Systematic reporting of computed tomography enterography/enteroclysis as an aid to reduce diagnostic dilemma when differentiating between intestinal tuberculosis and Crohn's disease: A prospective study at a tertiary care hospital.

BACKGROUND AND AIM: Crohn's disease (CD) and intestinal tuberculosis (ITB) have similar symptomatology and overlapping features on imaging, endoscopy, and histopathology. It is important to differentiate ITB from CD to initiate correct medical management. This prospective study aimed to characterize imaging features on computed tomography enteroclysis/enterography (CTE) that help in differentiating ITB from CD. METHODS: A total of 300 consecutive patients who underwent CTE with the suspicion of small bowel diseases were evaluated. CTE findings were documented on a detailed "CTE case record form" and were correlated with other investigations like endoscopy, histopathological and microbiological examination, and improvement on empirical therapy to arrive at a final diagnosis. Only confirmed cases of ITB/CD were included for further analysis. RESULTS: Final diagnoses revealed that 61 patients had ITB, 24 had CD, 90 patients had a final diagnosis not related to ITB/CD, and 125 had no bowel-related diseases. The sensitivity of CTE (ITB vs CD, 90.2 vs 91.6%) was higher than the sensitivity of ileocolonoscopy (ITB vs CD, 87 vs 83.3%). A homogenous pattern of bowel wall thickening and confluent bowel involvement were significantly more common in ITB. Stratified bowel wall thickening with mucosal hyperenhancement, skip lesions in the bowel, and a comb sign were significantly more common in CD. Stratified bowel wall enhancement with an intervening layer of fat was specifically (P < 0.001) seen in patients with CD, and necrotic (P = 0.002) and calcified (P = 0.055) lymph nodes were specifically seen in patients with ITB. CONCLUSION: We propose a systematic approach to the radiological differentiation of ITB from CD.

Bite Force as a Parameter for Comparison Between Three-Dimensional and Standard Titanium Miniplates for the Management of Anterior Mandibular Fractures: A Prospective Randomized Double-Blinded Clinical Trial.

BACKGROUND AND OBJECTIVES: To compare the efficacy of three-dimensional (3D) miniplates with standard miniplates in the osteosynthesis of anterior mandibular fractures on the basis of bite force recordings and other clinical parameters. METHODS: A prospective randomized double-blinded clinical trial was carried out for the treatment of anterior mandibular fractures. In total, 20 patients were randomly divided into two groups of 2-mm 3D and standard titanium miniplates. The assessment of patients was done at weekly intervals for 6 weeks using bite force recordings and other clinical parameters. RESULTS: A statistically significant difference was found in the duration of surgery which was less in group A as compared to group B (p = 0.03). No significant difference was found in other clinical parameters. INTERPRETATION AND CONCLUSION: The clinical outcome of both the 3D and standard miniplate systems in the present study was similar; however, the following advantages with the use of 3D miniplates can be highlighted:Relatively lesser operating time.Three-dimensional stability of the fracture site and simultaneous stabilization at superior and inferior borders in the fixation of mandibular fractures.

Locking Miniplate Osteosynthesis of Anterior Mandibular Fractures-Quo Vadis?

PURPOSE: This study compared the clinical stability and efficacy of locking miniplates with those of standard miniplates in the osteosynthesis of anterior mandibular fractures using bite force recordings and other clinical parameters. MATERIALS AND METHODS: A prospective randomized double-blinded clinical trial was carried out in patients from various hospitals of Hassan (India). Patients were randomly divided into 2 groups of locking (test) and standard (control) miniplate osteosynthesis. Bite force measurements were performed preoperatively and postoperatively at weekly intervals for 6 weeks using a bite force recorder. As a secondary outcome, patients also were assessed for other clinical parameters that might interfere with successful osteosynthesis at the fracture site. Appropriate statistical testing for intra- and intergroup measurements was carried out. RESULTS: Forty-eight men 28 ± 12.3 years old met the inclusion criteria (24 patients in each group). A statistically significant difference (P < .05) was found in the incisor bite force between the 2 groups, with values in the locking group exceeding those in the standard group at postoperative weeks 2 and 5. Duration of surgery was shorter in the locking group (P = .015). No relevant difference was found for the other clinical parameters. CONCLUSIONS: Bite force statistically increased at progressive follow-up visits compared with the preoperative recording in the locking group. Bite force recordings of patients treated with locking plates were higher and statistically relevant compared with those of patients treated with standard miniplates at the incisor region at postoperative weeks 2 and 5. The clinical outcomes of the 2 miniplate systems in the present study were similar; however, the locking miniplates required a relatively shorter operating time, produced less trauma to the periosteum and soft tissues with less hardware, and can be used as a "1-plate-for-all" system.

