The Role of Supraclavicular Flap in Reconstruction Following Resection in Buccal Mucosa Carcinoma.

Buccal mucosa is one of the common subsite for oral carcinoma. Following excision of the buccal mucosa tumor mass various pedicled and free flaps have been used to reconstruct the oral cavity defect. In this age of free flaps various locoregional pedicled flaps have been underrated and overlooked and supraclavicular flap is one of them. This flap meets the functional and cosmetic acceptance of the buccal mucosa defect reconstruction with minimal morbidity to the donor site. This paper presents author's experience of using supraclavicular flap in 10 patients of carcinoma buccal mucosa. In all cases surgical defect was completely covered by the flap, there was no necrosis of the flap. Functional and cosmetic outcome was acceptable in all the patients without compromising oncological clearance.

Multi-location evaluation of field pea in Indian climates: eco-phenological dynamics, crop-environment relationships, and identification of mega-environments.

Characterization of crop-growing environments in relation to crop's genotypic performance is crucial to harness positive genotype-by-environment interactions (GEI) in systematic breeding programs. Given that, the study aimed to delineate the impact of diverse environments on crop phenology and yield traits of dwarf-statured field pea, pinpointing location(s) favoring higher yield and distinctiveness within breeding lines. We tested twelve field pea breeding lines across twenty locations in India, covering Central Zone (CZ), North Western Plain Zone (NWPZ), North Eastern Plain Zone (NEPZ), and Northern Hill Zone (NHZ). Across these locations, maximum and minimum temperatures during flowering (TMAXF, TMINF) and reproductive period (TMAXRP, TMINRP) ranged 18.9-28.3, 3.3-18.0, 15.0-30.8, and 7.9-22.1oC, respectively. Meanwhile, notable variations in phenological and agronomic traits (coefficient of variation) were observed: flowering (31%), days to maturity (21%), reproductive period (18%), grain yield (48%), and 100-seed weight (18%). Combined ANOVA demonstrated an oversized impact of environment (81%) on yield, while genotype and GEI effects were 2% and 14%, respectively. The variables TMINF, TMINRP, and cumulative growing degree-day showed positive correlations with yield, while extended vegetative and maturity durations negatively influenced yield (p < 0.05). Additionally, linear mixed-models and PCA results explained that instability in crop phenology had significant influence on field pea yield. Seed weight was markedly varied within the locations (9.9-20.8 g) and both higher and lower seed weights were associated with lower yields (Optimal = 17.1 g). HA-GGE biplot-based on environment focus-scaling demonstrated three mega-environments and specific locations viz. Kota (CZ), SK Nagar (CZ), Raipur (CZ), Sehore (CZ), and Pantnagar (NWPZ) as the ideal testing-environments with high efficiency in selecting new genotypes with wider adaptability. The study findings highlight distinct impact of environments on crop phenology and agronomic traits of field pea (dwarf-type), hold substantial value in designing efficient field pea (dwarf-type) breeding program at mega-environment scale.

A Retrospective Study Comparing the Surgical Results of Platysma Myocutaneous Flap, Buccal Pad of Fat, and Nasolabial Flap for Reconstruction After Fibrotomy in Cases of Oral Submucous Fibrosis.

PURPOSE: To evaluate the effectiveness of nasolabial flap (NLF), a buccal pad of fat flap (BFP), and platysma myocutaneous flap (PMF) for reconstruction following fibrotomy for individuals with oral submucous fibrosis (OSMF). MATERIAL AND METHOD: A retrospective study was conducted among patients diagnosed with grade III and IV OSMF in the Department of Oral and Maxillofacial Surgery at Sharad Pawar Dental College between January 2016 and August 2018. The essential patient information was obtained from the Medical Record Department (MRD) at Acharya Vinoba Bhave Rural Hospital (AVBRH), Datta Meghe Institute of Medical Sciences (DMIMS) Sawangi (Meghe) Wardha. The patients were categorized into three groups: the NLF, the BFP, and the PMF groups. Each group had 16 patients, and factors such as interincisal width, diminished burning sensation in the mouth, inter-commissure distance, and flap necrosis were compared pre- and post-operatively. Student's unpaired t-test and chi-square test were employed for statistical analysis. RESULT: Mean interincisal mouth-opening increased from pre-operative 4.79 to 41.42 mm post-operatively in the NLF group, BFP group from 6 to 39.42 mm and in the PMF group from 9.26 to 39.34 mm with p value=0.0001. NLF group showed complete and partial resolution of the burning sensation of the mouth at 93.75% and 6.25%, BFP at 62.25% and 32.75% while in PMF it was 68.5% and 31.25% respectively. One year postoperatively 3.28 mm increase in inter-commissure width was observed in the NLF group with a marginal increase in the PMF group and a negligible increase in the BFP group. 18.75% partial flap necrosis was seen in BFP, 18.75% in the PMF group, and 6.25% in the NFL group. CONCLUSION: All the flaps are efficacious in treating OSMF, however, NLF stands ahead with its higher reliability owing to its excellent blood supply.

