Throat Packing Via Nasopharyngeal Airway for Severe Trismus Cases Requiring Surgical Intervention under General Anesthesia: A Simplified and Innovative Approach.

Throat packing is essential in oral and maxillofacial surgeries to prevent blood and tissue debris aspiration, reducing postoperative complications. Traditional oral route methods are often inadequate, especially in severe trismus cases like Oral Submucous Fibrosis (OSMF), TMJ Ankylosis, and post-traumatic conditions due to limited mouth opening. This study introduces a novel technique using a nasopharyngeal airway (NPA) for throat packing. The method involves inserting a hemostatic dressing through an NPA, ensuring minimal invasiveness and effective airway management. Proper positioning is confirmed with a laryngoscope or fiberoptic scope, and the dressing is secured to prevent dislodgement. This technique is easy, reproducible, and less injurious compared to traditional methods. At our center, throat packing via NPA was performed on 35 patients undergoing surgery under general anesthesia, resulting in high satisfaction and no reported complications.

Statistical analysis of air quality dataset of Kathmandu, Nepal, with a New Extended Kumaraswamy Exponential Distribution.

This paper aims to create a new probability distribution and conducts statistical analysis on air quality dataset from Kathmandu. Using this innovative distribution, we have studied the ground reality of air quality conditions of Kathmandu, Nepal. In our research, we have developed a new probability distribution known as the New Extended Kumaraswamy Exponential Distribution by introducing an additional shape parameter to the Extended Kumaraswamy Exponential (EKwE) Distribution. Statistical characteristics such as cumulative distribution function, probability density function, hazard function, reversed hazard function, skewness, kurtosis, survival function, and hazard rate function are studied. The suggested model is non-normal and positively skewed with increasing and inverted bathtub-shaped hazard rate curves. To assess the model's suitability, we utilized a real dataset comprising air quality data from Kathmandu, Nepal, during the year 2021. Study shows that the air quality data exhibit an increasing failure rate, but the P2.5, P10, and total suspended particle concentrations exhibited its lowest levels during the monsoon season and its highest levels during the winter season. Parameters of the model are estimated by using the least square estimation (LSE), maximum likelihood estimation (MLE), and Cramér-von Mises (CVM) approach for P10 at Ratnapark Station, Kathmandu. To assess the model's validity, P-P plots and Q-Q plots are employed. Model comparisons are carried out using Akaike Information Criterion (AIC), Corrected Akaike Information Criterion (CAIC), Bayesian Information Criterion (BIC), and Hannan-Quinn Information Criterion (HQIC). Furthermore, the goodness of fit of the proposed model is evaluated using test statistics such as Anderson-Darling (A2) test, Cramér-von Mises (CVM) test, and the Kolmogorov-Smirnov (KS) test along with their respective p-values. From the findings, we have found that the air quality status of Kathmandu, Nepal, was found to be poor. Proposed distribution provides a better fit with greater flexibility for forecasting air quality data and conducting reliability data analyses. Dataset is analyzed and visualized using R programming.

A screw and wire assisted coronoidectomy procedure: A technical note.

Temporomandibular joint (TMJ) ankylosis and oral submucous fibrosis (OSMF) often exhibit elongated hyperplastic coronoid processes with fibrous attachments to the temporalis muscle. In managing this condition, a vital step involves performing a coronoidotomy or coronoidectomy alongside the primary surgical procedure. While coronoidectomy is preferable due to reattachment issues, its complexity arises from the thickened and elongated coronoid process. Our technical note introduces a screw and wire assisted coronoidectomy method, found to be efficient, replicable, and time-saving.

Does surgical treatment of mandibular condyle head (diacapitular) fractures provide better outcomes than closed treatment? - a systematic review and meta-analysis.

