Systematic review and meta-analysis of surgical approaches for improving airway stability in infants with Robin sequence: Evaluating complications and outcomes.

The purpose of this systematic review and meta-analysis was to determine the most effective and least morbid surgical technique for relieving retroglossal airway obstruction in infants with Robin sequence (RS). The study adhered to PRISMA guidelines and included 25 studies (24 cohorts and one case series) that investigated interventions for airway improvement, including conservative measures, tongue-lip adhesion (TLA), mandibular distraction osteogenesis (MDO), and tracheostomy. The primary outcome variable was complication rate, while predictor variable was the use of interventions for airway improvement. Results showed that conservative measures were the preferred initial management strategy in most studies, while TLA was recommended for infants with mild obstruction, and MDO or tracheostomy was reserved for severe cases. Only complications could be analysed via meta-analysis due to data heterogeneity, revealing that tracheostomy had a summary odds ratio of 5.39 in favour of TLA, while MDO had a ratio of 2.8 over TLA, and the complication rates were similar between MDO and tracheostomy. If conservative measures fail, the study recommends mandibular distraction as the preferable technique for stable airway improvement. If the infant is unsuitable for distraction, tongue-lip adhesion may serve as an alternative, while tracheostomy should be reserved for cases of severe multi-level obstruction. The authors propose that large-scale, multicentre trials comparing long-term outcomes are required to establish definitive guidelines.

Unique presentation of an endemic opportunistic fungal infection: Disseminated coccidioidomycosis mimicking metastatic lung cancer with endotracheal and endobronchial involvement.

Coccidioidomycosis is a fungal infection primarily Endemic in the Southwest United States. Disseminated Coccidioidomycosis is a life-threatening variant that mainly occurs in an immunocompromised host. This report describes an unusual presentation of disseminated Coccidioidomycosis in an immunocompetent individual. The patient was admitted with a subacute cough, progressively worsening shortness of breath, significant weight loss, nodular skin lesions in upper extremities, and acute hypoxemic respiratory failure. Chest imaging revealed extensive nodularity and mass-like lesions. What sets this case apart is the significant endotracheal and endobronchial involvement, which mimicked metastatic lung cancer. The diagnosis was confirmed through serology and bronchoscopy biopsy. This case underscores the critical importance of considering detailed travel history and maintaining a high index of suspicion for fungal infections in patients with endobronchial lesions, particularly in regions where Coccidioidomycosis is endemic.

Delayed onset enophthalmos and hypoglobus mimicking silent sinus syndrome following midface trauma.

Craniomaxillofacial trauma is primarily diagnosed and managed by oral and maxillofacial surgeons. Among the cases encountered, midface fractures involving orbital walls are highly prevalent. In these fractures, involvement of the orbital walls, particularly floor of the orbit, can lead to considerable aesthetic and functional limitations. From a maxillofacial perspective, indications for surgical repair of orbital floor encompass marked decrease in ocular motility, fracture affecting more than 50% of surface area, an increase in orbital volume exceeding 18% and enophthalmos greater than 2 mm. In the absence of these discernible signs, surgical intervention is not generally indicated. However, in this case, an early adolescent with a history of midface trauma and minimal orbital floor fracture 8 months earlier presented with progressively delayed onset enophthalmos and hypoglobus closely resembling features of silent sinus syndrome. The enophthalmos and hypoglobus were corrected by placing custom-made non-resorbable high-density polyethylene implant in the orbital floor. Postoperative follow-up demonstrated aesthetically and functionally satisfactory outcomes.

Efficacy of topical curcuma longa in the healing of extraction sockets: A split-mouth clinical trial.

Background: The healing process after dental extraction is influenced by various factors, and finding effective strategies for promoting wound healing and reducing postoperative discomfort remains a challenge. This study aimed to evaluate the effectiveness of topical Curcuma longa gel in reducing pain and promoting wound healing after dental extraction, with the secondary objective of assessing the occurrence of dry sockets. The study was a split-mouth randomized controlled trial conducted at the oral and maxillofacial surgery department over 3 months. Materials and Methods: This split-mouth randomized controlled trial consisted of a total of 21 patients undergoing bilateral extractions. One extraction socket was randomly assigned to the test group, where Curcuma. longa gel was applied, while the contralateral socket served as the control group, receiving a placebo. Pain and wound healing were evaluated using standardized scales on the 3rd and 7th days postextraction. Descriptive statistics, paired t-tests, and unpaired t-tests were performed using the SPSS software version 19. The statistical significance was fixed at P ≤ 0.05. Results: The test group showed significantly higher mean healing scores on the 3rd and 7th days compared to the control group. On the 7th day, the test group had significantly lower mean pain scores than the control group. No cases of dry sockets were observed in either group. Conclusion: Topical Curcuma longa gel demonstrated positive effects in promoting wound healing and reducing pain after dental extraction. Clinicians should consider the use of Curcuma longa gel as a post-extraction medicament, particularly in cases involving multiple or traumatic extractions.