Testing and Diagnosis of Clostridioides difficile Infection in Special Scenarios: A Systematic Review.

INTRODUCTION: Clostridioides difficile infection (CDI) is a clinical and laboratory diagnosis. Populations at higher risk of developing disease require a high clinical index of suspicion for laboratory testing to avoid incorrect assumptions of colonization. Common risk factors include recent antibiotic use, elderly (>65 years old), and immunocompromised patients. C. difficile assays should be ordered in an algorithm approach to diagnose an infection rather than colonization. Screening tests are widely available in hospital systems, but novel molecular testing may aid in diagnosis in patients with inconclusive or discordant antigen and toxin test results.  Methods: Data was extracted from PubMed, Scopus, and Cumulative Index of Nursing and Allied Health Literature (CINAHL) databases based on the keywords "clostridioides difficile", "toxin assay", and "toxic megacolon". The data extracted is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. A total of 27 reports were included in this systematic review. RESULTS: Testing patients with a significant gastrointestinal surgical history, hypogammaglobulinemia, inflammatory bowel disease, intensive care unit, and immunocompromised patients for CDI is highly recommended. Diarrhea in these subsets of patients requires correlation of clinical context and an understanding of assay results to avoid over- and under-treating. CONCLUSION: CDI should be considered in all patients with traditional risk factors. Heightened clinical suspicion of CDI is required in patients with hypogammaglobulinemia, transplant recipients, patients with gastrointestinal surgical history, and inflammatory bowel disease. Testing should be limited to patients with clinical manifestations of CDI to ensure a high pretest probability for test interpretation. Healthcare workers should adhere to testing algorithms to optimize yield in the appropriate clinical context. Diagnostic assays should follow a sequential, stepwise approach to categorize the toxin expression status of the bacteria accurately.

Identification of new stable resistant sources and assessing agro-morphological performance of sponge gourd germplasm against Tomato Leaf curl New Delhi Virus incidence.

Tomato leaf curl New Delhi virus (TolCNDV) causes yellow mosaic disease, which poses a significant biotic constraint for sponge gourd cultivation, potentially resulting in crop loss of up to 100%. In the present investigation, 50 diverse genotypes were screened for 3 years under natural epiphytotic conditions. A subset of 20 genotypes was further evaluated across four different environments. The combined analysis of variance revealed a significant genotype × environment interaction. Eight genotypes consistently exhibited high and stable resistance in the preliminary screening and multi-environment testing. Furthermore, genotype plus genotype × environment interaction biplot analysis identified DSG-29 (G-3), DSG-7 (G-2), DSG-6 (G-1), and DSGVRL-18 (G-6) as the desirable genotypes, which have stable resistance and better yield potential even under diseased conditions. The genotype by yield × trait biplot analysis and multi-trait genotype-ideotype distance index analysis further validated the potential of these genotypes for combining higher yield and other desirable traits with higher resistance levels. Additionally, resistant genotypes exhibited higher activities of defense-related enzymes as compared to susceptible genotypes. Thus, genotypes identified in our study will serve as a valuable genetic resource for carrying out future resistance breeding programs in sponge gourd against ToLCNDV.

Computational study of the performance of a solar dryer for improvement in the shelf life of the food materials.

In this study, the thermal and drying characteristics of a thin layer food sample were investigated. An indirect type, simple, efficient, and economically feasible solar dryer was fabricated and used for food preservation. However, a dynamic model of a fabricated solar dryer was also presented to gain a better insight into the drying and thermal actions. This model consists of thermal modeling of the drying chamber, solar collector, and solar-dried food sample. The law of conservation of energy was applied to evaluate the temperature at different sections of the solar dryer with respect to drying time. All listed model equations were solved in the MATLAB environment. This study helps to examine the influence of solar radiation on the collector plate temperature, drying chamber temperature, food sample temperature, and performance parameters such as thermal efficiency with respect to drying time. Model data was found in good agreement with experimental data within a 4% error. It is concluded that the drying of food material is affected by air temperature, the collector temperature, mode of heat transfer, and material characteristics such as dimension and mass of the food sample.

