Traumatic Hemifacial Avulsion and Degloving Injury With Left Zygomaticomaxillary Complex Fracture: A Case Report.

Managing gross maxillofacial injuries poses significant challenges due to potential complications such as airway obstruction, cervical spine injuries, and damage to cranial structures. The resultant deformities from these injuries can have enduring psychological effects, which, if left unaddressed, can be devastating. This report outlines an approach for a patient with a history of a bull gore injury wherein a 49-year-old male presented to the Department of Oral and Maxillofacial Surgery, reporting an alleged animal attack. The patient had experienced avulsion of the left eye and degloving injuries affecting the lower eyelids, nose, left cheek, and upper and lower lips, along with skin over the chin, coupled with a left zygomaticomaxillary complex fracture. Subsequently, a comprehensive single-stage primary reconstruction and repair procedure was performed. Immediate single-stage reconstruction has shown success in achieving excellent functional and aesthetic outcomes. Preserving original tissue during debridement is crucial in preventing infection and minimizing flap loss.

Efficacy of clear aligner wear protocols in orthodontic tooth movement-a systematic review.

BACKGROUND AND OBJECTIVES: Different expedited aligner wear protocols are currently in practice. This review was undertaken to systematically appraise the available evidence on the comparative efficacy of orthodontic tooth movement (OTM) across the different wear protocols. SEARCH METHODS: Two assessors conducted comprehensive searches of electronic databases, including MEDLINE (via PubMed), Scopus, Embase, Web of Science, Google Scholar, Directory of Open Access Journals, Cochrane Library, OpenGrey, and Clinical Trial Registry, till 18 February 2024. Titles and abstracts were independently screened. SELECTION CRITERIA: Prospective or retrospective studies comparing expedited wear protocols with the conventional 14-day protocol were included. DATA COLLECTION AND ANALYSIS: A pre-piloted data extraction form was used. Risk of bias (RoB) assessment employed the Cochrane RoB 2.0 tool for randomized-controlled trials (RCTs) and the Newcastle-Ottawa scale for non-RCTs. The quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation Pro tool. RESULTS: Six studies, including 3 RCTs and 3 non-RCTs, were selected from 9076 records. Four studies (two RCTs and two retrospective cohort) found no statistically significant difference (P > 0.05) in the OTM efficacy between expedited and conventional protocols. Two studies (one RCT and one prospective cohort) found greater efficacy (P < 0.05) with the 14-day protocol, with the RCT reporting greater efficacy for certain movements, such as maxillary posterior intrusion, maxillary posterior distal tipping and buccal torquing, and mandibular posterior intrusion and extrusion. One RCT reported statistically insignificant difference (P > 0.05) in pain perception between the 10-day and 14-day protocols. Two studies demonstrated low RoB, two moderate, and two high RoB. The evidence level was very-low for OTM efficacy and high for pain perception. Meta-analysis was precluded due to significant heterogeneity among the studies. CONCLUSIONS: Within the limitations of the study, the 7-day, 10-day, and 14-day protocols did not show any significant difference in OTM efficacy, except for certain movements that exhibited superior outcomes with the 14-day wear. Hence, a 'hybrid aligner-wear protocol', based on clinical judgement, might serve a better alternative in complex situations. REGISTRATION: PROSPERO CRD42021288179.

Does orthodontic treatment improve the Oral Health-Related Quality of Life when assessed using the Malocclusion Impact Questionnaire-a 3-year prospective longitudinal cohort study.

OBJECTIVES: To assess the change in Oral Health-Related Quality of Life (OHRQoL) following orthodontic treatment using the Malocclusion Impact Questionnaire (MIQ) and to test the responsiveness of MIQ to treatment-associated changes. METHODS: A longitudinal prospective cohort study, in an orthodontic postgraduate centre, Kerala, India. Patients under 18 years were invited to complete the MIQ before the start of treatment (T0) and 1 month after treatment completion (T1). TheIndex of Orthodontic Treatment Need and Peer Assessment Rating (PAR) scores were assessed at both time periods as well as a global transition judgement at T1. RESULTS: Two hundred and ten participants were recruited and 162 completed both questionnaires (45.1% males; 54.9% females; age = 12-18 years, mean = 16.8; SD = 1.7). There was large reduction in MIQ scores from T0 (mean = 28.1, SD = 6.1) to T1 (mean = 3.7, SD = 2.6). 53% reported a large improvement in oral health and related life quality after treatment, 32% minimal change, and 15% no change. None reported worsening in OHRQoL at T1. There was a significant positive correlation between change in MIQ score and change in PAR score (r = 0.358), pretreatment aesthetic component (rho = 0.467) and dental health component (rho = 0.491) of the index of orthodontic treatment (IOTN-DHC), and treatment time (rho = 0.502). Regression analysis revealed the change in PAR score and pretreatment IOTN-DHC to be independent predictors of change in MIQ score. Standardized effect size (4.0) and standardized response mean (2.9) were large and the minimal important difference was 7.7. Receiver operating characteristic analysis reported a high diagnostic accuracy of MIQ. CONCLUSIONS: There was a significant improvement in OHRQoL following orthodontic treatment when assessed using a condition-specific measure for malocclusion. MIQ was found to be responsive to changes associated with orthodontic treatment.

