Myofibrosarcoma of Maxilla - Case Report and Review of Literature.

Myofibrosarcoma is a distinct mesenchymal malignancy which commonly occurs in head and neck region. It has a high tendency for local recurrence and distant metastasis. 39-year-old male presented with epistaxis, nasal obstruction and left sided complete loss of vision. He underwent functional endoscopic sinus surgery and guided biopsy. MRI scan showed a lesion epicentred in the left maxillary sinus, superiorly extending into the orbit. He underwent Class 4b maxillectomy with neck dissection, tracheostomy and free flap reconstruction. Histopathological examination yielded final diagnosis as myofibrosarcoma of maxilla. The patient was planned for adjuvant radiotherapy and has been disease free for 3 years.

Extraskeletal Myxoid Chondrosarcoma of Floor of Mouth-A Rare Case Report and Review of Literature.

Introduction: Chondrosarcomas are rare malignancies of the cartilage and myxoid chondrosarcoma is its variant which commonly occurs in soft tissue of extremities. Extraskeletal chondrosarcoma is a rare malignant neoplasm of bone or soft tissue origin and is characterized by the presence of spindle cells admixed with well differentiated cartilage or chondroid stroma. They are mostly radioresistant tumours and surgical resections with adequate margins is considered as the ideal treatment modality with adjuvant radiotherapy in high grade tumours and add on chemotherapy, in case of presence of poor prognostic factors. Case Report: A 51-year-old diabetic, hypertensive female patient presented to our outpatient department with difficulty in chewing food for a duration of 6 months. On clinical examination, she had an ulceroproliferative growth involving right lower alveolus and floor of mouth. MRI face and neck with contrast showed a 4.1 × 2.9 × 4.5 cm lesion involving right lower alveolus extending to floor of mouth. Biopsy showed features of extraskeletal myxoid chondrosarcoma. She was planned for upfront surgery (Right composite resection with modified radical neck dissection with free fibula flap). Patient was stable post-surgery and was discharged in stable condition. Final histopathology report was high grade myxoid chondrosarcoma. The case was presented in tumour board and the patient was planned for adjuvant radiotherapy. She has been on regular follow up for the past 2 years and shows no signs of recurrence. Conclusion: Extraskeletal myxoid chondrosarcoma of oral cavity is a rare entity and very few cases are reported. It is a malignant neoplasm which is diagnosed with the help of immunohistochemistry. Surgery is the ideal modality of treatment accompanied by adjuvant radiotherapy in cases of high-grade tumours.

A Rare Case Report of Osteosarcoma of Maxilla with Double Free-Flap Reconstruction.

Osteosarcomas are rare and highly malignant bone tumours which are composed of malignant mesenchymal cells producing osteoid or immature bone. Maxillary osteosarcomas are rare tumours accounting for less than 1% of head and neck malignancies. Aggressive surgical resection is the main modality of treatment with good reconstruction. Due to the complex anatomy and location of maxilla as well as its proximity to the skull, resection with negative margins is always a challenge and so is the reconstruction so as to reduce the morbidity of the patient and to also give a good functional and cosmetic outcome. Clinical outcomes can be improved with administration of neoadjuvant or adjuvant chemotherapy in selected cases and radiotherapy in case of positive margins. A 41-year-old male patient presented to the outpatient department with complaints of a bulge over the hard palate for the past 1 year. CT scan showed a 6 × 5 × 4 cm osseous expansile lesion arising from the maxillary bone. Biopsy of the tumour showed features of conventional high-grade osteosarcoma. Plate-preserving maxillectomy with tracheostomy was done followed by reconstruction with a double free flap. On post-operative day 1, the flap showed signs of venous congestion and a new free anterolateral thigh flap was done. Patient was discharged on day 7 with a Ryles tube and a tracheostomy tube in situ. Final histopathological examination showed that the tumour was a high-grade chondroblastic osteosarcoma. After regular post-operative visits in the outpatient department and evaluation with flexible laryngoscopy, patient was started on oral feed by day 10 and decannulated by day 15. He has been on regular follow-up for the past 1 year and shows no signs of recurrence or residual disease on clinical examination as well as imaging. Maxillary osteosarcoma is a rare bone tumour which requires accurate imaging and biopsy for accurate surgical planning. The ideal treatment modality is radical resection with negative margins and appropriate reconstruction. With the advent of microvascular surgery, free flaps form the backbone for reconstruction of such large defects.

Tellurium Containing Long Lived Emissive Fluorophore for Selective and Visual Detection of Picric Acid through Photo-Induced Electron Transfer.

A novel tellurium (Te) containing fluorophore, 1 and its nickel (2) and copper (3) containing metal organic complex (MOC) have been synthesized to exploit their structural and optical properties and to deploy these molecules as fluorescent probes for the selective and sensitive detection of picric acid (PA) over other commonly available nitro-explosives. Furthermore, density functional theory (DFT) and single crystal X-ray diffraction (SCXRD) techniques revealed the inclusion of "soft" Tellurium (Te) and "hard" Nitrogen (N), Oxygen (O) atoms in the molecular frameworks. Owing to the presence of electron rich "N" and "O" atoms along with "Te" in the molecular framework, 1 could efficiently and selectively sense PA with more than 80 % fluorescence quenching efficiency in organic medium and having detection limit of 4.60 µM. The selective detection of PA compared to other nitro-explosives follows a multi-mechanism based "turn-off" sensing which includes photo-induced electron transfer (PET), electrostatic (π-π stacking and π-anion/cation) interaction, intermolecular hydrogen bonding and inner filter effect (IFE). The test strip study also establishes the sensitivity of 1 for detection of PA.