Efficacy of intraosseous saline injection for pain management during surgical removal of impacted mandibular third molars: a randomized double-blinded clinical trial.

Background: Surgical extraction of impacted mandibular third molars is the most common procedure performed by oral surgeons. The procedure cannot be performed effectively without achieving profound anesthesia. During this procedure, patients may feel pain during surgical bone removal (at the cancellous level) or during splitting and luxation of the tooth, despite administration of routine nerve blocks. Administration of intraosseous (IO) lignocaine injections during third molar surgeries to provide effective anesthesia for pain alleviation has been documented. However, whether the anesthetic effect of lignocaine is the only reason for pain alleviation when administered intraosseously remains unclear. This conundrum motivated us to assess the efficacy of IO normal saline versus lignocaine injections during surgical removal of impacted mandibular third molars. The aim of this study was to assess the efficacy of IO normal saline as a viable alternative or adjunct to lignocaine for alleviation of intraoperative pain during surgical removal of impacted mandibular third molars. Methods: This randomized, double-blind, interventional study included 160 patients who underwent surgical extraction of impacted mandibular third molars and experienced pain during surgical removal of the buccal bone or sectioning and luxation of the tooth. The participants were divided into two groups: the study group, which included patients who would receive IO saline injections, and the control group, which included patients who would receive IO lignocaine injections. Patients were asked to complete a visual analog pain scale (VAPS) at baseline and after receiving the IO injections. Results: Of the 160 patients included in this study, 80 received IO lignocaine (control group), whereas 80 received IO saline (study group) following randomization. The baseline VAPS score of the patients and controls was 5.71 ± 1.33 and 5.68 ± 1.21, respectively. The difference between the baseline VAPS scores of the two groups was not statistically significant (P > 0.05). The difference between the numbers of patients who experienced pain relief following administration of IO lignocaine (n=74) versus saline (n=69) was not statistically significant (P > 0.05). The difference between VAPS scores measured after IO injection in both groups was not statistically significant (P >0.05) (1.05 ± 1.20 for the control group vs. 1.72 ± 1.56 for the study group). Conclusion: The study demonstrates that IO injection of normal saline is as effective as lignocaine in alleviating pain during surgical removal of impacted mandibular third molars and can be used as an effective adjunct to conventional lignocaine injection.

OXIS Contacts as a Risk Factor for Approximal Caries: A Retrospective Cohort Study.

Purpose: The purpose of the present study was to evaluate the individual susceptibility of four different types of OXIS contact areas (open [O], point [X], straight [I], and curved [S]) to approximal caries in children. Methods: A retrospective cohort study was performed using clinical photographs and cone-beam computed tomography images of children, available from January 1, 2014, to August 31, 2015, showing the presence of at least one caries-free contact area between the primary molars. A single calibrated examiner scored 1,102 selected contacts using OXIS criteria from the occlusal view and subsequently evaluated the same contacts with a minimum follow-up period of one year for the presence of approximal caries. Results: Of the 1,102 contacts, 259 (23.5 percent) were found to be carious or restored due to approximal caries. Multivariate logistic regression analysis showed that only the type of contact played a significant role in caries prevalence (P<0.05). The odds ratios of OXIS contacts for the development of approximal caries were: S contact-147.4 (95 percent confidence interval [95% CI] equals 19.7 to 1101.7); I contact-24.5 (95% CI equals 3.4 to 177.9); X contact-1.1 (95% CI equals 1.0 to 12.5); and O contact-1.00 (reference). Conclusions: Among the OXIS contacts, the S type was most susceptible to approximal caries due to its complex morphology. The broad contact areas, namely, I and S types, are at greater risk for approximal caries in primary molars than O and X contacts.

Feasibility of Use of the 8th Edition of the American Joint Committee on Cancer Staging for Head and Neck Cancers in Indian Scenario: An Evaluative Study.

