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.

Airway Blocks Vs LA Nebulization- An interventional trial for Awake Fiberoptic Bronchoscope assisted Nasotracheal Intubation in Oral Malignancies.

BACKGROUND: Patients with intra-oral malignancies warrants use of awake Fiberoptic assisted naso-thracheal intubation to secure an airway due to multiple risk factors leading to anticipated difficult airway. Different techniques such as airway blocks, local anesthesia (LA) gargles, spray, nebulization and  mild  sedation are in practice to improve  the success rate of fiberoptic assisted intubation. METHODS: Sixty patients  of  ASA I and II with Mallampatti score 3 and above, posted for Commando operations were enrolled in this study and were divided into 2 groups. Group AB (Airway Block, n=30) were given Superior laryngeal nerve block bilaterally and recurrent laryngeal nerve block  transtracheally  with Inj  2% Lignocaine. Second Group AN (Airway Nebulization, n=30)  patients airway was nebulized with 4% Lignocaine  with ultrasonic nebulizer. After confirmation of satisfactory anesthesia clinically Fiber-optic assisted naso-tracheal intubation was attempted. Hemodynamic monitoring, total time taken for intubation, patients comfort and any complications occurred were noted. Statistical Analysis- All the observed values were tabulated and analyzed using software SPSS version 17.0. RESULTS: Demography and Hemodynamic observations were comparable in the groups.  The time taken for intubation, patient comfort score, intubation conditions were excellent in AB group than in group AN. Airway complications like laryngospasm and cough were noted in AN Group. CONCLUSIONS: Judicial use of combined Airway blocks such as Bilateral Superior and trans-tracheal recurrent laryngeal nerve blocks could facilitate a successful fiber-optic assisted awake naso-tracheal intubation in anticipated difficult intubation with negligible complications.
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Borle's triangle: A reliable anatomical landmark for ease of identification of facial nerve trunk during parotidectomy.

PURPOSE: An accurate understanding of the anatomy, identification and preservation of facial nerve is critical in performing successful functional parotidectomies. The current literature is replete with inconsistencies of various landmarks when used alone for identification of facial nerve trunk (FNT). The purpose of the paper is to introduce a new anatomical triangle, Borle's triangle (BT) for safer and reliable operative identification of FNT during parotodectomies. PATIENTS AND METHODS: Between Aug 2014 and Dec 2017, twelve patients who reported with unilateral disease of the parotid gland with intact facial nerve function who underwent superficial or complete parotidecomies were included in the study. BT was conceptualized by intersection of three imaginary lines drawn along anatomical structures and forming a triangle comprising of angles a, b and c. RESULTS: Introperatively, BT helped reliably identify the FNT and its branches successfully in all the cases. The mean distance of FNT from angle b was found to be 12.18 ±â€¯1.7 mm. Transient neurological deficits with one or more branches were seen in four cases whilst, one case had transient deficit with all the five peripheral branches. All of them spontaneously resolved completely by the end of three months post operatively. CONCLUSIONS: When used in isolation, substantial variations exist in distances measured from anatomic landmarks to the main FNT in the literature. The BT utilizes three commonly used anatomical landmarks. It predictably helps in proper anatomic orientation, identification and preservation of FNT and branches with ease in parotidectomies.

Assessment of Fracture Resistance Capacity of Different Core Materials with Porcelain Fused to Metal Crown: An in vitro Study.

Aim: The aim of the study was to evaluate the capacity to resist fracture in different core buildup materials with porcelain fused to metal (PFM) crown. Materials and methods: Totally, 45 mandibular single rooted first premolars were collected, which were sound along with similar shape and size. The teeth were sectioned at 15 mm above the root apex sparing the sound tooth structure. The teeth were endodontically treated with the crown-down technique using nickel-titanium (NiTi) instrumentation. The specimens were randomized into three groups as per the core materials used and were labeled accordingly. Group I consisted of dual-cured composite resin, group II consisted of glass ionomer reinforced with resin, and group III consisted of Miracle mix. Universal loading machine is used for measuring the compres-sive load applied to fracture the tooth. Results: The mean value of compressive strength was maximum in the dual cured composite resin (598.42 ± 22.64) followed by glass ionomer reinforced with resin (478.88 ± 26.74) and Miracle mix (442.16 ± 30.10). The results showed a significant difference statistically within the core materials used with p < 0.05. The results from the Tukey's post hoc test of multiple comparisons between dual-cured composite resin vs glass ionomer reinforced with resin, dual-cured composite resin vs Miracle mix, and glass ionomer reinforced with resin vs Miracle mix showed a highly statistical difference with p < 0.05, which is significant. Conclusion: This in vitro study showed that the dual-cured composite resin had maximum resistance to fracture compared with other core buildup materials on teeth which were endodonti-cally treated. Clinical significance: Restoration of a tooth which is structurally compromised is a tricky job for all the dentists. Restoring it with a proper core buildup material with adequate fracture resistance makes the tooth structure stable. The core material should be able to resist all types of occlusal forces and to distribute it equally within the tooth structure. Keywords: Core buildup, Crowns, Endodontically treated teeth, Fracture resistance.