Assessment of Kidney Involvement in COVID-19 Patient.

BACKGROUND AND AIM: Physicians need to be aware of the difficulties that SARS-CoV-2 infection brings to other regions of the body, such as the kidneys, even though the key emphasis is on pulmonary characteristics. The most frequent kidney complication among COVID-19 hospitalized patients is considered acute kidney injury (AKI). This study aimed to describe overall different aspects of acute kidney injury (AKI) in COVID-19 patients admitted to JLNMCH during the COVID-19 pandemic and to determine the prevalence of AKI among COVID-19 hospitalized patients. METHODS AND MATERIALS: All adult patients (over the age of 18 years) who screened positive for COVID-19 in a swab specimen from areas of nasopharyngeal by reverse transcriptase polymerase chain reaction and then hospitalized were included in the study. Information was gathered on the patient's demographics, general medical history, and drugs prescribed. From past medical information, associated comorbidities and home pharmaceuticals were identified. We gathered hospitalization information, such as duration of stay in ICU, details about the application of mechanical ventilation, information regarding extracorporeal membrane aeration, details of the use of vasopressor administration, and baseline results of laboratory test along with baseline clinical information during 48 hours of hospitalization. RESULTS: The percentage of patients with no history of AKI requiring traumatic mechanical ventilation was 79.4%, while the percentage of patients with no history of AKI not requiring traumatic mechanical ventilation was 11.5%. The difference was relevant statistically (p<0.001). The percentage of patients with AKI of any stage requiring traumatic mechanical ventilation was 22.8%, while the percentage of patients with no history of AKI not requiring traumatic mechanical ventilation was 76.8%. The difference was relevant statistically (p<0.022). CONCLUSION: We discovered that AKI was a rather typical finding among hospitalized COVID-19 patients. Patients hospitalized for COVID-19 had a poor prognosis if they developed AKI.

Reconstruction with free flaps in robotic head-and-neck onco-surgeries.

AIMS AND OBJECTIVE: The aim of the present article is to highlight how reconstruction with free flaps is different and difficult in cases with robotic head-and-neck cancer surgery. It also highlights the technical guidelines on how to manage the difficulties. MATERIALS AND METHODS: Eleven patients with oropharyngeal cancer having undergone tumour excision followed by free-flap reconstruction been reviewed here. Nine patients had tumour excision done robotically through intraoral route while neck dissection done with transverse neck crease incision. There is a problem of difficult flap inset in this group of patient. Two patients had intraoral excision of tumour followed by robotic neck dissection via retroauricular incision. With no incision directly on the neck, microvascular anastomosis is challenging in this set of patients. Free flap was used in all the cases to reconstruct the defect. RESULTS: Successful reconstruction with free flap was done in all the cases with good outcome both functionally and aesthetically. CONCLUSION: Free-flap reconstruction is possible in robotic head-and-neck cancer surgery despite small and difficult access, but it does need practice and some technical modifications for good outcome.

Congenital cheek teratoma with temporo-mandibular joint ankylosis managed with ultra-thin silicone sheet interpositional arthroplasty.

Primary cheek teratomas are rare with < 5 reported cases. None had associated temporo mandibular joint ankylosis (TMJA). The fundamental aim in the treatment of TMJA is the successful surgical resection of ankylotic bone, prevention of recurrence, and aesthetic improvement by ensuring functional occlusion. Early treatment is necessary to promote proper growth and function of mandible and to facilitate the positive psychological development of child. Inter-positional arthroplasty with ultra-thin silicone sheet was performed. Advantages include short operative time, less foreign material in the joint space leading to negligible foreign body reactions and least chances of implant extrusion. Instead of excising a large bony segment, a thin silicone sheet was interposed and then sutured ensuring preservation of mandibular height. Aggressive post-operative physiotherapy with custom made dynamic jaw exerciser was used to prevent recurrence.

Intraoral excision of large submental dermoid.

Sublingual dermoids are the rarest forms of craniofacial dermoids mostly seen in young individuals. Excision of large and deep submental dermoid is generally done via extraoral approach scarring the most prominent part of the face, which can lead to post operative scar hypertrophy and hyperpigmentation especially in non-Caucasian races. Presence of such scars leads to adverse psychological effects in young individuals. Excision via intraoral route, although technically demanding, can be simplified using basic principles of plastic surgery leading to optimal aesthetic outcome with least downtime. We excised a large sublingual dermoid extending deep to the mylohyoid muscle through intraoral approach with excellent cosmetic results. Clinicians dealing with such lesions should keep these principals in their armamentarium when dealing with this rare subset of cases.