INTRODUCTION: Inclusion of depth of invasion (DOI) and a separate classification for human papillomavirus (HPV)-associated Oropharyngeal Cancers (OPCs) are two of the many major changes in the 8th edition of the American Joint Committee on Cancer staging system. After more than 2 years of implementation, the authors found the need to evaluate if the Indian clinicians found it feasible to apply the system in their practice and if the same has influenced their decision-making. METHODS: The survey was done in the form of a questionnaire which was distributed personally and via the internet to 100 clinicians. Seventy-two clinicians responded to the questionnaire. The results were analyzed and frequency distribution was computed. RESULTS: Eighty-three percent of the clinicians experienced that palpation of the tumour was not a reliable method to determine the DOI. The common issues stated by the clinicians were difficulty in assessing DOI in certain subsites of the oral cavity (most commonly retromolar trigone-83%), inability to determine DOI in patients with trismus, and inability to correlate pathological and clinical DOI. Thirteen percent of the clinicians did not rely on radiological tools for measuring the DOI. Seventy percent of the clinicians did not perform a P16 assay for patients with oropharyngeal cancers. Fifty percent of the clinicians preferred chemoradiotherapy for early HPV positive oropharyngeal cancers. DISCUSSION: Based on the results of the survey, the authors recommend a need for more interpretative guidelines and methods for determining the DOI. The authors also emphasize the need for determining HPV status for all oropharyngeal carcinomas.

Mid-Face Degloving: An Alternate Approach to Extended Osteotomies of the Midface.

Extended osteotomies for mid-face advancement require generous exposure of the anterior maxilla, nasal bones, infraorbital rims, orbital floor, zygoma, and the anterior third of the zygomatic arches. This cannot be obtained with an exclusive transoral approach. Hence, the surgeon is usually compelled to utilize supplemental cutaneous incisions that are a compromise on the purpose behind a cosmetic surgery. In order to alleviate the need for such compromise, the authors advocate the mid face degloving approach for extended osteotomies at Lefort II and Lefort III levels. Mid face degloving involves a combination of circumvestibular incision, with inter cartilaginous and transfixation components from a nasal incision. The authors have utilized this technique for 9 patients and documented favorable results. The purpose of this paper is to focus the utility of this approach in orthognathic surgery and promote this as a viable alternative to traditional approaches in surgery of the mid face because of the absence of external scars.

Management of a soft tissue tumor in a child with Worster Drought syndrome using 810 nm diode laser - A case report.

BACKGROUND AND AIMS: An out-patient surgical procedure in the paediatric age group is a tough task for a surgeon, more so when compounded with mentally challenging conditions like cerebral palsy. Every step involved, either administration of local anaesthesia or handling sharp surgical instruments around the face or achieving haemostasis, can be a challenge, with compromise on patient safety. Neither undue restraint nor general anaesthesia is advisable, considering the magnitude of the procedure. In such cases, a safe, rapid and effective technique that can be comfortably performed under topical anaesthesia without use of sharp instruments or needles would be an ideal option. The purpose of this paper is to highlight one such situation, where an intra-oral soft tissue tumor was safely and effectively ablated using diode laser, under topical anaesthesia in a child with cerebral palsy concurrent with Worster Drought syndrome. RESULTS: Topical anaesthesia provided adequate conditions to ablate the tumor. A bloodless field was achieved, with no need for sutures. The procedure was completed in less than half the time required for a conventional approach. Postoperative follow-up of 3 months showed complete healing with no recurrence. CONCLUSIONS: Portable diode lasers are an effective tool for minor oral surgical procedures in paediatric population especially, children who are mentally challenged.

Cervicitis: How Often Is It Non-specific!

BACKGROUND: Uterine cervix is most often reported as 'non specific cervicitis'. It is an effort to encourage specific reporting and thereby avoiding the term 'non specific' to a possible extent. MATERIALS AND METHODS: The study is carried out on 613 specimens of uterine cervix received at Department of Pathology, Aarupadai Veedu Medical College, Pondicherry, between 1(st) January 2010 to 31(st) December 2012. Histopathology slides of all the cases were studied for the presence of specific features of various inflammatory lesions. RESULTS are expressed in percentage. RESULTS: Chronic nonspecific cervicitis was the commonest inflammatory lesion constituting 89.23% of the cases. Other inflammatory lesions were follicular cervicitis in 6.85%, chronic cervicitis with koilocytosis in 3.75% and only one case (0.16%) of tuberculosis was observed. CONCLUSION: Importance of these benign lesions of the uterine cervix lies in the fact that some of them like Chlamydia, Papilloma infection have specific treatment and some of them form differential diagnosis for malignant lesions and some progress to malignancy.

Reconstruction of Nasal Cleft Deformities Using Expanded Forehead Flaps: A Case Series.