The choices for managing a condylar head fracture (CHF) of the mandible are either open surgical or closed functional treatments (CFT) and the decision depends on various factors. The purpose of this systematic review was to ascertain from the available literature whether the open method or CFT yields better outcomes in managing CHF. We have systematically reviewed published articles according to the PRISMA statement. The search was conducted in PubMed, Google Scholar, Semantic Scholar, and the Cochrane Library database for comparative studies about both open and closed treatments from inception until April 2023. The outcomes of interest were mouth opening (MO), protrusion, laterotrusion, postoperative pain, and malocclusion. Eight studies met the inclusion criteria. The review comprised of 326 cases, among which 177 were managed by open methods and 149 were treated by CFT. The incidence of postoperative malocclusion and pain were significantly less in the open group. MO was better in the open treatment group although this was not statistically significant. Protrusion and laterotrusion occurred slightly more in CFT, although these were also statistically not significant. Overall, meta-analysis favoured open methods of managing CHF. Although enough evidence exists for the use of open methods for selected condylar head fractures, CFT still demonstrated favourable outcomes in undisplaced fractures. The selection of a particular treatment method should be individualised on the basis of each particular case considering the risk/benefits. Further high quality randomised trials are needed to establish a therapeutic guideline.

Endoscopic-assisted intraoral approach for mandibular condyle fracture management: A systematic review and meta-analysis.

OBJECTIVE: Surgical innovation led to an endoscopic-assisted intraoral approach for managing condyle fractures. The purpose of this systematic review is to purview the role of the endoscope and determine the range of information, summarizing the evidence for the benefit of surgeons on an endoscopic-assisted intraoral approach. STUDY DESIGN: A literature search was conducted in PubMed, Google Scholar, Semantic Scholar, and Cochrane Library databases for studies mentioning the endoscopic intraoral approach for managing mandibular condylar fractures. Outcomes include the role of the endoscope, challenges, adjunct armamentarium, duration, and complications associated with the transoral and transbuccal approach for screw fixation. The meta-analysis was conducted with prevalence estimates and standardized means using STATA. RESULTS: Thirty-nine studies were included. A 30° angulated, 4-mm-thick endoscope was the most commonly used endoscope. Two mini plates were most commonly used for fixation. Facial nerve weakness was higher in the transbuccal approach (1.24%) than in the transoral approach (0.8%). Pooled analysis (6 studies) showed that the duration of the surgical procedure was less in the transoral approach compared with the transbuccal approach for screw fixation. The bailout was 1.49%. CONCLUSIONS: The endoscopic-assisted intraoral approach is reliable for condylar fracture management. The transoral and transbuccal approaches can be used for screw fixation with comparable outcomes.

Role of iodoform in jaw lesions: a systematic review.

Iodoform formulations are used as packing material following the surgical removal of jaw lesions. The purpose of this review was to explore the evidence and efficacy of iodoform-based dressings. We have systematically reviewed published articles according to the PRISMA statement. The search was conducted in PubMed, Google Scholar, Semantic Scholar, and the Cochrane Library database for articles mentioning the use of iodoform as dressing material for jaw lesions from January 2000 to March 2022. Finally, 92 studies were included. A total of 386 patients whose ages ranged from five months to 86 years (male n = 180, female n = 117). Different formulations of iodoform used were BIPP (n = 67), Whitehead's varnish (n = 17), iodoform (n = 7) and, iodine (n = 1) for its antiseptic properties. An iodoform impregnated gauze pack was changed once a week, most commonly, for a stipulated duration, until complete healing of the cavity. In the present review, iodoform was used, most commonly, in pathological cavities following surgical treatment of ameloblastoma and odontogenic keratocyst. Toxicity was reported in two studies. Based on the current review, iodoform is relatively safe and can be used in the management of extensive jaw lesions in which secondary healing is expected. Prospective and randomised control trials are recommended to assess the efficacy of various formulations and to delineate the timeframe for patient compliance.

A rare case of bilateral pseudoaneurysm secondary to mandibular condyle fracture-a case report with review of literature.

This paper aims to present a rare case report of bilateral pseudoaneurysm secondary to condylar fracture and its management with a brief review of literature. A patient of age 19 years with alleged history of road traffic accident presented 6 weeks lately to our department with slow growing swelling in right preauricular area. History revealed bilateral condylar fracture with right parasymphysis fracture of mandible for which patient underwent maxillomandibular fixation for 4 weeks. The diffuse swelling in preauricular region showed positive signs of pulsation and audible bruit. Ultrasonography and contrast-enhanced computed tomography suggested the bilateral presence of vascular anamoly from the terminal branches of external carotid artery. Diagnostic angiography confirmed presence of pseudoaneurysm at the bifurcation of the internal maxillary artery and superficial temporal artery (STA) on right side whereas on the left side it was at proximal STA. Bilateral endovascular coil and gel foam embolization was done and thrombosis was confirmed with high frequency ultrasound on fourth postintervention day. The swelling completely resolved in a period of 1 month with no evidence of recurrence in the following 2-year follow-up period. Routine investigation revealed presence of pseudoaneurysm on left side which was completely without any clinical signs as repoterd by many cases of condylar fracture in the literature review. Pseudoaneurysm may remain silent and are exposed intraoperatively with massive bleeding which causes significant morbidity. Hence, prompt diagnosis and management is essential to avoid unexpected complication perioperatively.

