Giant Osteoma of Zygoma Mimicking Pseudo-Temporo-Mandibular Joint Ankylosis: A Case Report.

Giant osteoma is a rare entity in the head and neck region when compared to long bones. Even in the head and neck region, the paranasal sinuses are commonly associated, but the involvement of jaw bones is very rare. The lesions are usually asymptomatic and so remain undiagnosed for years. In the reported case, the distinct presentation with reduced mouth opening made it more confusing to diagnose as it became somewhat similar to symptoms of temporo-mandibular joint disorder. The involvement of the zygomatic bone with its extension into the mandibular ramus region made it more unique in its presentation. The objective of the current article is to present an unusual case of giant osteoma of zygoma causing reduced mouth opening, misdiagnosed as a true intra-articular temporo-mandibular joint ankylosis previously. This was then diagnosed correctly with help of a computed tomography scan and histopathology and treated with surgical excision.

Primary Tubercular Osteomyelitis Affecting the Mandibular Condyle - A Case Report.

Rationale: Primary orofacial tuberculosis (TB) accounts for <3% of all cases of TB. TB of the mandibular condyle is often misdiagnosed owing to its rarity. Patient Concerns: This report presents a 19-year-old female who presented with a painful swelling over the right preauricular region. The radiographic evaluation suggested a diagnosis of suppurative osteomyelitis of the condyle. Diagnosis: Clinically, the aetiology of the swelling was considered as infective. The histopathological examination of the resected specimen showed tuberculous granuloma and the polymerase chain reaction came positive.This confirms the diagnosis of tubercular osteomyelitis. Mantoux test and sputum acid-fast bacilli were found to be negative. Treatment: The patient was subjected to sequestrectomy with high condylectomy and systemic multidrug antitubercular regimen for 6 months. Outcomes: There was a resolution of infection postoperatively with subsequent regeneration of healthy bone. Take-away Lessons: Early identification and prompt diagnosis is imperative for better treatment outcomes.

Comparative assessment of corticotomy facilitated rapid canine retraction using piezo versus bur: A randomized clinical study.

PURPOSE: The leading concern of orthodontic patients is prolonged treatment with fixed appliances and demand speedy treatment from the orthodontists. Piezocision is a relatively innovative, safe and reliable technique of corticotomy in the domain of surgically-accelerated orthodontic treatment. Our aim was to compare the efficiency of piezo corticotomy (piezocision) and conventional bur in rapid orthodontic tooth movement (OTM). SUBJECTS AND METHOD: The study employed a randomized, double-blind, split-mouth design. 24 subjects with Class II div 1 malocclusion were randomly assigned to the two interventions, viz; piezo and bur group. The primary parameters evaluated were the rate and amount of tooth movement and total treatment time required for canine retraction. Additionally, the duration of surgery and postoperative complications were also evaluated. OBSERVATIONS AND RESULTS: Rate and amount of tooth movement were significantly higher with reduction in total treatment time in piezo compared to bur group. The duration of surgery was significantly longer in piezo group with no significant difference observed in post-operative complications. CONCLUSION: Piezo-guided corticotomy was effective in providing rapid OTM with profound reduction in total treatment time and may be proposed as a suitable adjuvant to conventional corticotomy having comparable post-operative complications.

Does diagnostic accuracy of surgeon's perception outweigh frozen section analysis in determining intraoperative clear mucosal surgical margins in oral squamous cell carcinoma patients?

INTRODUCTION: The lucrativeness of the frozen section for intraoperative margin assessment in head and neck squamous cell carcinoma is debatable till date. The purpose of this study was to evaluate whether surgeon's perception by gross examination (GE) of margin is an alternative to frozen section. AIM: The aim was to compare the diagnostic accuracy (DA) of surgeon's perception of tumor-free mucosal and soft-tissue surgical margins intraoperatively assessed by GE and frozen section analysis (FSA). METHODOLOGY: A prospective, observational study was conducted on 59 histologically proven cases of oral squamous cell carcinoma. Two hundred and thirty-six mucosal margins were assessed by an experienced surgeon (ES) and thereafter subjected subsequently to FSA. These results were compared with the gold standard histopathology (HPE). The sensitivity (SS), specificity (SP), positive predictor value (PPV), negative predictor value (NPV), and DA of surgeon's perception by GE were calculated and subsequently compared with FSA and HPE using descriptive and inferential statistics. RESULTS: The SS, SP, PPV, NPV, and DA of ES by GE were 80%, 99.12%, 80%, 99.12%, and 98.30%, respectively when compared to HPE, and the SS of 90%, SP of 98.32%, PPV, NPV, and DA were 69.23%, 99.57%, and 97.98%, respectively when compared with HPE. The results of the surgeon's perception by GE were comparable to the results of FSA. CONCLUSION: The study concludes that surgeon's perception by GE is upfront reliable alternative intraoperative method to FSA in places where FS is not available.

The regenerative potential of skin and the immune system.

