Angiokeratoma of tongue in the pediatric age group: a rare presentation.

BACKGROUND: Angiokeratoma is a rare cutaneous presentation with unknown etiology. CASE PRESENTATION: A case of a 10-year male, who was presented to the ENT OPD with a swelling over the posterior aspect of the tongue. The chief complaints included growth on the right side of the posterior third of the tongue which was extending up to the base of the tongue on the same side. CONCLUSION: Excisional biopsy was taken and sent for histopathology which was suggestive of inflamed angiokeratoma. Post-excision there is no recurrence till date.

Evaluation of Tongue Functions After Free Flap Reconstruction.

Squamous cell carcinoma of the tongue is the most common malignancy of the oral cavity, the lateral border being the commonest site. The treatment strategies mandate surgery followed by appropriate reconstruction as the first line of management. There are many suitable methods of reconstruction of tongue defects after surgery, but the principle of an ideal reconstruction method should provide not only satisfactory structural cosmesis, but also good restoration of function. We present our experience with the skin lined free flaps reconstruction for defects of the tongue and floor of mouth, and present analyses of the functional outcomes of reconstruction. This prospective longitudinal study included 93 patients and was conducted in a tertiary care center in Punjab. All patients underwent free flap reconstruction after tumor removal. The functional outcome of the tongue following reconstruction was evaluated 9 months after the completion of treatment. Functions were assessed and matched with sexes and age-matched normal individuals. The data obtained were analyzed by the student 't' test and the p values < 0.05 were considered statistically significant. The duration of swallowing in patients with FRF flap and ALT flap when compared to the normative was significant (< 0.05). There were changes in configuration and volume of the oral cavity after surgery which generates resonant and articulatory alterations, thus the intelligibility of the patient's speech is lowered. There is also a restriction in the tongue movements and reduction in the sensations of the reconstructed part of the tongue. Both the free ALT flap and the FRF flap can provide acceptable functional restoration of the tongue after radical tumor resection.

PMMC flaps for reconstruction of oral defects in the age of microvascular flaps: A developing nation perspective.

Purpose: The purpose of this study was to compare Pectoralis major myocutaneous flap (PMMC) and Free flaps for reconstruction of post ablative defects in patients undergoing treatment for oral squamous cell carcinoma and to understand the reasons for choosing each from a developing nation perspective. Material and methods: In the present study, a retrospective study was conducted of the patients treated by either free flaps or PMMC flaps for reconstructive procedures over a five year period in the Department of Oral and Maxillofacial Surgery, Shri Guru Ram Das Institute of Dental Sciences and Research. Results: Out of 90 PMMC flaps, 44 patients (48.8%) had reconstruction due to lack of micro vascular facility at the center, in 39 patients (43.3%) due to financial constraints and in 7 patients (7%) due to associated comorbities. The overall complication rate in PMMC group was 30% as compared to 28% in Free Flap group. Total flap loss was seen in 3 flaps (2 microvascular and 1 PMMC) while marginal necrosis of skin paddle was seen in 12 patients (13%) in the PMMC group. Conclusion: Though, the selection of PMMC flap over free flap was influenced by many factors, results of this study suggest that PMMC flap still has a major role in post-ablative defect reconstruction even in this era of free flaps, especially in developing countries like India.

Impact of Hyoid Position, Mandible Body Length and Anthropometric Measurements on Sleep Indices in Patients with Snoring in North Indian Population.

Introduction: In Indian population, the estimated prevalence of OSA is 7.5% to 13.5%. Craniofacial anatomical variations and obesity are the major risk factors for OSA. Among the craniofacial anatomy, the neck circumference and abnormal craniofacial morphology play an important role in the pathogenesis of OSA. Obesity is the major risk factor for which waist and hip circumference and BMI are considered. Aim: The aim of this paper was to evaluate the impact of hyoid position, mandible body length (MBL) and anthropometric measurements on sleep indices in patients with snoring in North Indian population. Methods: In this cross-sectional study, we analyzed the position of the hyoid, mandible body length and anthropometric measurements, of 104 patients attending ENT OPD with the complaint of snoring and excessive daytime sleepiness. All subjects underwent a full overnight polysomnography. The position of the hyoid, MBL and the anthropometric measurements were compared with the sleep architecture of the subjects, and a p value < 0.05 was considered significant. Results: A strong positive correlation is seen between the position of the hyoid, MBL and anthropometric measurements on the sleep indices in this study. Pearson 2-tailed correlation was evaluated, and upon analysis, it was found that at significance level of 0.01, obesity (BMI) is strongly correlated with overall AHI with correlation coefficient of 0.926, whereas AHI in supine position was having coefficient of 0.837 and AHI on right side and left side was almost same 0.597 and 0.575, respectively. Similarly WC is strongly correlated with AHI and RDI, having coefficient of 0.930 with both. NC and HC also showed strong positive correlation with overall AHI and RDI having correlation coefficient of 0.893, 0.926 with AHI and 0.893, 0.926 with RDI, respectively. The MBL also showed a strong positive correlation with AHI and RDI with correlation coefficient of 0.994 in both. The position of the hyoid also showed a strong positive correlation with AHI and RDI. Conclusion: Results indicated that significant positive correlation was found between position of the hyoid, MBL and anthropometric measurements on the sleep indices in patients with snoring in North Indian population.