Ethnomedical Applications and Conservation Status of Leguminosae- Caesalpinioideae Plants in Uttar Pradesh, India.

BACKGROUND: This review highlights the folklore, ethnomedicinal uses and conservation status of Caesalpinioideae in Uttar Pradesh (India). AIMS: It aims at compiling available data on traditional medicine, biological activity, phytochemical information and assessing the regional red list status of Caesalpinioideae in Uttar Pradesh. The information provided would help in formulating new drugs and medicines and addressing global conservation issues of such medicinally exploited species. METHODS: The current study included an extensive and systematic review of available literature, the study of previous collections of herbarium specimens, random interviews with locals and tribals, field surveys, and GeoCAT tool-based assessment during 2016-2020. The study reports that the majority of species of Caesalpinioideae are used for curing digestive problems (about 20 species) and skin diseases (19 species). RESULTS: Almost all the species have antimicrobial and antioxidant properties. These pharmacological activities can be attributed to the presence of various types of anthraquinones in plants. CONCLUSION: The regional conservation status reveals that eight species qualified for the status of regionally threatened category while two species fall under the near threatened category.

A systematic review and meta-analysis of the surgical outcomes in patients with osteochondroma of mandibular condyle.

Many options exist in the diagnosis and management of condylar osteochondroma. The purpose of this study was to provide a congregate information concerning treatment of the osteochondroma involving the mandibular condyle. The search was conducted in PubMed, Google Scholar, Semantic Scholar, and Cochrane database until February 2022. Twenty-seven studies were included for the final review. The review included 439 patients who underwent surgical management for mandibular condylar osteochondroma. The position of osteochondroma was mentioned in 13 studies. Preauricular, retromandibular, endaural, submandibular, transzygomatic, and intraoral approaches were used for approaching the tumor. Surgical techniques included resection, conservative condylectomy, and total condylectomy. Concomitant orthognathic surgery was performed along with tumor resection in 19 studies. In the entire review, the recurrence rate was 0.22% (1/439). The results of the meta-analysis showed that 2 studies reported significant malocclusion events after surgical therapy. Total joint replacement after tumor resection has a higher improvement in maximal mouth opening (8 mm) compared with vertical ramus osteotomy and no reconstruction groups, which have similar improvements (6 mm). The mainstay of treatment of osteochondroma is surgical excision either as condylectomy or conservative condylectomy. Among the various reconstruction modalities, total joint replacement showed better improvement in mouth opening. Adjunct procedures like orthodontic and orthognathic surgery have an important role in holistic management of severe cases. The treating surgeon must choose the surgical procedures in a pragmatic way.

Nonendoscopic intraoral approach for condylar fracture management-a systematic review.

OBJECTIVE: The recent trend favors the open reduction and internal fixation of condylar fractures to prevent long-term consequences. Nonendoscopic intraoral approach is an option for management without a visible scar. The purpose of this systematic review was to explore the evidence, armamentarium, methods of reduction and fixation, challenges, and complications. STUDY DESIGN: We have systematically reviewed published articles on the intraoral approach for condylar fracture management following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search was conducted in PubMed, Google Scholar, Semantic Scholar, and Cochrane library database, to find relevant articles from January 1980 to March 2022. Descriptive statistics were applied to obtain the results. RESULTS: Finally, 23 studies were included. The incision described for the intraoral approach was similar to sagittal split osteotomy in all studies. A wide array of specialized instruments, methods, and challenges has been outlined for visualization, reduction, and fixation. The incidence of complications in the entire review was 23% (72/306). CONCLUSION: The challenges encountered in the nonendoscopic intraoral approach for condylar fracture management can be negated with the use of specialized instruments and with experience. However, further research is warranted for a specialized set of miniature instruments to ease the procedure, make it time-efficient and optimize hardware selection.

Monitoring the distribution pattern and invasion status of Ageratina adenophora across elevational gradients in Sikkim Himalaya, India.