99mTc-methylene diphosphonate single-photon emission computed tomography/computed tomography improves the diagnostic accuracy of osteoid osteoma.

We present a case of a 17-year-old football player who had previously received multiple facet joint injections for presumed secondary osteoarthritis. 99mTc-methylene diphosphonate single-photon emission computed tomography/computed tomography imaging of the cervical spine demonstrated focal increased radiopharmaceutical activity in the right C2 lamina, which was associated with an osteolytic lesion with a central irregular sclerotic nidus. Surgical pathology confirmed an osteoid osteoma.

Is aggressive gap arthroplasty essential in the management of temporomandibular joint ankylosis?-a prospective clinical study of 15 cases.

The purpose of this three-year, prospective, follow-up study was to evaluate whether aggressive gap arthroplasty is essential in the management of ankylosis of the temporomandibular joint (TMJ). Fifteen patients were treated by the creation of a minimal gap of 5-8mm and insertion of an interpositional gap arthroplasty using the temporalis fascia. Eleven patients had unilateral coronoidectomy and 4 bilateral coronoidectomy based on Kaban's protocol. Preoperative assessment included recording of history, clinical and radiological examinations, personal variables, the aetiology of the ankylosis, the side affected, and any other relevant findings. Patients were assessed postoperatively by a surgeon unaware of the treatment given for a minimum of 3 years, which included measurement of the maximal incisal opening, presence of facial nerve paralysis, recurrence, and any other relevant findings. Of the 15 patients (17 joints), 12 had unilateral and three had bilateral involvement, with trauma being the most common cause. The patients were aged between 7 and 29 years (mean (SD) age 20 (8) years). Preoperative maximal incisal opening was 0-2mm in 8 cases and 2-9mm in 9. Postoperatively adequate mouth opening of 30-40mm was achieved in all cases, with no recurrence or relevant malocclusion during 3-year follow up. However, patients will be followed up for 10 years. Aggressive gap arthroplasty is not essential in the management of ankylosis of the TMJ. Minimal gap interpositional arthroplasty with complete removal of the mediolateral ankylotic mass is a feasible and effective method of preventing recurrence.

Double-layered closure of oroantral fistula using buccal fat pad and buccal advancement flap.

Some of the traditional methods that are being employed in the repair of oroantral communication can be broadly divided into local and distant flaps. Recently, because of various advantages, buccal fat pad is increasingly being employed in the repair of oroantral fistula and other oral defects worldwide. However, there are some problems that can be encountered while harvesting BFP which has to be taken care of. In this paper, we present a case with one of such problems, its management, and review of literature on the same.

Management of mandibular interforaminal fractures using 3 dimensional locking and standard titanium miniplates - a comparative preliminary report of 10 cases.

