolus Squamous Cell Carcinoma

Abstract Introduction Squamous cell carcinoma (SCC) of the maxillary alveolus is a relatively rare disease. There is lack of data on this subsite as compared with other sites. The factors that affect survival in cases of maxillary alveolar SCC are tumor stage, local and cervical metastases, histological grading, and the margin status. Objectives To evaluate the overall survival (OS), the disease free survival (DFS), and the complex interaction and effects of margin status, histological differentiation, habits (such as smoking and the use of smokeless tobacco products), and cervical and distant metastases based on clinicopathological data. Methods We examined the electronic database at our hospital from 2003 to 2017. We included all cases with a histopathological diagnosis of SCC of the maxillary alveolus. Tumors originating primarily from the maxillary alveolus were included, while those originating from adjacent subsites, like the hard palate, the buccal mucosa or the maxillary sinus were excluded. We also excluded all the patients who were not operated on with a curative intent. Results More than half of the patients had stage-IV tumors at the time of presentation, while only one fourth of them had nodal metastasis. The rate of recurrence increased in cases of primary tumors in advanced stages and the degree of histological differentiation. The 2-year and 5-year OS rates were of 54.5% (18 patients) and 30.3% (10 patients) respectively. Conclusion Primary tumors in advanced stages, histological grade, and presence of nodal metastasis are poor prognostic markers in terms of long-term survival.

Administration of Vaccine Preservative Thimerosal Produces Impairment in Rat Liver

Abstract The present research was planned to analyze the toxic effects of thimerosal on rat liver. Mercury and mercury compounds are universally known toxicants for animals and humans. Thimerosal is widely used in the vaccines as a preservative which contains 49.6% mercury. Twenty-four adult male albino rats were distributed into four groups (n=6). The first group was considered as a control group. While, second, third and fourth groups were intoxicated with 0.5, 10 and 50 µg/kg thimerosal (i.m.) respectively. After 30 days, rats were slaughtered to analyze the liver tissues. The results of the experiment exposed that thimerosal instigated significant (p<0.05) increase in alanine transaminase (ALT), alkaline phosphatase (ALP) and aminotransferase (AST) levels. Catalase (CAT), superoxide dismutase (SOD), peroxidase (POD) activities and Glutathione (GSH) and protein levels were significantly (p<0.05) reduced. Furthermore, significant increases in Hydrogen peroxide (H2O2), thiobarbituric acid reactive substances (TBARS) level and DNA damage was observed. Histopathological study revealed severe damages, e.g. fatty alterations, deterioration of lobular structure and degeneration of nuclei in hepatic tissues of thimerosal treated rats. Results of present investigation revealed that thimerosal induces hepatotoxicity at different levels.

Improved antifungal activity of barley derived chitinase I gene that overexpress a 32 kDa recombinant chitinase in Escherichia coli host

Abstract Agricultural crops suffer many diseases, including fungal and bacterial infections, causing significant yield losses. The identification and characterisation of pathogenesis-related protein genes, such as chitinases, can lead to reduction in pathogen growth, thereby increasing tolerance against fungal pathogens. In the present study, the chitinase I gene was isolated from the genomic DNA of Barley (Hordeum vulgare L.) cultivar, Haider-93. The isolated DNA was used as template for the amplification of the ∼935 bp full-length chitinase I gene. Based on the sequence of the amplified gene fragment, class I barley chitinase shares 93% amino acid sequence homology with class II wheat chitinase. Interestingly, barley class I chitinase and class II chitinase do not share sequence homology. Furthermore, the amplified fragment was expressed in Escherichia coli Rosetta strain under the control of T7 promoter in pET 30a vector. Recombinant chitinase protein of 35 kDa exhibited highest expression at 0.5 mM concentration of IPTG. Expressed recombinant protein of 35 kDa was purified to homogeneity with affinity chromatography. Following purification, a Western blot assay for recombinant chitinase protein measuring 35 kDa was developed with His-tag specific antibodies. The purified recombinant chitinase protein was demonstrated to inhibit significantly the important phytopathogenic fungi Alternaria solani, Fusarium spp, Rhizoctonia solani and Verticillium dahliae compared to the control at concentrations of 80 µg and 200 µg.