INTRODUCTION: Reconstruction of the nasal clefts is a challenging task considering the nasal anatomic complexity and their possible association with craniofacial defects. The reconstruction of these defects needs extensive amounts of soft tissue that warrant the use of forehead flaps. Often presence of cranial defects and low hairline compromise the amount of tissue available for reconstruction warrenting tissue expansion. AIM: To evaluate the efficacy of tissue expansion in reconstruction of congenital nasal clefts. SUBJECTS AND METHODS: 9 patients with congenital nasal clefts involving multiple sub units were taken up for nasal reconstruction with expanded forehead flaps. The average amount of expansion needed was 200 ml. The reconstruction was performed in 3 stages. RESULTS: Expanded forehead flaps proved to be best modality for reconstruction providing the skin cover needed for ala, columella and dorsum with minimal scarring at the donor site. CONCLUSION: Expansion of the forehead flap is a viable option for multiple sub unit reconstruction in congenital nasal cleft deformities.

A rare case of multiple oblique facial clefts with supernumerary teeth: case report.

Oblique facial clefts are rare congenital anomalies that can present alone or in association with other craniofacial anomalies. A high degree of clefting in the embryo may lead to hyperdontia secondary to dichotomy of the dental lamina. Multiple facial clefts with hyperdontia are clinically challenging and demand comprehensive rehabilitation. This article reports a case of multiple oblique facial clefts of variable severity with multiple supernumerary teeth in a 12-year-old boy. The varied clinical presentation along with the rarity of the occurrence mandate documentation.

Incidence and consequences of bur breakage in orthognathic surgery: a retrospective study with discussion of 2 interesting clinical situations.

PURPOSE: To determine the incidence of bur breakage in routine orthognathic surgery, as well as its postsurgical sequela, and to illustrate 2 cases with more than 6 months' follow-up. PATIENTS AND METHODS: We performed a retrospective evaluation of case records of 76 consecutive orthognathic surgical procedures performed by a team of 2 surgeons over a period of 16 months, between January 2009 and July 2010, at a single center. RESULTS: Surgical bur breakage was reported in 5 patients in the series. Of these, 3 were retrieved whereas 2 were not, 1 of which caused a foreign body reaction in the patient, which persisted for a duration of almost 1 year. CONCLUSION: Instrument breakage may be a relatively common occurrence with the use of surgical burs in orthognathic surgery but its incidence is seldom recorded or reported. This study gives insight into the probability of postoperative sequela of these instruments when left in situ and a protocol for management of broken instruments.

Cervical necrotizing fasciitis: an unusual sequel of odontogenic infection.

Cervical necrotizing fasciitis is a rare infection of the fascial planes, which is less common in head and neck, because of the rarity and higher vascularity in the region. We reviewed five patients with cervical necrotizing fasciitis of odontogenic infection managed at a teaching hospital at Chennai, India. There were four men and one woman, of whom four patients were diabetic and hypertensive, with a mean age of 53 years. Mandibular molars (periapical or pericoronal abscess) were found to be the source of infection in all of the cases. The treatment involved incision and drainage and debridement. Anti-microbial drugs were given for all the patients, which included cephalosporins, metronidazole and gentamycin. In four patients the wound healed by contracture and one patient required split skin grafting. Due to the smaller extent of the necrosis, better control of the systemic disease and small size of the sample, there was neither a major complication nor death. This paper reminds us that cervicofacial necrotizing fasciitis (CNF) remains one of the potential complications of long standing odontogenic infections in patients with immune-compromised status, particularly in lower dentition.

Cervical necrotizing fasciitis: An unusual sequel of odontogenic infection

Cervical necrotizing fasciitis is a rare infection of the fascial planes, which is less common in head and neck, becauseof the rarity and higher vascularity in the region. We reviewed five patients with cervical necrotizing fasciitisof odontogenic infection managed at a teaching hospital at Chennai, India. There were four men and one woman,of whom four patients were diabetic and hypertensive, with a mean age of 53 years. Mandibular molars (periapicalor pericoronal abscess) were found to be the source of infection in all of the cases. The treatment involved incisionand drainage and debridement. Anti-microbial drugs were given for all the patients, which included cephalosporins,metronidazole and gentamycin. In four patients the wound healed by contracture and one patient required split skingrafting. Due to the smaller extent of the necrosis, better control of the systemic disease and small size of the sample,there was neither a major complication nor death. This paper reminds us that cervicofacial necrotizing fasciitis(CNF) remains one of the potential complications of long standing odontogenic infections in patients with immunecompromisedstatus, particularly in lower dentition (AU)