PURPOSE: The aim of this follow up clinical study was to compare and evaluate the effectiveness of 2mm 4 holed 3-dimensional (3D) locking titanium miniplates over standard miniplate fixation using Champy's technique in the management of interforaminal mandibular fractures. PATIENTS AND METHODS: A prospective randomized double blind clinical trial was carried out in patients with well defined inclusion and exclusion criteria. Patients were followed for a period of 2 months at the intervals of 1 week, 2 weeks, 4 weeks, 6 weeks and 2 months by a blinded senior oral surgeon for wound dehiscence, infection, postoperative occlusion, significant postoperative complications, need for post-operative inter maxillary fixation and radiological evaluation of reduction, fixation. RESULT: 10 patients were enrolled in both the groups in this preliminary report with no case of clinically significant postoperative complications. In comparison, 3D locking plates were economical, easy to adapt, required less operating time, and provided better stability. However, 2 patients in group 1 (3D locking plates) with severely displaced unfavourable fractures required 6 holed plates or more for adequate stability. CONCLUSION: Because of its added advantages and encouraging results in comparison to standard miniplate, we suggest use of 3D 4 holed locking 2mm titanium miniplate for the management of isolated moderately displaced mandibular fractures in inter mental foramen region.

Unusual oral complications of herpes zoster infection: report of a case and review of literature.

A case of herpes zoster infection with unusual oral complications involving the mandibular division of the trigeminal nerve is presented. The post-herpetic complications of osteonecrosis, spontaneous exfoliation of teeth, and subsequent pathologic fracture of mandible in the absence of concurrent predisposing factors in a 65-year-old man are demonstrated. Forty-one cases with osteonecrosis and spontaneous exfoliation of teeth previously presented in the literature are reviewed. This is the first report of pathologic fracture after herpes zoster infection.

Comparison of 3-dimensional and standard miniplate fixation in the management of mandibular fractures.

PURPOSE: The aim of this follow-up study was to compare 3-dimensional (3D) and standard (Champy's) miniplate fixation in the management of mandibular fractures, and to analyze advantages and disadvantages of one over the other. PATIENTS AND METHODS: A prospective randomized clinical trial was carried out in patients with well-defined inclusion and exclusion criteria. Patients were followed for 2 months for wound dehiscence, infection, segmental mobility, postoperative occlusion, significant period of postoperative complications, and radiological evaluation of reduction and fixation. RESULTS: Twenty patients were enrolled in both the groups with no case of wound dehiscence. In group 1, 2 patients had mild segmental mobility (P = .07), 2 patients had surgical site infection (P = .07), and 2 patients involving mental nerve had involved roots of teeth (P = .07). Radiological evaluation did not show any statistically significant difference in reduction (P = 1.4), but showed a significant difference (P = .03) in fixation between the 2 groups, especially in cases involving the mental nerve (ie, fracture near or involving the mental foramen) and oblique fractures. CONCLUSION: Champy's miniplate system is a better and easier method than the 3D miniplate system for fixation of mandibular fractures. In comparison, the 3D miniplate system is unfavorable for use in cases of oblique fractures and those involving the mental nerve, and is also difficult to adapt. In most cases, it provides good stability but with excessive implant material because of extra vertical bars incorporated for countering the torque forces. However, operative time is less because of simultaneous stabilization at both superior and inferior borders.

The need of postoperative radiographs in maxillofacial fractures--a prospective multicentric study.

There is still debate about the appropriateness of taking postoperative radiographs in the management of maxillofacial fractures. We did a prospective, multicentre study with predefined inclusion and exclusion criteria involving seven centres with a minimum sample size of 50 patients from each (total n=431). A standard data sheet was given to operators to record clinical and radiological variables before and after operation. The information obtained was analysed to evaluate the need for routine postoperative radiographs in the management of maxillofacial fractures. Patients were followed up for one month postoperatively. The parasymphyseal (n=240) was the most commonly encountered fracture site. The orthopantograph was the most commonly used radiograph, being recorded in 421 cases (98%) before, and all 305 cases in which it was recommended after, the operation. Assessment of the reduction after fixation was the most common reason (n=237, 78%)) for advising postoperative radiographs. Intraoperative reduction and immediate postoperative occlusion were better indicators (p=0.02 and 0.01) of reduction, fixation, and clinical outcome than immediate postoperative radiographs. The practice of advising postoperative radiographs routinely should be discouraged as it has no significant role in the management of maxillofacial fractures.