Nasolabial and extended nasolabial flaps for reconstruction in oral submucous fibrosis

OBJECTIVES: The objective of the study was to evaluate the results of nasolabial/extended nasolabial flaps as a modality for treatment of oral submucous fibrosis. MATERIALS AND METHODS: Eleven patients of Stage III or IVa maximum interincisal opening were selected to be operated. Nasolabial/extended nasolabial flaps were done for both the sides. All of the flaps were done in a single stage and were inferiorly based. A similar flap harvest/surgical technique was utilized for all the cases. RESULTS: The preoperative mouth opening ranged from 5 to 16 mm, with a mean of 10.09 mm. At 6 months the mouth opening ranged from 29 to 39 mm. Some of the complications encountered were poor scar, wisdom tooth traumatising the flap, decreased mouth opening due to non compliance and too much bulk. All of theses were managed satisfactorily. CONCLUSION: The nasolabial flap is a very reliable flap to restore the function of oral cavity. Important adjuvant measures are habit cessation, lifestyle changes, and aggressive physiotherapy.

Surgical correction of grade III hypertelorism

Orbital hypertelorism is an increased distance between the bony orbits and can be caused by frontonasal malformations, craniofacial clefts, frontoethmoidal encephaloceles, glial tumors or dermoid cysts of the root of the nose, and various syndromic or chromosomal disorders. We report a series of 7 cases of hypertelorism that were treated in our hospital. The underlying causes in our series were craniofacial clefts 0 to 14 (4 cases), craniofacial clefts 1 to 12 (1 case), and frontonasal encephalocele (2 cases), all congenital. Surgical techniques used to correct the deformity were box osteotomy and medial wall osteotomy with or without calvarial and rib grafts. A few of our cases were reoperations with specific challenges.

Double mutation of Saccharomyces cerevisiae for enhanced β-D-fructofuranosidase fructohydrolase productivity and application of growth kinetics for parametric significance analysis

Abstract The kinetics of an extracellular β-D-fructofuranosidase fructohydrolase production by Saccharomyces cerevisiae in a chemically defined medium, i.e., sucrose peptone agar yeast extract at pH 6, was investigated. The wild-type was treated with a chemical mutagen, methyl methane sulfonate. Among the six mutants isolated, methyl methane sulfonate-V was found to be a better enzyme producing strain (52 ± 2.4a U/mL). The maximum production (74 ± 3.1a U/mL) was accomplished after at 48 h (68 ± 2.7a mg/mL protein). The mutants were stabilized at low levels of 5-fluoro-cytocine and the viable ones were further processed for optimization of cultural conditions and nutritional requirements. The sucrose concentration, incubation period and pH were optimized to be 30 g/L, 28 °C, and 6.5, respectively. The methyl methane sulfonate-V exhibited an improvement of over 10 folds in enzyme production when 5 g/L ammonium sulfate was used as a nitrogen source. Thin layer chromatography and high-performance liquid chromatography analysis illustrated the optimal enzyme activity supported by the higher rate of hydrolysis of sucrose into monosaccharides, particularly α-D-glucose and β-D-fructose. The values for Qp (2 ± 0.12c U/mL/h) and Yp/s (4 ± 1.24b U/g) of the mutant were considerably increased in comparison with other yeast strains (both isolates and viable mutants). The mutant could be exploited for enzyme production over a wider temperature range (26–34 °C), with significantly high enzyme activity (LSD 0.048, HS) at the optimal temperature.

Comparison of outcome of percutaneous nephrolithotomy in adult versus paediatric patients

Objective: To compare the outcome of percutaneous nephrolithotomy [PCNL] in terms of operative time, hospital stay, stone clearance, and postoperative complications in adult versus paediatric patients

Study Design: Descriptive case series

Place and Duration of Study: Shifa International Hospital, Islamabad, from January 2010 to December 2013

Methodology: A retrospective analysis of 155 patients who underwent PCNL from January 2010 to December 2013. The patients were divided into 2 groups: patients aged ? 12 years were included in paedriatic group [A] while patients aged > 12 years were included in adult group [B]. The patients were analyzed for age, gender, stone size, operative time, stone clearance, hospital stay, and peroperative and postoperative complications. Data was collected by chart review on specified proforma

