Estimation of Titanium Levels in Blood Following Reconstruction of Post-Craniotomy Defect by Titanium Mesh Using Inductively Coupled Plasma-Optical Emission Spectroscopy (ICP-OES).

Introduction: Titanium and its alloys are the most popular choice of materials for the reconstruction of craniofacial defects. They have lighter weight and are nonferromagnetic, which makes them an advantage in cranial defect reconstruction. Although the formed oxide layer makes them corrosion-resistant, levels of titanium in blood have been seen in trace amounts. This is the first study as per authors' knowledge that a study of such kind has been conducted. Materials and methods: A pilot study was carried out at a tertiary level hospital, considering the inclusion and exclusion criteria in patients who were planned for the reconstruction of the residual defect using titanium mesh. Preoperative and 03- and 06-months postoperative blood samples were collected and analyzed for estimating the levels of titanium ions in blood by inductively coupled plasma-optical emission spectroscopy (ICP-OES). Results: Friedman's two-way analysis of variance by ranks was considered for testing of hypothesis summary, owing to the smaller sample size. The analysis suggested an increase in levels was minimal. Considering the asymptotic significances (two-tailed significance), a significance level was 0.050, which directed us to reject the null hypothesis. Pairwise comparison suggested the presence of negative values indicating steady increase in levels. Cluster analysis indicated that although minimal there is a cluster of difference in the values at all three stages. Continuous field information was used to determine the level with regard to the level of titanium at the three stages of study. Conclusion: The study revealed that the levels of titanium ions increase on prolonged contact with living tissues. The trace elements have to be analyzed at regular intervals. This first-of-the-time study if extended to larger sample size would reveal interesting facts.

Volumetric Analysis and Healing Ratio: Refining Prognostic Assessment in Maxillofacial Cysts Using Cone-Beam Computed Tomography.

Introduction: Volumetric analysis with imaging techniques provides clinicians with the capability to visualize the spatial extent of the lesions. CBCT offers images with minimal radiation, facilitating a detailed assessment of cystic dimension's relationships. This crucial information helps in formulating appropriate strategies, including excision, enucleation, or nonsurgical approaches. The "Healing ratio" emerges as a valuable technique for prognostic evaluation. Materials and Methods: This retrospective study focused on outpatient cases with, clinic-radiologically diagnosed cases of odontogenic keratocyst or radicular cysts. Preoperative CBCT was utilized for volumetric analysis through MIMIC Software. Subsequent analyses were performed at 24 and 48 weeks postoperatively. The healing ratio was calculated for further correlation. Results: A total of 21 cases were included in the study, with a mean age of 36.67 years with predominance of males (72.6%, n = 16). Healing ratio estimation revealed minimal or no association with age, gender, and location on point-biserial analysis. Noteworthy implications were observed concerning total cyst volume and the specific diagnosis of the cyst. Results suggested more favorable healing outcomes in smaller cysts and those diagnosed as radicular cysts. Discussion: Proficiency in deciphering three-dimensional CBCT images accurately demands specialized training. The crux of our study lies in the application of volumetric analysis, particularly the "Healing Ratio," as a robust means of evaluating prognoses in management. The Healing Ratio, derived from three-dimensional imaging techniques, offers a comprehensive insight into the spatial dynamics of cystic lesions. Our findings underscore its significance as the optimal technique for prognostic assessment in the context of cyst management. Supplementary Information: The online version contains supplementary material available at 10.1007/s12663-024-02168-7.

Incidence of Facial Nerve Injury and Sialocele Formation Following Mandibular Condylar and Sub-condylar Fracture Fixation.

Purpose: To study the incidence of sialocele formation in the parotid gland and to study the incidence of facial nerve affliction following treatment of mandibular condylar and sub-condylar fractures. Materials and methods: The present study is a retrospective study conducted on a total of 82 patients with 107 sub-condylar and condylar fractures treated in this centre from August 2008 to August 2020. The surgical approaches used to treat the fractures were considered, and the occurrence of sialocele, salivary fistula and facial nerve paralysis was noted. The facial nerve function was analysed using House-Brackmann system of classification. Results: The incidence of sialocele formation was seen in 15.87% of cases, and the incidence was seen more commonly during a preauricular approach (52.94%) followed by retromandibular (41.17%) followed by anterior parotid transmassetric approach (11.76%). The incidence of facial nerve affliction was seen in 17.57% of cases with majority of them showing temporal branch involvement in 21.05% of cases. Conclusion: During the treatment of condylar and sub-condylar fractures, the facial nerve is at considerable risk of damage; however, understanding the anatomy of the nerve is of importance to avoid such complications. Sialocele formation is also an undesirable complication of such surgeries, a prompt diagnosis and early treatment is mandatory to overcome further unwanted sequel.

Evaluation of occlusal forces using T scan analysis following mandibular fracture fixation.

