Subtractive versus additive indirect manufacturing techniques of digitally designed partial dentures

PURPOSE@#The purpose of this in vitro study was to evaluate the accuracy of digitally designed removable partial denture (RPD) frameworks, constructed by additive and subtractive methods castable resin patterns, using comparative 3D analysis. @*MATERIALS AND METHODS@#A Kennedy class III mod. 1 educational maxillary model was used in this study. The cast was scanned after modification, and a removable partial denture framework was digitally designed. Twelve frameworks were constructed. Two groups were defined: Group A: six frameworks were milled with castable resin, then casted by the lost wax technique into Co-Cr frameworks; Group B: six frameworks were printed with castable resin, then casted by the lost wax technique into Co-Cr frameworks. Comparative 3D analysis was used to measure the accuracy of the fabricated frameworks using Geomagic Control X software. Student's t-test was used for comparing data. P value ≤ .05 was considered statistically significant. @*RESULTS@#Regarding the accuracy of the occlusal rests, group A (milled) (0.1417 ± 0.0224) showed significantly higher accuracy than group B (printed) (0.02347 ± 0.0221). The same results were found regarding the 3D comparison of the overall accuracy, in which group A (0.1501 ± 0.0205) was significantly more accurate than group B (0.179 ± 0.0137). @*CONCLUSION@#In indirect fabrication techniques, subtractive manufacturing yields more accurate RPDs than additive manufacturing.

In Situ hybridization and light and electron microscopes of cervical squamous cell carcinoma infected with human Papillomavirus

Aim of the work-In Egypt cervical carcinoma is ranked as a number 6 of all malignant tumors. There is growing evidence that the human papillomavirus [HPV] is associated with the development of cervical cancer

Patients and Methods-The present study hunted HPV in Egyptian biopsies of cervical cancer by using in situ hybridization [ISH] technique .Light microscopy and ultra-structural features accompanied by squamous cell carcinoma [SCC] of the cervix were monitored

Results-The ultra structural study revealed viral particles in some epithelial cell nuclei and cytoplasm in the moderately-differentiated squamous cell carcinoma. These were suggested to be Herpes Simplex Virus [HSV]

Conclusion-The potential relation between HPV and HSV in the incidence of Cervical Squamous Cell Carcinoma is discussed

Retropharyngeal abscess in children; changes in airway clinical presentation and management

Diagnosis of retropharyngeal abscess [RPA] in children is based on clinical suspicioun with supportive imaging studies RPA is frequently described as acute airway emergency. There is nowadays a change in the clinical presentation and management that has been explored in this study. The study included cases identified by a diagnosis of RPA including infectious and traumatic cases with confirmatory computed Tomography [CT] scan findings. Patients were treated with conservative antibiotics, CT-guided needle aspiration or open transoral drainage under general endotracheal anesthesia. Seventeen patients were identified. The mean age was 5.5 years. The symptoms were in the following order of frequency; posterolateral neck pain in 70.5%, odynophagia and drooling 47%, fever 29.4%, lateral neck mass 23.5%, and lastly respiratory distress in 1 patient [5.8%]. The commonest sign was limitation of neck movement 88.2%; of those, 10 patients [58.8%] had limitation of neck extension, 3 [17.6%] had torticollis, 2 [11.7%] had limitation on flexion. Following signs were, fever 53%, enlarged tender upper cervical lymph nodes 47%, tachypnea 35%, posterior pharyngeal bulge 11.7%, inspiratory stridor 5.8%, posterior pharyngeal wall congestion 5.8%. Conservative medical treatment with IV antibiotics alone was successful in 4 [23.5%], transoral incision drainage done for 5 patients [29.4%] patients, external neck drainage in 2 [11.7%] patients, transoral needle aspiration of pus plus IV antibiotics successful in 6 [35%]. Airway related side effects were self-limited and none of the patients needed tracheostomy. Children with RPA present with manifestations other than respiratory distress or stridor. CT scan is useful in confirming the diagnosis. IV antibiotics alone can be effective in clinically stable patients; transoral needle aspiration of pus covered by IV antibiotics be helpful while transpharyngeal incision drainage can be reserved for clinically unstable or difficult to aspirate patients

Outcome and quality of life after intratympanic therapy for control of Meniere's disease

Meniere's disease [MD] is characterized by spontaneous attacks of vertigo, fluctuating sensorinewal hearing loss, aural fullness, and tinnitus. Many therapeutic options exist for the management of patients with Meniere's disease, nevertheless, there is no proven cure to date. Over the past decade, intratympanic administration of gentamycin or corticosteroid has become a major treatment modality for intractable MD. The study aimed at identifying the efficacy of intratympanic treatment, from the author's view point, whether gentamicin or corticosteroids and its effect on the quality of life. Prospective investigational protocol. 45 MD patients, divided into 3 groups of 15 patients each, treated with gentamicin-[group a], corticosteroids [group b] and saline [group c]. ENT Outpatient clinic, at Mansoura University Hospitals. All the patients were subjected to thorough history taking, otoscopic examination and full audiovestibular evaluation. Administration of activities of daily living scale [ADL] questionnaire to assess the self perceived disablement immediately before injection, 1, 6 and 12 months post injection. Repeated injections for complete control of vertigo in groups A and B were almost identical in comparison to placebo group [c]. Nevertheless, hearing sensitivity and speech discrimination scores were markedly improved in the corticosteroids [B] group, in contrast to the further deterioration that took place in the gentamicin [A] group. ADL significantly improved post treatment in both a and b groups only. Intratympanic gentamicin tltration offers a minimally invastive, cost-effective, low morbidity means of managing vertigo. Intratympanic injection of corticosteroids results in control of vertigo with improved hearing sensitivity and better speech discrimination scores than gentamicin