Potable water production through a low-cost single chamber solar still in north India.

The main aim of this study is to evaluate the performance of a single slope solar still and to assess the effect of nanofluid on its performance. A single basin single slope solar still was designed and fabricated at the Department of Chemical Engineering, IET Lucknow. Its performance was assessed in terms of the yield of potable water. The effect of various climatic parameters was also studied. Al2O3 nanofluid was used to enhance the yield of the solar still. In the presence of nanofluid, the total yield of the solar still improved by 16.6%. Its economic feasibility was analyzed and reported. The portability of the small size of solar stills, its better economics, easy fabrication, and good performance make them very useful for industrial as well as household purposes.

A comparative evaluation of masticatory load distribution in different types of prosthesis with varying number of implants: A FEM analysis.

Aim: To identify the optimal number and position of implants to reduce stress concentration on the implant, denture, and attachment system for sustaining an overdenture prosthesis. Materials and methods: By incorporating one to eight indigenous implants with bar-type attachments, eight 3D finite element models of mandibular overdentures were created. All models received a 200 N vertical load, and the biomechanical characteristics of peri-implant bone were assessed. Result: The study observed that with a vertical load of 200 N, the maximum equivalent stress around peri-implant tissue in all models was within the physiological tolerance threshold of bone. The von Mises stress values ranged from 116.18 MPa to 536.7 MPa. Conclusion: The three-implant-supported overdenture model revealed superior peri-implant stress, stability, cost-effectiveness, and hygiene maintenance outcomes. Placing a third implant in the mid-symphysis region may offer a practical solution to reduce rotations in two-implant-supported overdentures.

A Single Standard Polyvinyl Chloride 3D Skull Model to Create the Polymethyl Methacrylate Cranioplasty Flap: A Novel and Low-Cost Technique.

BACKGROUND: Although, cranioplasty is a commonly performed neurosurgical procedure worldwide, the cost of available cranioplasty implants is a major issue in a low-income country like India. The aims of this study were to introduce a novel and low-cost technique using a single standard three-dimensional (3D) skull model to guide the polymethyl methacrylate (PMMA) cranioplasty flap production and to evaluate the functional and cosmetic outcomes. METHODS: We retrospectively evaluated 47 cases of PMMA cranioplasty in the period from February 2019 to June 2022. A single standard 3D skull model was used to make the PMMA cranioplasty flaps. The overall cost of this PMMA implant was compared with that of other available cranioplasty implants. The functional and cosmetic outcomes were evaluated postoperatively. RESULTS: The mean age of our patients was 37.17 ± 13.83 years and the age range was 17 to 63 years. The primary cause of surgery was trauma in the majority of cases (n = 31, 65.96%). The mean operative time was 78.55 ± 19.82 minutes. The cosmetic results were very satisfying in 46 of 47 (97.87%) patients and moderately satisfying in 1 (2.12%) patient. Overall, there were three (6.38%) complications. CONCLUSION: Our technique provides excellent functional and cosmetic outcomes. The overall surgical cost of these PMMA implants was lower than that of the other available cranioplasty implants. This technique is currently the most cost-effective option for cranioplasty.

Anterior retropharyngeal approach (ARPA) for high cervical spine.

BACKGROUND: One of the major challenges in operating on the spine lies in taking an anterior approach for the high cervical spine. In patients with a short neck, Klippel-Fiel syndrome or when the C3 vertebra is high in relation to the hyoid bone, it will be difficult to access the C3 body. The transoral route is a highly contaminated zone, and therefore, no instrumentation or grafts can be placed through it. METHOD: The anterior retropharyngeal approach (ARPA) for the high cervical spine. CONCLUSION: The anterior retropharyngeal approach is an excellent approach for the high cervical spine where instrumentation is needed. This route provides wide exposure of the C1-C3 region, avoiding the contaminated of the oral cavity.

Peak ADAMTS13 activity to assess ADAMTS13 conformation and risk of relapse in immune-mediated thrombotic thrombocytopenic purpura.