Results: One hundred and twenty-nine [129] patients including 44 [34.10%] females and 85 [65.89%] males with a mean age of 45.00 +/- 1.44 years were adults. Twenty-six palrents with mean age of 9.21 +/- 5.70 years, 17 [65.4%] males and 9 [34.6%] females, were included in the paedriatic group. Mean stone size was 2.12 +/- 1.01 cm in paedriatic group compared to 2.52 +/- 0.77 cm in adult group [p = 0.023]. Mean operative time in paedriatic group was 158.8 +/- 39.63 minutes compared to 119.34 +/- 37.06 minutes in adult group [p < 0.001]. Mean hospital stay in paedriatic group was 2.76 +/- 1.14 days compared to 3.12 +/- 1.27 days in adult group [p=0.1881]. Peroperative stone clearance was in paedriatic group was 93.28 +/- 9.23% compared to 90.81 +/- 12.23% in adult groups [p = 0.331]. One patient in the adult group developed urosepsis

Conclusion: There was no significant difference in outcome of percutaneous nephrolithotomy in terms of hospital stay, stone clearance, and postoperative complications in adult versus paediatric patients. Operative time was significantly shorter in adult cases compared to paedriatic cases

Central obesity as a risk factor for impaired glucose tolerance

Objectives: To examine the association of central obesity [measured as waist-to-hip ratio] with glucose intolerance, and to compare the mean fasting blood sugar and the mean random blood sugar levels of centrally obese and non- obese adults

Study Design: Analytical case-control study

Place and Duration of Study: This study was carried out at the Medical Wards and OPDs of Civil Hospital Karachi from June 2015 to December 2015

Materials and Methods: The subjects were selected by non-probability convenience. Based on their waist-to-hip ratio they were divided into centrally obese [group A] and non-obese [group B]. The cut-off point for waist-to-hip ratio was 1.0 for males and 0.85 for females. One hundred non-diabetic, healthy adults were included in each group. All the subjects underwent a 2 hour 75-gm oral glucose tolerance test. Fasting blood sugar and random blood sugar at two hours post-glucose challenge were measured

Results: Five individuals had blood sugar levels in the diabetic range and were excluded from the study. Impaired glucose tolerance was observed in fifteen out of 98 subjects in the centrally obese group and six out of 97 subjects in the non-obese group. This difference was statistically significant [p=0.04]. Statistically significant difference was also observed between the mean fasting blood sugar and the mean random blood sugar of the two groups [p<0.001 in both cases]. The odds ratio for a person with central obesity to have impaired glucose tolerance was estimated to be 2.74

Conclusion: There is a significant association between central obesity [waist-to-hip ratio] and glucose intolerance

Frequency of hypomagnesemia in patients with diabetes mellitus at civil hospital Karachi

Objective: To determine frequency of hypomagnesemia in diabetic patients presenting at Civil Hospital Karachi

Study Design: Cross-sectional study

Place and Duration of Study: This study was conducted at a Diabetic Clinic in National Institute of Diabetes and Endocrinology [NIDE], Karachi from January to June 2016

Materials and Methods: All patients > 12 years of age of either sex, diagnosed cases of diabetes mellitus [either Type I or Type II] of > 5 years duration and have given consent for participation in the study were included. Patients with acute pancreatitis and have history of alcoholism [such conditions results in reallocation of the magnesium from extracellular to intracellular space], occurrences of diarrhea, regurgitating and nasogastric suction, ostomies and gastrointestinal fistulas [conditions which result gastrointestinal magnesium loss] and patients receiving diuretics, chemotherapeutic agents [cisplatin], antimicrobials [amphotericin B, aminoglycosides, pentamidine, capreomycin. vancomycin, and foscarnet], immunosuppressants [tacrulimus and cyclosporine], and proton-pump inhibitors, [as all these drugs results in renal loss of magnesium] were excluded

Results: The average age of selected patients with diabetes mellitus was 46.81 +/- 6.8 years. Of 350 patients, 203 [58%] were female and 147 [42%] were male; 176 [50.3%] patients had diabetes for >/= 7years; 269 [76.9%] patients had type II diabetes and 275 [78.6%] had uncontrolled diabetes. The mean serum magnesium level was 1.48 +/- 0.36 mg/dl and the frequency of hypomagnesemia was 227 [64.9%] cases

Conclusion: It is concluded from this study that the frequency of hypomagnesemia was 64.9% among study population

Awareness about the baseline blood glucose levels, risk factors and complications among diabetic patients attending OPD of national institute of diabetes and endocrinology, Karachi