Is Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) Valid for the Indian Population?-A Psychometric Study.

OBJECTIVES: A culturally adapted and validated Oral Health-Related Quality of Life (OHRQoL) inventory helps to reliably compare patient perceptions among different populations. The Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) evaluates the impact of dental aesthetics on OHRQoL. This study aimed to develop a regional version of PIDAQ (PIDAQMal) for the Indian population and to assess differences in perceptions due to malocclusion in different population groups. MATERIALS AND METHODS: PIDAQMal was derived through the translation process and pilot-tested to assess test-retest reliability. Psychometric properties were tested on 285 subjects (31.2% males, 68.8% females; age range 18-25 years). Normative treatment need was assessed using Index of Orthodontic Treatment Need (IOTN)-Dental Health Component and subjective assessment using IOTN-Aesthetic Component (AC) and Perception of Occlusion Scale (POS). PIDAQMal mean domain scores were compared with those of the previously validated versions to assess difference in perceptions. RESULTS: Internal consistency and test-retest reliability were good (Cronbach's α = 0.83-0.88; Intraclass Correlation Coefficient = 0.74-0.91). IOTN-AC and POS scores showed significant correlation with PIDAQMal scores ensuring convergent validity (P < 0.001). Discriminant validity was confirmed by statistically significant differences (P < 0.001) in PIDAQMal scores between subjects with no treatment need and moderate/definite need. Factor analysis derived four domains with one item showing cross-loading. Difference in mean domain scores among the previously validated versions of PIDAQ confirmed socio-cultural differences in perceptions due to malocclusion. CONCLUSION: PIDAQMal was found to be reliable and valid for the Indian subjects and can be used as a condition-specific OHRQoL measure. Socio-cultural differences in perceptions were brought to light using the translated scale.

Comparison of respiratory distress syndrome amongst preterm twins (28-34 Weeks) born within and after two weeks of completion of single antenatal corticosteroid course: A bidirectional cohort study.

BACKGROUND: The literature on neonatal outcomes in preterm twins delivered before 34 weeks but within and after 14 days of a single initial steroid course is limited. MATERIAL AND METHODS: This bidirectional (226 prospective and 42 retrospectives) cohort study was performed at a tertiary care teaching hospital in South India. We compared the respiratory distress syndrome and neonatal death amongst preterm twins from 28 to 34 weeks born < 14 days (Group A, n=268) and after 14 days (Group B, n=268) of completion of a single course of antenatal steroids. We used multivariable regression analysis (log-binomial model) to adjust for confounding variables. We generated a propensity-matched score with probit regression to analyse outcomes (respiratory distress and neonatal deaths). RESULTS: The two groups had significant differences in the distribution of birthweight, gestation period and mode of delivery. On adjusted analysis, the period of gestation below 33 weeks and weight below 1.5 kg had the maximum influence on respiratory and other morbidities, and weight less than 1 kg on neonatal death. [adjusted relative risk (ARR) 26.06, (95%CI=2.37-285.5), p=0.008]. On propensity scoring after matching all these variables, we found an [ARR of 2.0 (95% CI: 1.03-3.88), P=0.017] for neonatal death after 14 days of steroid injection. The ARR for respiratory distress syndrome was 1.13 in those born after 14 days of steroids, though it did not reach statistical significance. CONCLUSION: On propensity scoring, the steroid-delivery interval more than 14 days was associated with a significantly increased risk (ARR of 2) of neonatal death.

Spray freeze drying: Emerging applications in drug delivery.

Spray freeze drying is relatively a recent drying technique involving heterogeneous set of steps which includes droplet formation, freezing, and sublimation. It has proven benefits over other drying methods in terms of producing products with improved structural integrity, superior quality, and better shelf stability. With such merits, spray freeze drying has found numerous applications in the field of drug delivery. Spray freeze drying yields particles of sizes and densities that show higher stability in the lungs, nasal mucosa, intestine, and skin, as compared to other drying technologies. These particles also possess the vital trait of sustained release and specificity through various delivery routes as compared to conventional drying techniques. This drives the market for commercialization of spray freeze dried drugs. The focus of this paper is on manufacturing approaches of spray freeze dried powders, with emphasis on its application in drug delivery systems. An overview of other applications of spray freeze drying is also presented.

Comparison of the visco-elastic behavior of a pre-impregnated reinforced glass fiber composite with resin-based composite.

OBJECTIVES: The visco-elastic behavior of a pre-impregnated reinforced glass fiber composite (everStick) was compared with a resin-based particulate composite (Filtek P60) by using dynamic mechanical analysis (DMA) to determine their storage modulus (E') and damping ratio (tandelta). METHODS: These materials were subjected to three-point bend tests using a PerkinElmer DMA7. In temperature mode, the temperature was increased from 26 to 140 degrees C at 1 Hz. In frequency mode, the range was 1-10 Hz at a constant temperature of 37 degrees C. RESULTS: In both temperature and frequency modes, E' for everStick was significantly higher and tandelta was significantly lower than those for Filtek P60, indicating that the stiffness of the pre-impregnated glass fiber composite was higher and its damping property was lower than those for resin-based particulate composite. SIGNIFICANCE: The glass fiber restorative composite appears to absorb less energy in repeated stress and is less likely to retain external energy as residual stress.