Nodal level affection in elective neck dissection for squamous cell carcinoma of the larynx

The best prophylactic treatment for the NO neck is a subject of debate. Some authors propose lateral selective lymph node dissection [levels II-IV] for laryngeal squamous cell carcinoma [SCC] on the basis of probability of finding occult metastases in those lymph nodes. The necessity of routine dissection at level IV has been questioned. The purpose of this study was to find the incidence of level IV metastases in patients with transglottic and supraglottic SCC who underwent lateral neck dissection. We retrospectively evaluated 54 patients with N0 supraglottic and transglottic SCC who underwent total laryngectomy and selective [level II-IV] neck dissection. Twelve patients [22.2%] had occult neck metastases, 3 of them had also contralateral occult positive nodes. Level IV involvement occurred only in one patient [1.85%] ipsilaterally who had also other positive ipsilateral nodes at level II-III. Extracapsular spread [ECS] occurred in 23.8% of positive nodes. Elective dissection of level IV in clinically NO supraglottic and transglottic SCC may be unnecessary and reserved for cases with highly suspicious involvement of level II-III nodes to avoid occasional morbidity associated with its dissection

Laryngo-tracheal obstruction: results of surgical technique and role of virtual endoscopy in patient evaluation

Introduction: upper airway obstruction is a continuous challenge in diagnosis especially if surgical intervention is required. [1-2-3-4-5] Virtual laryngoscopy [VL] is a technique for creating computer simulations of anatomy from radiological image data and viewing those simulations in a way that is analogous to conventional endoscope.[6]

Aim of the work: the aim of this work was to evaluate the results of surgical reconstruction and to compare the findings with virtual laryngoscopy [VL] and conventional endoscopy in diagnosis of upper air way obstruction

Patients and methods: a prospective study was done at Mansoura University Hospitals at Departments of Otolaryngology and Cardiothoracic surgery, on thirty two patients with an age range of 14-72 years

Results: patients presented with upper airway obstruction, 15 cases of laryngeotracheal trauma, advanced laryngeal carcinoma [10 patients], 2patients of cervical tracheal carcinoma, and granulomatous lesions [5 patients]. Fiber optic and rigid endoscopy were attempted in all patients. Biopsy was done for 28 patients to confirm diagnosis. Spiral CT was performed with slice thickness 2 mm, pitch 1.2mm, and reconstruction .interval 1.5mm. CT data was transferred to workstation software to analyze both ante-grade and retrograde end luminal VL with conventional endoscopy and operative findings. Patients presented with cancer and trauma were operated for laryngectomy and laryngotrache0-plasty. Rigid endoscopy showed upper airway obstruction in 8 patient's trans glottis carcinoma [65%], 1 patients in granulomatous lesions [18%], and 3 [20%] cases of trauma with total success rate 41%. VL showed all luminal obstruction. Only three cases the narrowed segment length was less than operative measurement with total accuracy [94%]. Operation was done for traumatic and cancer patients, comparing the rustles of operative finding and VL

Conclusion: we conclude that high resolution and multiple image of VL are depicting the intraluminal and transmural extent of laryngeal disease non- invasively especially in traumatic causes. Surgical repair is a challenging procedure, however, it could be done with a good results and minimal morbidity and mortality. The mobilization of the trachea and larynx is essential step for closure sutures without tension is highly important. The usage of neck collar in the opposite manner is useful to prevent patient from neck hyperextension and disruption of tracheal sutures

Carotid body tumors: challenging complexity of diagnosis and surgical management

The tumor of the carotid body tumor [CBT], is a rare tumor, only about 1000 cases had been reported in the literature. It's of obscure origin and misdiagnosed if it is suspected. CBT is usually benign and commonly presented as a non-painful cervical mass. The aim of this study was to analyze diagnostic and therapeutic aspects and complications of surgery of CBT in Mansoura University Hospitals. We present eight patients had 10 carotid body tumor. Male to female ratio was [1: 2], age ranged between 13-72 years in the period between May 2000 to December 2003. The aim of this study was to analyze diagnostic and therapeutic aspect and complications of surgery of CBT in Mansoura University Hospitals. All patients were identified and complete radiological study was done including CT, MRI, Doppler Ultrasound and Angiography. Clinically, there were no secreting tumors in these patients. Preoperative immobilization was done in seven cases 24hours before surgery. All patient were operated on for tumor resection. Result the blood loss for these patients was fewer than those without immobilization. Only one case needed resection of the carotid and interposition graft. One patient had preoperative nerve deficit. Neurological deficits were noted in three patients out of nine patients [33%] immediately after surgery and two patients out of seven had permanent deficit [29%]. One patient deceased in the postoperative period from pulmonary embolism [12.5%]. Our conclusion is: the diagnosis of CBT is depending on suspicious, radiology is essential. Embolization decreases blood loss and facilitates tumor removal. Observation is not recommended because of the progressive behavior of the tumor associated with increased risk of neurological deficit. Surgery is the treatment of choice with minimal morbidity and mortality

Complications of endoscopic management of choanal atresia

A prospective study in Mansoura University Hospital, Egypt in the period between 2000-2004 in 19 patients presented with nasal obstruction either unilateral in 10 cases with average age 4-18 years and male to female is 7:2, and 9 neonates presented with bilateral choanal atresia where seven females and 2two males]. Follow up period is 12-18 months. All patients of neonates stay one night at ICU. All patients operated under general anesthesia endoscopically two cases required for revision surgery and stent for 12 weeks two had adhesions that need splint, only one had collumellar injury and vestibular stenosis and one had posterior pharyngeal wall ulcer. We conclude that endoscopic treatment for choanal atresia is safe with minimal complications