Objective: To evaluate awareness among diabetic patients attending OPD of National Institute of Diabetes and Endocrinology, Karachi, about the baseline blood glucose levels, Risk factors and Complications

Study Design: Cross-sectional study

Place and Duration of Study: This study conducted at the OPD of National Institute of Diabetes and Endocrinology [NIDE], at OJHA campus of Dow University of Health Sciences, Karachi from January to March 2016 in Karachi

Materials and Methods: Adult, age 18 years and above, cases of diabetes were recruited from OPD of National Institute of Diabetes and Endocrinology [NIDE], at OJHA campus of Dow University of Health Sciences, Karachi. Data was collected using a structured questionnaire which was translated into local language i.e. Urdu. SPSS was used for statistical analysis

Results: A total of 100 participants completed the interview out of which 53% were male and 47% were female. Mean age of the participants was 49.3 +/- 10.7 years. Regarding the knowledge about target blood glucose levels, only 39% of the participants correctly identify the fasting blood glucose level while only 26% correctly answered random blood glucose levels. Overall mean score of knowledge and awareness was 40%. Male had better knowledge then female. Mean score for male was 50% compared to 30% among female. This difference was statistically significant p-value <0.05. Over all 45% of the participants were found to have poor knowledge scores, 35% had acceptable while only 20% had acceptable knowledge scores

Conclusion: This study found that there is low level of awareness among the patients attending diabetic outpatient clinics of NIDE. This indicates gaps in the patient care which needs attention. There is need to integrate patient education regarding glycemic targets, risk factors, complications and self-care as essential component of care through different channels of communication

New direct acting antiviral agents for the treatment of hepatitis C: 2016 and beyond

Hepatitis C is one of the commonest public health problems with 130 million people infected worldwide and the burden is increasing. Previously, Interferon along with Ribavirin was the mainstay of treatment but it was associated with toxic side effects. An all-oral regimen with higher rates of sustained viral response [SVR], minimal side effects and no restriction for liver fibrosis staging, was long awaited. Several all-oral interferon-free direct acting antiviral agents [DAAs] have now been approved by FDA for different genotypes of HCV. These include Sofosbuvir, Ledipasvir, Daclatasvir, Simeprevir, Dasabuvir, Ombitasvir. Paritaprevir and Ritonavir. These agents are also available in different combinations commercially under various trade names. A number of studies have proved their efficacy and the AASLD and EASL guidelines recommend several options for each genotype in different categories including treatment naive, relapsers, failure, compensated and decompensated cirrhosis. The purpose of this article is to review the persistently changing treatment regimens for hepatitis C and to simplify the dynamicity of the subject and selection of appropriate regimen for these patients

Delayed single stage perineal posterior urethroplasty

To determine the delayed single stage perineal posterior urethroplasty for treatment of posterior urethral stricture/distraction defect. Descriptive case series. Department of Urology, Jinnah Postgraduate Medical Centre, Karachi, from January 2009 to December 2011. Patients were selected for delayed single stage perineal posterior urethroplasty for treatment of posterior urethral stricture / distraction defect. All were initially suprapubically catheterized followed by definitive surgery after at least 3 months. Thirty male patients were analyzed with a mean follow-up of 10 months, 2 patients were excluded as they developed failure in first 3 months postoperatively. Mean patient's age was 26.25 +/- 7.9 years. On follow-up, 7 patients [23.3%] experienced recurrent stricture during first 10 months. Five [16.6%] patients were treated successfully with single direct visual internal urethrotomy. Two patients [6.6%] had more than one direct visual internal urethrotomy and considered failed. Re-do perineal urethroplasty was eventually performed. The overall success rate was 93.3% with permissive criteria allowing single direct visual internal urethrotomy and 76.6% with strict criteria allowing no more procedures postoperatively. Posterior anastomotic urethroplasty offers excellent long-term results to patients with posterior urethral trauma and distraction defect even after multiple prior procedures

Effect of previous exposure to HBV on liver histology and treatment response in CHC patients