Understanding the spread intensity and population dynamics of invasive plant species is a prerequisite for developing management strategies in the Himalayan Forest ecosystems that are experiencing an accelerated rate of climate change. Although there are studies on the occurrence of few invasive species in the Himalayan ecosystems, systematic information on their intensity of spread and species association is still missing. Considering existing data gaps, we aimed to assess the intensity of spread and distribution pattern of A. adenophora, one of the high-concern invasive species (HiCIS) of India that is causing havoc in the Himalayas, across an elevational gradient. Field data were collected in 2018 and 2021 in the Indian federal state of Sikkim, located in the Eastern Himalayas. We analyzed the population status and species association of A. adenophora along an elevational gradient ranging from > 600 m to 2700 m above sea level, which was divided into seven gradients of 300 m width, and each gradient was further randomly sampled. Overall, 81 species were present in association with A. adenophora, including 58 herbs, 19 shrubs, and 4 climbers, belonging to 30 families and 67 genera in the region. No other species continuously co-occurred along with A. adenophora throughout the elevation ranging from > 600 m to 2700 m. The species observed increased frequency (100%), density (40.51 ind./100 m2), and basal cover (11.25 cm2/m2) in the elevational gradient 1500-1800 m in 2018. In 2021, A. adenophora dominated the highest elevational gradient (< 2400-2700 m) with increased frequency (99.96%), density (58.41 ind./100m2), and basal cover (42.54 cm2/100m2), which demonstrated rapid invasion and improved plant health and reproductive vigor in comparison to the lower elevational gradient in Sikkim Himalaya. Despite being completely absent at the highest elevation (< 2400-2700 m), in 2018, it observed gregarious spread at the highest elevation in 2021, which is of serious concern to ecologists. The presence of the targeted species in all seven studied altitudinal gradients reflects stage III of the species invasion. An enormous shift in the distribution pattern along elevational gradients within a short time span is alarming for the Himalayan ecosystem since it is becoming a thriving habitat for invasive species owing to anthropogenic activity. We mapped the potential geographical extent using the species distribution model (SDM) and predicted the suitable habitat of distribution in Sikkim Himalaya. In order to curtail the spread and counteract the negative impact of this species on native vegetation in Sikkim Himalaya and ultimately reverse the process, local and regional initiatives for its biological control and management must be taken.

Straight lift technique as an alternative to surgical extraction of an intact, partially impacted mesioangular mandibular third molar.

Impacted mandibular third molar removal is the most common procedure performed by oral and maxillofacial surgeons. An array of alternative procedures have been suggested, like operculectomy in cases of pericoronitis and coronectomy in certain cases. However, these procedures pose several disadvantages, and we propose a relatively non-invasive 'straight lift technique'. This technique is specifically useful in straightening abnormally positioned mesioangular third molars as a substitute of complete removal. This can improve tooth function, eliminate the need for surgical intervention, and reduce the risk of complications associated with third molar removal.

Fabrication of α-Fe2O3 Nanostructures: Synthesis, Characterization, and Their Promising Application in the Treatment of Carcinoma A549 Lung Cancer Cells.

In the present work, iron nanoparticles were synthesized in the α-Fe2O3 phase with the reduction of potassium hexachloroferrate(III) by using l-ascorbic acid as a reducing agent in the presence of an amphiphilic non-ionic polyethylene glycol surfactant in an aqueous solution. The synthesized α-Fe2O3 NPs were characterized by powder X-ray diffraction, field emission scanning electron microscopy, transmission electron microscopy, atomic force microscopy, dynamic light scattering, energy dispersive X-ray spectroscopy, Fourier transform infrared spectroscopy, and ultraviolet-visible spectrophotometry. The powder X-ray diffraction analysis result confirmed the formation of α-Fe2O3 NPs, and the average crystallite size was found to be 45 nm. The other morphological studies suggested that α-Fe2O3 NPs were predominantly spherical in shape with a diameter ranges from 40 to 60 nm. The dynamic light scattering analysis revealed the zeta potential of α-Fe2O3 NPs as -28 ± 18 mV at maximum stability. The ultraviolet-visible spectrophotometry analysis shows an absorption peak at 394 nm, which is attributed to their surface plasmon vibration. The cytotoxicity test of synthesized α-Fe2O3 NPs was investigated against human carcinoma A549 lung cancer cells, and the biological adaptability exhibited by α-Fe2O3 NPs has opened a pathway to biomedical applications in the drug delivery system. Our investigation confirmed that l-ascorbic acid-coated α-Fe2O3 NPs with calculated IC50 ≤ 30 µg/mL are the best suited as an anticancer agent, showing the promising application in the treatment of carcinoma A549 lung cancer cells.