ABSTRACT: Previous studies have demonstrated that >38% of patients with immune-mediated thrombotic thrombocytopenic purpura in remission with activity >50% had an open ADAMTS13 (a disintegrin and metalloproteinase with thrombospondin type 1 motif, member 13) conformation. We assessed ADAMTS13 conformation in remission (ADAMTS13 activity >60%), focusing on peak ADAMTS13 activity levels and longitudinal assessment in 420 samples across 157 patients. Fewer cases had an open conformation at peak ADAMTS13 activity than unselected remission samples with ADAMTS13 activity >60% (23% vs 43%). Patients with a closed ADAMTS13 conformation at peak ADAMTS13 activity had an eightfold lower relapse rate in the subsequent year (9% vs 46%) and a fivefold lower relapse rate within 2 years (23% vs 62%) compared with cases with an open conformation. Patients with an open conformation at peak ADAMTS13 activity required preemptive anti-CD20 treatment earlier than those with a closed conformation (median, 10 vs 25 months). Longitudinally, an open conformation was evident at, and often preceded relapse. When the conformation was already open before relapse, an increase in the conformation index at relapse was seen despite the undetectable anti-ADAMTS13 immunoglobulin G (IgG) antibody. In cases with detectable anti-ADAMTS13 IgG antibody, these became undetectable before achieving a closed conformation, highlighting the relapse risk even with undetectable anti-ADAMTS13 IgG antibody and the clinical utility of open/closed during monitoring. To our knowledge, this is the first study to show an association between relapse risk and ADAMTS13 conformation when activity levels are at a peak. The open conformation identifies antibody-mediated subclinical disease that is not detectable by the current ADAMTS13 testing.

Comparative analysis of soil quality and enzymatic activities under different tillage based nutrient management practices in soybean-wheat cropping sequence in Vertisols.

In the modern era, intensive agricultural practices such as agrochemicals are applied in excessive amounts to enhance agricultural production. However, imbalanced adoption of these chemicals has arisen in the dwindling of agriculture factor productivity and soil quality. To maintain soil fertility and production, these chemical fertilizers must be supplemented with organic inputs. Keeping this in the backdrop, a research trail was established during 2018-19 and 2019-20 years at Research Farm of Agriculture University, Kota, India. The treatment setup was comprised of 5 treatment modules viz., conservation tillage + organic management (CAOM), conservation tillage + chemical management (CACM), conventional tillage + chemical management (CTCM), conventional tillage + organic management (CTOM) and the package of practices (PoPs) with four replications. Results indicated that the highest organic carbon (0.68%), bacterial (29.11 × 107 cfu g-1), fungal (4.77 × 104 cfu g-1), actinomycetes populations (5.67 × 104 cfu g-1), acid phosphatase (44.1 µg g-1 h-1), urease (45.3 µg g-1 h-1) and dehydrogenase (23.3 µg triphenylformazan [TPF] g-1 h-1) activity in soil were found in the treatment of conservation organic system during both the years of study at each soil depth. In contrast to other parameters, the highest system productivity was observed with conservation chemical crop management approaches, with a soybean equivalent yield of 4615 kg ha-1 in a soybean-wheat system of production. Furthermore, the soil quality index (SQI) significantly varied from the lowest score (0.30) at 45-60 cm layer of soil in the package of practices to the highest score (0.92) at 0-15 cm layer of soil with regards to the conservation organic which shows, 206.67 percent enhancement through the soil profile of various crop management practices. The SQI variation from 0-15 to 45-60 cm soil depth was 130.0, 81.08, 60.0, 175.0 and 83.33 percent, respectively, for CAOM, CACM, CTCM, CTOM and PoPs. Amongst, different systems, the highest mean performance was noticed under the conservation organic systems for physical and biological properties. Hence, in line with the salient outcome, we may propose that the conservation chemical system needs to be followed to improve crop productivity, whereas, conservation organic seems a good option for soil health with long-term viability.

Alleviating summer heat stress in cowpea-baby corn intercropping with stress-reducing chemicals and fertility variations.