To analyze the influence of previous exposure to HBV on liver histology and treatment outcomes in chronic hepatitis C [CHC] patients. Case control study. Rawalian Liver Clinic, Department of Medicine, Holy Family Hospital, Rawalpindi, from January 2011 to December 2012. Medical records of CHC patients attending the Rawalian Liver Clinic were retrospectively analyzed. Virological and treatment responses along with histological changes were compared between cases [anti-HBc positive] and controls [anti-HBc negative]. Significance was determined through chi-square test at p < 0.05. Among the 592 CHC patients, 254 [42.9%] had serological evidence of a positive anti-HBc [cases] and 338 [57.1%], patients had negative anti-HBc [controls]. No significant difference was found between ETR, SVR and treatment responses [n=220] between the two groups. Out of 65 patients whose liver biopsy data was available, cases were more likely to respond in the absence of fibrosis [63.2%, [n=24] vs. 36.8%, [n=14], p=0.001]. The controls responded more in the presence of fibrosis [100% [n=9] vs. 0, p=0.001]. There was no significant effect of anti-HBc positivity on grades of inflammation and consequent treatment response [p=0.14]. There are a significant number of CHC patients with markers of previous HBV infection in Pakistani population. Previous HBV [anti-HBc positive] does not seem to have an adverse effect on liver histology and treatment responses in HBV infection

Amyand's hernia; a case report

An appendix in an inguinal hernial sac is called as Amyand's Hernia. The appendix may or may not be inflamed. It is a rare occurrence in surgical practice. A 23 years old male presented with the clinical diagnosis of strangulated right inguinal hernia. On surgical exploration acutely inflamed appendix was found in the hernial sac. Appendicectomy and hernia repair was carried out. Inguinal hernia is one of the most common general surgical procedures. Unexpected hernial sac contents like an inflamed appendix may be encountered and dealt accordingly

Gallstone ileus: a complication least expected

Gallstone ileus is an uncommon cause of mechanical small bowel obstruction. A high index of suspicion is needed so as to avoid the morbidity and mortality related to this condition in geriatric population in which it occurs more frequently. A 60-year old female presented with signs and symptoms of acute small bowel obstruction. Surgery a large stone was found impacted in the terminal ileum with a fistulous tract between the gallbladder and duodenum

Open dismembered pyeloplasty for uretero-pelvic junction obstruction

To report our experience with open dismembered pyeloplasty for uretero-pelvic junction obstruction. Retrospective study was conducted in the Department of Urology, Jinnah Postgraduate Medical Centre, Karachi for a period of five and half years from May, 2006 to December, 2011. All patients with uretero-pelvic junction obstruction were entered into a database to record patients clinical features, diagnostic tools, operative and post-operative details and follow-up. Over a five-years period, 13 procedures were performed. After clinical evaluation all patient had extensive haematological and radiological workup for diagnosis of uretero-pelvic junction obstruction. All were subjected to open pyeloplasties, out of these 13 patients; one had an aberrant lower pole vessel compressing uretero-pelvic-junction. All procedures were stented. Repair was done with 3/0 vicryl sutures all patients were catheterized and wound drained. Mean operating time was 60 - 100 minutes with about 100cc blood loss requiring no transfusion. The mean follow up was one year. One patient developed post-operative haematuria and was managed conservatively. Two patients developed fever secondary to urinary tract infection despite adequate treatment of urinary tract infection according to culture and sensitivity pre-operatively. One patient developed surgical emphysema detected post-operatively, which required tube thoracostomy. Neither patient developed recurrent symptoms nor had any evidence of obstruction on the renogram on follow-up. Objectively all patients were followed up by intravenous urogram, stress renogram, Urine C/S. Subjective and objective follow-up revealed success in 100% of patients whereas success is defined as no or minimal holder on DTPA renogram, improving renal function and decreasing dilatation on successive intravenous urogram. All patients had a mean post-operative hospital stay of 02 - 04 days Folley catheter was removed after 10-days, double-j- stents were removed after two to three weeks. Our success rate following open pyeloplasty with limited follow-up was 100%. It is comparable with International data. Recent international trend is toward Uretro-pelvic Junction Obstruction [UPJO] repair with laparoscopic approach, they are claiming success rate of 95%

Correction of facial asymmetry associated with unilateral hypoplastic mandible with monobloc distraction osteogenesis in adult

Facial asymmetrey can be corrected by bimaxillay orthognathic surgery and distraction osteogenesis. We report a case of facial asymmetry which was corrected using monobloc distraction osteogenesis. A monobloc was created using an osteosynthesis fixation device from the zygomatic buttress to the mandible, LeFort I osteotomy was combined with mandiular angle osteotomy and the bloc was distracted using uni-directional distractor