Does suprahyoid muscle complex pull cause relapse following genial advancement by distraction osteogenesis? An electromyographic study.

Active pull of the suprahyoid muscle complex (SMC) was thought to be the main contributor of relapse in mandibular or chin advancement, but literature evidence lacks human studies that assess the role of the SMC following genial advancement (GeA). This study therefore aimed to analyse the influence of SMC pull on relapse following GeA by distraction osteogenesis based on electromyographic (EMG) changes. EMG was recorded and analysed preoperatively (T0), at four months (T1), and at one-year follow up (T2) at three submental regions during two different activities. The outcome variables were EMG changes of the SMC, and hard and soft tissue relapse. Assessment was carried out by comparison of EMG and lateral cephalograms taken at T0, T1, and T2. Ten patients (7 male and 3 female; median (SD) age 21.2 (3.99) years, range 18-28) were included. The EMG values revealed a statistically significant reduction between T0 and T1. T2 values were not higher than T0 during any activity. The results of Pearson's correlation demonstrated no significant relation between the amount of relapse and change in EMG values. This study concluded that active pull of the SMC is not the actual reason for skeletal relapse in chin or mandibular advancement. Passive biomechanics such as adnexial or muscular connective tissue, and paramandibular periosteum pull with native bone remodelling might be the prime reasons for relapse. However, further large sample studies are warranted to find the actual causes of relapse.

Quantification of dissolved H2 and continuous monitoring of hydrogen-rich water for haemodialysis applications: An experimental study.

The prevalence of oxidative and inflammatory stress in end-stage renal disease (ESRD) patients has often been associated with chronic haemodialysis therapies. Over the past decades, several reports have shown the potential of hydrogen molecule as an antioxidant in the treatment of various medical conditions in animal models, as well as in pilot studies with human patients. Recently, a hydrogen-enriched dialysate solution has been introduced, holding promise in reducing the oxidative and/or inflammatory complications arising during haemodialysis. To this end, a standardised measuring method to determine the levels of hydrogen in dialysate and subsequently in blood is required. This study explores the possibility of quantifying hydrogen concentration using a novel contactless sensor that detects dissolved hydrogen in liquids. An experimental circuit is assembled to validate the sensitivity and accuracy of the hydrogen monitoring system (Pureron Japan Co., Ltd) through in vitro investigations with physiological solutions. Measurements of dissolved molecular hydrogen concentration are corroborated by an established oxygen sensor providing continuous partial pressure readings. The relationship between the applied H2 content in the gaseous mixture and the H2 concentration value at equilibrium is linear. At the same time, the hydrogen monitoring system has a rather long response time, and its readings seem to slightly diverge from sensor to sensor as well as at different temperatures. For this reason, a sensor recalibration might be necessary, which could become part of the product's ongoing development. Nevertheless, the aforementioned minor deficiencies can be mostly considered negligible in applications such as haemodialysis.

Central granular cell odontogenic tumor of mandible in a child.

Central granular cell odontogenic tumor (CGCOT) is sporadic benign odontogenic tumor and it especially occurs in women older than 50 years of age. Radiologically it manifests as unilocular to the multilocular radiolucency with sometimes mixed densities. Histopathology displays sheets and islands of large eosinophilic cells with abundant granular cytoplasm, however few cases exhibit inadequate epithelium, thus creating a diagnostic confusion. Though, resection is advocated by some surgeons, however because of the non-aggressive biological behaviour, enucleation or curettage is the treatment of choice for this lesion. Till now only 39 cases have been reported in the past six decades. We are reporting the first case of CGCOT occurring in the youngest age of eleven-year-old patient with massive size of 11 × 7 × 6 cm. This would add CGCOT as a differential diagnosis in the bony lesions of younger individuals. In addition, the importance of immunohistochemistry studies in cases with scarce odontogenic epithelium and the potential role of Carnoy's solution in the management of this rare tumor in this age group was emphasized.