Over the past century, the average surface temperature and recurrent heatwaves have been steadily rising, especially during the summer season, which is affecting the yield potential of most food crops. Hence, diversification in cropping systems with suitable fertilizer management is an urgent need to ensure high yield potential during the summer season. Since intercropping has emerged as an important strategy to increase food production, the present study comprises five intercropping systems in the main plot (sole cowpea, sole baby corn, cowpea + baby corn in 2:1, 3:1, and 4:1 row ratio), three levels of fertilizer viz. 100 (N20 P40), 125 (N25 P50), and 150% (N30 P60) recommended dose of fertilizer (RDF) in the subplot, along with two stress-mitigating chemicals (0.5% CaCl2 and 1% KNO3) in the sub-sub plots. A split-split plot system with four replications was established to carry out the field experiment. The effect of intercropping, fertilizer levels, and stress-mitigating chemicals on crop growth rate (CGR), relative growth rate (RGR), plant temperature, relative water content (RWC) and chlorophyll content of cowpea and baby corn, as well as cowpea equivalent yield (CEY), was investigated during the summer seasons of 2019 and 2020. The experiment was conducted at Agriculture University, Kota (Rajasthan), India. Results showed that CGR, RGR, RWC and chlorophyll content of both crops and CEY were maximum under intercropping of cowpea and baby corn in a 2:1 row ratio compared to other intercropping systems. However, the plant temperature of both crops was significantly lower under this system. CEY, CGR, RGR, and chlorophyll content were considerably greater in the subplots with a fertilizer application of 150% RDF compared to lower levels of fertilizer (100 and 125% RDF). Our findings further show that foliar application of CaCl2 0.5% at the flowering and pod-developing stages of cowpea dramatically boosted CEY, CGR, RGR, RWC, and chlorophyll content of both crops and lowered the plant temperature.

Alterations in the von Willebrand factor/ADAMTS-13 axis in preeclampsia.

BACKGROUND: Preeclampsia is a gestational hypertensive disorder characterized by maternal endothelial activation and increased ratio of soluble fms-like tyrosine kinase-1 (sFlt-1) inhibitor to placental growth factor (PlGF). The von Willebrand factor (VWF)/ADAMTS-13 axis is of interest because of the underlying endothelial activation and clinical overlap with pregnancy-associated thrombotic thrombocytopenic purpura. OBJECTIVES: To assess VWF, ADAMTS-13, and VWF/ADAMTS-13 ratio in preeclampsia and look for associations with sFlt-1/PlGF ratio and clinical features. METHODS: Thirty-four preeclampsia cases and 48 normal pregnancies were assessed in a case-control study. Twelve normal pregnancies in women with a history of preeclampsia formed an additional comparator group. VWF antigen (VWF:Ag) and VWF activity (VWF:Ac [VWF:glycoprotein IbM]) were measured via automated immunoturbidimetric assay, ADAMTS-13 activity was measured via fluorescence resonance energy transfer-VWF73 assay, and sFlt-1 and PlGF were measured via enzyme-linked immunosorbent assay. RESULTS: VWF:Ag was higher in preeclampsia than in normal pregnancy (median, 3.07 vs 1.87 IU/mL; P < .0001). ADAMTS-13 activity was slightly lower (median, 89.6 vs 94.4 IU/dL; P = .02), with no severe deficiencies. Significant elevations in VWF:Ac were not observed in preeclampsia, resulting in reduced VWF:Ac/VWF:Ag ratios (median, 0.77 vs 0.97; P < .0001). VWF:Ag/ADAMTS-13 ratios were significantly higher in preeclampsia (median, 3.42 vs 2.06; P < .0001), with an adjusted odds ratio of 19.2 for a ratio of >2.7 (>75th centile of normal pregnancy). Those with a history of preeclampsia had similar ratios to normal pregnant controls. VWF:Ag/ADAMTS-13 and sFlt-1/PlGF were not correlated. However, percentage reduction in platelets correlated positively with VWF:Ac (P = .01), VWF:Ac/VWF:Ag ratio (P = .004), and sFlt-1/PlGF ratio (P = .01). CONCLUSION: The VWF/ADAMTS-13 axis is significantly altered in preeclampsia. Further investigation of potential clinical utility is warranted.

Sustainable pathways for solar desalination using nanofluids: A critical review.

Water is a fundamental requirement for the survival of human beings. Although water is abundantly available across the globe, access to freshwater still remains a major concern. Most of the water available is saline or brackish, which is not fit for human consumption. Desalination is the optimum solution for production of potable water from saline water. A major shortcoming of conventional desalination technologies is their dependence on fossil fuel that results in environmental degradation, global warming, etc. Therefore, sustainable desalination technology has evolved as a need of hour. Among all renewable energy resources, solar energy is abundantly available and can be potentially harvested. Therefore, solar energy can be used to drive sustainable desalination technologies. A solar still converts saline water into freshwater in a single step using solar energy. But the major drawbacks of solar still are relatively lower efficiency and lower yield. Nanofluids are widely used to overcome these limitations due to their extraordinary and unique properties. This paper critically reviews the recent research performed on the application of nanofluids in solar desalination systems. Methods of nanofluid preparation, their types and properties are also discussed in detail. Application of nanofluids in solar desalination systems is discussed with special attention on performance enhancement of solar stills. Combinations of nanofluids with various other performance enhancement techniques are also considered. The effectiveness of nanofluids in solar stills is found to be dependent majorly on the nature and concentration of the nanofluid used.

