Evaluate the Effectiveness of Toluidine Blue for Obtaining Safe Margins in Resection of Oral Squamous Cell Carcinoma.

Aims: To evaluate the effectiveness of toluidine blue for obtaining safe margins in oral squamous cell carcinoma. Materials and methods: Intra-operatively irrigation of the lesion and its surrounding areas was done with toluidine blue solution for 20 s. Followed by irrigation with 1% acetic acid to remove all the mechanically retained stain. The unstained margins were demarcated using incision placed by no 15 BP blade. The lesion was resected with a safe margin of 1 cm away from the stained tissue. Neck dissection was done according to the nodal status. The tumor along with the resected margins was sent for histopathological examination. Statistical analysis was performed to calculate specificity of the vital stain. The cross tabulation between epithelium of the stained and unstained margins was done and subjected to Chi-square test to calculate the significance. Results: The toluidine blue vital stain has a sensitivity of 93.33%. Out of 15 cases, 2 patients recorded positive excision margins leading to recurrence at primary site; 1 patients recorded positive excision margins leading to recurrence at secondary site; 1 patient recorded free excision margins but had recurrence at secondary site; remaining 11 patients recorded free excision margins and did not have recurrence. Conclusion: Vital staining with toluidine blue is concluded to be specific in demarcating the dysplastic tissue adjacent to the carcinomatous lesion, which when excised along with the adjacent dysplastic tissue leads to a decrease in the recurrence in oral squamous cell carcinoma cases. Furthermore, it is inexpensive, easily available and does not add significantly to the operating time. Moreover, it provides a gross visualization of dysplasia surrounding the lesion especially in cases where in the margins are not well defined. Hence, toluidine blue can be a useful and inexpensive adjunct to identify margins intra-operatively in the current scenario where intra-operative frozen sections are not available.

Elongated Pterygoid Hamulus: A case Report.

A case is reported of a patient suffering from pain and swelling on the left side of the palate. Elongated pterygoid hamulus appeared to be the cause of his discomfort. we report on a case of elongation of pterygoid hamulus that was managed successfully by surgical treatment and a review of the literature. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-03853-8.

Evaluation of Metastatic Lymph Nodes in Oral Squamous Cell Carcinoma: A Comparative Study of Clinical, FNAC, Ultra Sonography and Computed Tomography with Post Operative Histopathology.

All the head and neck tumours, more than 90% are squamous cell carcinomas (SCC). The presence of metastatic cervical lymph nodes histologically positive for SCC provides one of the simplest and most important prognostic factor in patients with head and neck cancer. In this study, all patients were examined clinically for, location, number, size, shape, consistency and fixation of cervical neck nodes to the underlying structure, and the same was carried out by FNAC, USG and CT. Findings of these modalities and histopathological results were compared for the overall metastases of lymph nodes in the neck. The accuracy of clinical examination was 87.77% and sensitivity only 41.66%. FNAC has the greatest specificity, 98.71% and least sensitivity, 33.33%. The accuracy of FNAC was 90%. The positive predictive value and negative predictive value of FNAC were 80.0% and 90.58% respectively. USG revealed 50% of sensitivity. Specificity of USG was 93.58% and accuracy 87.77%. CT scan have the highest sensitivity among all other tests, 66.66%.The negative predictive value for CT scan was also the highest, 94.59%. Specificity and accuracy of CT scan was 89.74% and 86.66% respectively. This study concludes that USG with FNAC is the most accurate in evaluating metastatic lymph nodes in oral squamous cell carcinoma patients along with other investigations like CT scan for staging of the oral squamous cell carcinoma.

Management of Sub-Condylar and Angle of Mandible Fracture by a Trans-Buccal Trocar Along With an Intra-Oral Approach.

To evaluate the management of sub-condylar and angle of mandible fracture by a trans-buccal trocar along with an intra-oral approach. Study parameters included were assessment of adequacy of anatomical repositioning, fixation and stability of fracture site by radiographs, pre and post - operative occlusion by photographs. Evaluation of anatomical repositioning was done with fracture gap measurement on orthopantomogram after 6 months by applying paired student's T test. In mandibular angle fracture, pre- operatively, the mean of anatomical repositioning fracture gap measurement on orthopantomogram was 4.06 mm with a standard deviation of 1.42 mm and 6 months post-operatively, the mean was 0.5 mm with a standard deviation of 0.32 mm. The P value was < 0.00001, which shows a very high significant. In sub-condylar fractures, pre- operatively, the mean of anatomical repositioning fracture gap measurement on orthopantomogram was 6.77 mm with a standard deviation of 3.54 mm and 6 months post-operatively, the mean was 1.57 mm with a standard deviation of 2.37 mm. As the sample size was small, P value could not be calculated. The use of the trans-buccal trocar provides adequate anatomical repositioning, fixation, stability, occlusion and good accessibility during placement of plate and screws.

Comparison of Frontozygomatic versus Sigmoid Notch Approach for Extraoral Maxillary Nerve Block Anesthesia: A Prospective Clinical Trial.