Safety of non-anaesthesiologist-administered propofol sedation in ERCP

Propofol is increasingly being used for sedation purposes during endoscopic retrograde cholangiopancreatography [ERCP]. This study aimed to evaluate the safety of nonanaesthesiologist administration of propofol [NAAP] during therapeutic ERCP. Patients, who underwent ERCP at Centre for Liver and Digestive Diseases, Holy Family Hospital, Rawalpindi, were included in the study. Propofol sedation was administered by a physician who was a non-anaesthesiologist certified in basic and advanced cardiac life support. The total study duration was 6 months. The primary outcome variable was the frequency of any sedation-related complication. A total of 156 patients [41% males and 59% females] were enrolled in the study. The mean propofol dose used during the procedure was 201 +/- 132 mg. The mean propofol dose, when adjusted to weight and duration of procedure, was 0.05 +/- 0.04 mg kg[-1] min[-1]. According to the American Society of Anesthesiologists [ASA] classification. 136 [87%] patients were placed in ASA class I and II and 20 [13%] patients were of ASA class III. Only two patients developed sedation-related complication: one minor requiring bag-mask ventilation and other major requiring mechanical ventilation via endotracheal intubation. Both were managed by the trained non-anaesthesiologist and gastroenterologist at the pIace of procedure. No patients required cardiopulmonary resuscitation and admission to the intensive care unit. There were no sedation-related deaths. NAAP sedation can be considered safe for low-risk patients [ASA class I and II] undergoing ERCP. The presence of a trained anaesthetist is advisable in high-risk patients [ASA class III and higher] with significant co-morbidities

Dengue hemorrhagic fever: comparison of patients with primary and secondary infections

Dengue hemorrhagic fever [DHF] is considered to be associated with secondary dengue infection. This study was conducted to note frequency of primary and secondary dengue infection in DHF patients. Additionally these patients were compared in terms of age, gender, laboratory parameter, diseases severity and outcome. In this cross sectional observational study DHF patients fulfilling DHF criteria of Dengue Expert Advisory Group [DEAG] were included and divided into groups based on dengue specific IgG positivity and ratio of IgM to IgG. Group I, patients with secondary dengue infection were IgG positive or their ratio of IgM to IgG was <1.2. Group II, primary dengue infection patients were IgG negative or their ratio of IgM to IgG was >1.2. The two Groups were compared for statistically significant association in terms of age, gender, laboratory parameter [at admission hematocrit [HCT], platelet, white blood cell [WBC] counts, alanine aminotransferase [ALT] value], severity [DHF or dengue shock syndrome], and outcome [recovered or expired]. Two hundred thirty-four DHF patients were included. 66.2% was male and 33.8% female. Mean patient age was 28.8 +/- 12.4 years. Based on dengue markers results, 61.5% patients were categorized to Group I, and 38.5% to Group II. Statistically significant association between the two Groups was noted in terms of at admission platelet count, and ALT value, P value <0.05. Primary dengue infection is frequently associated with DHF. Patients with DHF caused by secondary dengue infection have lower at admission platelet counts and higher ALT value

Comparison of silastic and acrylic interpositioning for the treatment of temporomandibular joint ankylosis

The aim of this study was to compare the treatment outcome of thirty unilateral temporomandibular joint [TMJ] ankylosis cases treated in Pakistan Institute of Medical Sciences [PIMS], Islamabad within four years by either silastic or acrylic interpositional arthoplasty. Patients having bilateral TMJ ankylosis, age less than 16 years, coronoidectomy required during procedure, already operated cases and medically compromised patients were excluded from the study. Pre and post-operative assessment was done by thorough history, physical examination and radiographic evaluation [OPG and CT scan] to determine the cause of ankylosis, the maximal inter-incisal opening, complications including infection, presence of facial nerve paralysis and recurrence rate. The maximal inter-incisal opening in the pre-operative period ranged from 0-11mm and was recorded at a mean of 32.7+/-5.8mm for cases treated with silastic interposition and 29.5+/-6.8mm for the ones treated with acrylic one year after surgery. Infections, swelling, pain and nerve injuries were reported in both the groups post-operatively. Both silastic and acrylic were found to be statistically similar in terms of maximal inter-incisal opening, complications and recurrence rates. Recurrence was observed in only one patient treated by acrylic inter-positioning. Silastic however demonstrated itself to be a better choice in terms of handling and patient tolerability