Exergoeconomic and Thermodynamic Analyses of Solar Power Tower Based Novel Combined Helium Brayton Cycle-Transcritical CO2 Cycle for Carbon Free Power Generation.

In the present study, a novel combined power cycle for solar power tower (SPT) system consisting of helium Brayton cycle (HBC) and transcritical CO2 (TCO2) for waste heat recovery is being studied for carbon-free generation. The performance of the proposed SPT based combined cycle (SPT-HBC-TCO2 cycle) is compared with SPT based basic cycle (SPT-HBC) based on exergoeconomic and thermodynamic analyses. It is concluded that the SPT-based combined cycle (SPT-HBC-TCO2 cycle) produces a thermal efficiency of 32.39% and exergy efficiency of 34.68% with an electricity cost of 1.613 UScent kWh-1. The exergy and thermal efficiency of the SPT-based combined cycle are enhanced by 13.18% and 13.21% respectively, while electricity cost is reduced by around 2% as compared to the SPT-based basic cycle (SPT-HBC) configuration at base conditions. A notable finding is that, despite the additional expenditures related to the bottoming cycle, the cost of electricity is lesser for the proposed combined cycle. Additionally, a comparison with the related prior published research exhibits that the performance of the current novel system is superior to that of the systems based on steam rankine cycle and supercritical CO2 cycles.

Transition between distinct hybrid skyrmion textures through their hexagonal-to-square crystal transformation in a polar magnet.

Magnetic skyrmions, topological vortex-like spin textures, garner significant interest due to their unique properties and potential applications in nanotechnology. While they typically form a hexagonal crystal with distinct internal magnetisation textures known as Bloch- or Néel-type, recent theories suggest the possibility for direct transitions between skyrmion crystals of different lattice structures and internal textures. To date however, experimental evidence for these potentially useful phenomena have remained scarce. Here, we discover the polar tetragonal magnet EuNiGe3 to host two hybrid skyrmion phases, each with distinct internal textures characterised by anisotropic combinations of Bloch- and Néel-type windings. Variation of the magnetic field drives a direct transition between the two phases, with the modification of the hybrid texture concomitant with a hexagonal-to-square skyrmion crystal transformation. We explain these observations with a theory that includes the key ingredients of momentum-resolved Ruderman-Kittel-Kasuya-Yosida and Dzyaloshinskii-Moriya interactions that compete at the observed low symmetry magnetic skyrmion crystal wavevectors. Our findings underscore the potential of polar magnets with rich interaction schemes as promising for discovering new topological magnetic phases.

Reactivation of varicella zoster virus following trigeminal schwannoma resection.

Varicella zoster is found exclusively in humans. Infected people with this virus result in chickenpox followed by dormant virus within neural ganglia. This dormant virus, once activated, may affect any ganglia or nerves of the body but most commonly involves the thoracic, cervical and trigeminal nerves in decreasing order of frequency. We review three such cases in which manipulation of the trigeminal ganglion resulted in reactivation of varicella at homologous operative sites. Each patient underwent surgeries in which the trigeminal ganglion was manipulated for the resection of trigeminal schwannoma under a microscope through various approaches. All three patients developed reactivation of varicella at homologous operative sites. A thorough history of chickenpox infection should be taken in patients who are undergoing surgeries for trigeminal pathology. Early diagnosis should be made once any vesicular lesions are seen with prompt treatment. Reassurance and counselling are necessary in these patients. If possible, prophylaxis may be started in all such patients. Further studies are warranted to determine the exact cause of reactivation.

C2 Superior Facetal Osteotomy: A Novel Technique in Complex Craniovertebral Junction Surgery for C1 Lateral Mass Screw Placement.

Complex craniovertebral junction (CVJ) defects account for a considerable proportion of CVJ diseases. Given the heavily assimilated C1, an unfavorable C1-C2 joint orientation, an overriding C2 superior facet, a low-hanging occiput, and an abnormal vertebral artery course with a high-riding vertebral artery, placement of C1 lateral mass screws might be difficult. To address this, a novel technique for placing C1 lateral mass screws that avoid vertebral artery injury, low-hanging occiput, and overriding C2 superior facet was developed in this study. This approach enables firm fixation of C1-C2 even in difficult situations where the placement of the C1 lateral mass is challenging.