BACKGROUND: With definitive indications, extraoral techniques of achieving regional nerve blocks are a boon to oral and maxillofacial surgical practice. Though less commonly practiced, since general anesthesia is more favored, certain medical conditions favor the use of regional nerve blocks over general anesthesia. To block the maxillary nerve extraorally, sigmoid notch approach and frontozygomatic approach have been previously described in the literature, but a clinical trial comparing these techniques is sparse. This study attempts to compare both the approaches for their efficacies while paying an equal attention to the associated complications. MATERIALS AND METHODS: Two hundred patients aged between 40-90 years of ASA 1 and 2 category were equally divided into two groups and underwent extraction of maxillary teeth under local anesthesia using 2% lignocaine with 1:80,000 adrenaline. Frontozygomatic approach to reach the foramen rotundum was employed in group A (n = 100) and sigmoid notch approach in group B (n = 100). Pain during injection, time required for onset of subjective and objective symptoms of anesthesia and duration of anesthesia were the study parameters. Associated complications were documented and discussed. Student's unpaired t test was used for statistical evaluation. RESULTS: Although both the techniques were found to be feasible, statistical evaluations favored the frontozygomatic approach with respect to faster onset and a longer duration of the anesthetic effect. The anatomical considerations in either techniques suggested that the incidence of potential complications of accidental entry of the needle into the orbit, skull and vessel injuries was higher when using sigmoid notch approach as against the frontozygomatic approach. CONCLUSION: Though sigmoid notch approach, described widely in the literature, can be employed successfully, certain anatomical considerations and technical modifications in the frontozygomatic approach have made the latter a more practical and feasible approach. When both the maxillary and the mandibular nerves need to be blocked simultaneously, sigmoid notch may be employed, but isolated maxillary nerve block is better achieved using frontozygomatic approach.

Efficacy and feasibility of frontozygomatic angle approach for extra oral maxillary nerve block in oral surgery: a descriptive clinical trial.

BACKGROUND: Pain control is an integral part of minor oral surgery and maxillary/mandibular nerve blocks have proved promising in achieving the same. Although intra oral techniques of maxillary nerve block are common and are widely used, there are certain inherent disadvantages and potential complications. Less commonly described in the literature, the extra oral techniques have a wide spectrum of indications as well as can be more advantageous than the intra oral approach. This prospective clinical trial is an attempt to evaluate the feasibility and the efficacy of the extra oral frontozygomatic approach to the foramen rotundum to block the maxillary nerve. MATERIALS AND METHODS: Sample size was 100 patients and the inclusion criteria were patients of ASA I or II category who needed extraction of a minimum of 4 maxillary teeth in the same quadrant in a single sitting while exclusion criteria were patients with a history of allergy to local anesthesia, medically compromised patients in whom dental extraction was contraindicated. Mean age was 71.9 years and 56 patients were males while 44 were females. Only a single quadrant (first or second) was chosen as the operative site in each patient and local anaesthesia was secured using a 21 gauge 89 mm long spinal needle with frontozygomatic angle approach and the parameters used were pain experienced during the injection, onset of subjective symptoms, time required for the peak effect (objective symptoms), pain during extraction and the duration of anesthesia. All the parameters were expressed as mean values with standard deviations. RESULTS: A successful anesthesia was secured in first attempt in 98 patients while in 2 patients, the procedure had to be repeated owing to the difficulty in reaching the target site. A majority of the patients i.e., 71 % scored 0-2 (no pain) on visual analogue scale (VAS) while only 2 patients experienced a moderate degree of pain. Subjective symptoms were reported in 27.24 s (mean value) and 12.93 s (mean value) in the palate and the infraorbital fossa respectively. Peak effect of anesthesia was noted in 66.7, 37.38 and 31.71 s (all values expressed as mean) in palate, infraorbital fossa and posterior superior alveolar areas respectively. CONCLUSION: Although with only dental extraction as the procedure of choice, the present study has favoured the frontozygomatic angle approach for the maxillary nerve block as simple, safe, efficacious and associated with minimum and clinically mild complications.

Use of amnion as a graft material in vestibuloplasty: a clinical study.

The need to cover the exposed periostium has meant that a number of materials including mucosal and skin grafts are regarded as suitable for grafting in oral and maxillofacial surgery. To circumvent the disadvantages of other materials such as skin, biological membranes have been suggested as options, including fetal membrane. The objective of the present study was to evaluate the clinical efficacy of amnion as a graft material for vestibuloplasty, to increase the depth of the sulcus for complete rehabilitation with dentures in 10 patients with a follow up period of 3 months. Ten patients with deficient depth of the mandibular vestibular sulcus who were referred from the Department of Prosthodontics were listed for mandibular labial vestibuloplasty using Clark's technique followed by grafting with amnion over the denuded periostium. The vestibular depth was evaluated at the end of the 1st week, 2nd week, 4th week, and 3rd month postoperatively, and compared with the preoperative vestibular depth. We had no cases of graft necrosis either complete or partial. However, the reduction in the depth of the labial vestibule ranged from 17% to 50% after 3 months' follow up. A mean (SD) labial vestibular depth of 13.3 (1.8)mm was achieved immediately postoperatively, and 10.0 (3.1)mm at 3 months' follow up. We conclude that grafts of amniotic membrane are viable and reliable for covering of the raw surface, prevent secondary contraction after vestibuloplasty, and maintain the postoperative vestibular depth.