Skin has the natural ability to heal and replace dead cells regulated by a network of complex immune processes. This ability is conferred by the population of resident immune cells that act in coordination with other players to provide a homeostatic environment under constant challenge. Other than providing structure and integrity, the epidermis and dermis also house distinct immune properties. The dermal part is represented by fibroblasts and endothelial cells followed by an array of immune cells which includes dendritic cells (DCs), macrophages, mast cells, NK-cells, neutrophils, basophils, eosinophils, αß T lymphocytes, B-cells and platelets. On the other hand, the functionally active immune cells in the epidermis comprise keratinocytes, DCs, NKT-cells, γδ T cells and αß T cells (CD4+ and CD8+). Keratinocytes create a unique microenvironment for the cells of the immune system by promoting immune recognition and cellular differentiation. T lymphocytes exhibit tissue-specific tropism toward the epidermis and the lymphatic drainage system important for their function in immune regulation. This diversity in immune regulators makes the skin a unique organ to overcome pathogenic or foreign invasion. In addition, the highly coordinated molecular events make the skin an attractive model to understand and explore its regenerative potential.

"Piezosurgery vs bur in impacted mandibular third molar surgery: Evaluation of postoperative sequelae".

PURPOSE: Piezosurgery is a relatively novel, precise and safe technique of ostectomy in the domain of oral and maxillofacial surgery. Our aim was to compare the inflammatory outcomes of osteotomy using piezosurgery and conventional bur in impacted mandibular third molar (IM3M) surgery. SUBJECTS AND METHOD: The study implemented a randomized, double-blind, crossover design. 120 sides in 60 patients were randomly allocated to the two interventions used, viz; conventional bur and piezosurgery. The primary outcome variables evaluated were facial swelling, trismus, pain, and paresthesia. Additionally, the duration of surgery and the frequency of soft tissue injuries with the use of two techniques were also evaluated. RESULTS: Pain, swelling, trismus, and soft tissue injuries emerged to be significantly higher with the use of bur as compared to the piezo. The duration of surgery was significantly extended in the piezo group and no significant difference was observed in the occurrence of paresthesia between the two groups. CONCLUSION: The result suggests that piezosurgical osteotomy technique is superior to conventional bur in terms of the postoperative inflammatory outcomes in IM3M surgery.

Is 0.75% ropivacaine more efficacious than 2% lignocaine with 1:80,000 epinephrine for IANB in surgical extraction of impacted lower third molar?

PURPOSE: We aim to compare and evaluate the anesthetic efficacy and safety of inferior alveolar nerve block (IANB) using 0.75% ropivacaine and 2% lignocaine with 1:80,000 epinephrine in lower impacted third molar (LI3M) surgery. PATIENTS AND METHOD: We designed a prospective randomized, double-blind, split-mouth study evaluating 60 systemically healthy patients with the presence of bilateral symmetrically oriented LI3M. The sides and sequence of drug administered were randomly allocated. The primary outcome variables analyzed were hemodynamic stability, profoundness of anesthesia, and duration of postoperative analgesia. Time of onset, duration of soft tissue anesthesia, patients requiring analgesics, and their quantity for five postoperative days were recorded. RESULTS: Early onset of anesthesia was seen in Lignocaine (68.6 ± 20.4 s) compared with Ropivacaine (104.1 ± 17.7 s) with significant differences (p = 0.001). Both the anesthetic solutions were found to be equipotent in providing profound intraoperative anesthesia. No significant difference emerged in perioperative hemodynamic stability. Ropivacaine exhibited statistically significant differences in the duration of soft tissue anesthesia (p = 0.001) and postoperative analgesia (p = 0.001). Patients requiring rescue pain medication and the number of analgesics consumed were greater on first and during five postoperative days in lignocaine when compared with that of ropivacaine with significant differences p < 0.001 and p < 0.001 respectively. CONCLUSION: The results suggest that 0.75% ropivacaine is effective in providing adequate anesthesia, prolonged postoperative analgesia, and better postoperative pain control with a safer cardiovascular profile in LI3M surgery. It can be an addition to the existing list of long-acting local anesthetics used for LI3M surgery.

Mandibular Ramus Fracture: An Overview of Rare Anatomical Subsite.

Aim. The present study aims at exemplifying the incidence, and aetiology and analyses the outcomes of open reduction internal fixation (ORIF) over closed treatment of mandibular ramus fractures. Patients and Method. In the present retrospective analysis of mandibular fracture patients, variables analysed were age, sex, cause of injury, pretreatment occlusion, treatment given, period of maxillo-mandibular fixation (MMF), and posttreatment occlusion. Results. Out of 388 mandibular fractures treated, ramus fractures were 12 (3.09%). In the present study, predominant cause of mandibular ramus fracture was road traffic accident (RTA) n = 07 (58.33%) followed by fall n = 04 (33.33%) and assault n = 1 (8.33%). The average age was 35.9 years with a male predilection. Of these, 9 patients were treated with ORIF while remaining 3 with closed treatment. The average MMF after closed treatment was 21 days and 3 to 5 days after ORIF. There was improvement in occlusion in all 12 patients posttreatment with no major complication except for reduced mouth opening in cases treated with ORIF which recovered with physiotherapy and muscle relaxants. Conclusion. Mandibular ramus fractures accounted for 3.09% with RTA as a common aetiology. ORIF of ramus fractures facilitated adequate functional and anatomic reduction with early return of function.