Introduction: Mandible receives maximum impact following maxillofacial trauma. The dentate segment in particular is of importance as it has a direct bearing on the occlusive forces. The studies that have been carried out are either based on crude clinical evaluations or make use of elaborate and labor-intensive techniques. This study made use of T-scan analysis for objective identification of occlusive forces following mandibular fracture fixation. Materials and Methods: Eighty clinic-radiologically diagnosed cases of dentate segments of the mandible were considered, after random sampling method. The occlusion analysis was done by use of a T scan to obtain Relatively Occlusal Force. The procedure was repeated at 04-, 24-, 36-, and 48-weeks intervals. The data was recorded on Excel Spreadsheet (Microsoft Inc) and analysis was done using SPSS software. Results: The cases were predominantly males with a homogenous distribution of cases of age. The age versus gender distribution was more skewed in the female subgroup with a higher kurtosis value. Both evaluative (Pearson's) and inferential (paired t) tests were applied to reason the study. It was observed that the ROF values decreased in values as compared to pre-operative/post-treatment (Difference of Mean = 2.19, SE = 2.13) compared to 4 (Difference of Mean = -0.40 SE = 0.188),24 (Difference of Mean = -1.22, SE = 0.24) and 36 (Difference of Mean = -3.24, SE = 0.30) weeks, which however surpassed the pre-operative levels at 48 weeks post-operative period. This is suggestive of impending muscular imbalance in the initial periods. The surpass of 48 weeks may be due to optimal forces that were their pre-trauma. Conclusion: Mandibular fracture fixation is the most widely used and also a time-tested modality in the management of mandibular trauma. The evaluation of occlusive forces needs an understanding of their behavior following such fixation. The present study used T-scan analysis to objectify such forces and added extra insight apart from clinical evaluations of tooth contact and parafunctional movements.

Traumatic Myositis Ossificans of Temporalis Muscle: Systematic Review, Meta-Analysis and Case Reports.

Introduction: Traumatic myositis ossificans is rare pathology affecting muscles/soft tissue. Its involvement in temporalis muscle is rarely reported in literature. The aetiopathogenesis is unknown, the diagnosis is based on clinco-radiological findings. Surgical management and follow-up are paramount. Materials and Methods: A database search was done using Science Direct and PubMed search engines along with other published and unpublished literature. The final publications were tabulated using a custom made Performa. The available publications were subjected to appropriate statistical analysis. The data were recorded on excel spreadsheet (Microsoft Inc), and review was made using Review Manager (Rev Man) software for meta-analysis. Results: A total of 21 articles were considered for systemic review and meta-analysis. Forest plotting for demographics included the gender predilection/age of involvement. The data segregation was done with "temporalis involved" group and "other than temporalis involved" group. The study was free of homogeneity ( τ 2 = 0.26 I 2 = 5%) for gender and age. The overall analysis revealed that Temporalis muscle although rare to be affected shows greater propensity for involvement. This is supported by a lesser degree of heterogeneity ( τ 2 = 0.000) with a I 2 value of (The test showed a higher degree of significance for overall effect of muscle involvement (Z = 2.33, p = 0.02) (< 25%). The test showed a higher degree of significance for overall effect of muscle involvement (Z = 2.33, p = 0.02) (< α = 0.05).Case reports.Two male cases with similar age predilection, reported after sustaining trauma. Both the cases presented with limited mouth opening and ultrasound was done for the first time to arrive at clinic-radiological diagnosis. The management was conservative with temporalis myotomy and coronidectomy. Conclusion: Traumatic myositis ossificans presents as a rare disorder that poses a dilemma to the treating surgeon. The present article makes an attempt to critically analyse the pathology that is scantly reported in the literature.

Scientific literacy and the medical student: A cross-sectional study.

Background: Problem-solving, critical thinking, communication skills and the ability to interpret data are four core components of scientific literacy, which any student must acquire during the educational process. This is of specific relevance to the medical profession as doctors need to be 'scientific' in their approach. The nine domains of scientific literacy are further grouped under two major abilities: understanding methods of enquiry that lead to scientific knowledge and the ability to organize, analyse and interpret quantitative data and scientific information. Methods: We included all first-year medical students within the first 2 months of admission in four medical colleges of India. We used the Test of Scientific Literacy Skills, a self- administered questionnaire, which is a validated and standardized tool for evaluating scientific literacy among students. Results: A total of 525 medical students participated in our study over 3 years-335 were males and the majority of students (73.5%) had joined medical college from schools affiliated with the Central Board of School Education system. The presence of scientific literacy skills across the study sample was low. Conclusion: The relative lack of scientific literacy uncovered by our study needs to be addressed by medical colleges, using innovative student-centred approaches and incorporating social media literacy. Reforms are urgently required in the school education system, which serves as a feeder to the medical education system.