Mucormycosis of Paranasal Sinuses of Odontogenic Origin Post COVID19 Infection: A Case Series.

The Severe acute respiratory syndrome and the Middle East respiratory syndromes emerged in 2002 and 2012 respectively. Currently the world is witnessing a global pandemic caused by a novel coronavirus, the severe acute respiratory syndrome coronavirus 2 (SARS CoV- 2) causing the Coronavirus 2019 (COVID-19). Mucormycosis is a fungal infection primarily affecting individuals with an immunocompromised state like diabetes mellitus, malignancies etc. Patients who have or have had COVID-19 infection with pre-existing uncontrolled Type 2 Diabetes mellitus are presumably more vulnerable for emergence of fungal infections cases. This article presents a report of 6 cases with histopathological proven mucormycosis associated with COVID-19 and uncontrolled Diabetes mellitus.

Expression of Cyclin-D1 and p53 as Prognostic Markers in Treatment of Oral Squamous Cell Carcinoma.

Cyclin D1 and p53 play an important role in tumorigenesis of human cancers. The present study aims to evaluate cyclin D1 and p53 expression in resectable OSCC, and to determine their prognostic significance at the end of 5 year follow-up: A total of 100 patients aged 31-74 years, stage 3/4 were recruited. Cyclin D1 and p53 expression in the tumour tissue was estimated by IHC and was statistically correlated with demographic and clinicopathological data and prognosis was evaluated at the end of 5 year outcome. The positive expression rate of cyclin D1 was 50% and p53 it was 40% and they neither showed any statistical significant correlation with each other nor with demographic or clinicopathological data. The OS was 32%.Negative and weak expression predicted better outcomes with regard to DFS and OS. DFS and OS were significantly worse in patients of overexpressed cyclin D1 (p < 0.001) and p53 (p = 0.008). Cyclin D1 is a better prognostic marker as compared to p53 for both DFS and OS. p53 expression (high versus low) for disease free non-survival and overall nonsurvival showed an OR of 3.576 (p = 0.003) and 8.803(p < 0.001) respectively for strong expression while in case of cyclin D1 it showed an OR of 13.067(p < 0.001) and 37.465(p < 0.001) for strong expression.So higher the level of expression of tumour markers higher is the odds ratio so poorer is the prognosis. Overexpression of cyclin D1 and p53 was significantly associated with poor prognosis in terms of DFS and OS.

Chondrosarcoma of Mandible: A Rare Case Report.

INTRODUCTION: Chondrosarcomas (CS) are malignant mesenchymal tumours with cartilaginous differentiation that rarely affects the maxillofacial region. It accounts for approximately 10-20% of malignant bone tumours. The CS is rare in occurrence with aggressive course with high malignant potential, and poor prognosis. CASE REPORT: Here we report a rare case of a 37year old female presenting tumoral mass in the lower jaw, for the past 3 years, which was gradually progressive in nature with an area of skin ulceration. The CT revealed a well- defined lesion with soft tissue component measuring 15x12x10 cm in size infiltrating both right and left masseter. Biopsy confirmed the diagnosis of grade IIICS. Considering the size and aggressive nature of the lesion, surgical resection was done. The reconstruction of the mandible was done with vascularised fibula pedicle flap to achieve acceptable cosmesis. The patient was discharged uneventfully. Though few cases of high grade CS have been reported in literature but CS of this enormous size has not been reported yet. CONCLUSION: In this case report we documented the management of a relatively rare but challenging reconstructive maxillofacial surgery. Since in this case the CS was enormous in size and aggressive surgery was required, the cosmetic and functional outcomes were challenging. In our case report we have found that a vascularised fibula pedicle flap gives a good functional and cosmetic outcome and can be used for reconstruction of complete mandible.

To Evaluate the Pre and Post Shunt Sensorineural Hearing Loss in Hydrocephalus Patients.

Hydrocephalus means watery head and defined as disturbance of formation, flow, or absorption of cerebrospinal fluid. The clinical presentation of hydrocephalus includes hearing loss especially sensorineural hearing loss (SNHL). Ventriculoperitoneal (VP) shunting is the most commonly performed procedure in these patients. Pure tone audiogram, impedence and BAEPs, were done for preoperative hearing assessment in 20 hydrocephalus patients. Out of 20 patients, 12 cases (60%) had SNHL while, rest 8 (40%) patients had mixed hearing loss. Post VP shunting hearing improvement was observed in 14 patients (70%) whereas it worsened in 30% of patients. The result is even better if shunt is placed at early age.

Doing Mastoidectomy Along with Tympanic Membrane Repair Reduces the Need for Revision Procedures: A Prospective Study.

To determine the role of cortical mastoidectomy on the results of tympanoplsty in tubotympanic type of chronic suppurative otitis media. A prospective, observational, interventional study was conducted from a period of October 2006-October 2008. This included 40 patients of either sex in the age group of 15-45 years having tubotympanic type of CSOM. Tympanoplasty with mastoidectomy was done in all the patients and they were followed up for graft acceptance and hearing impairment for 5 years to see the long term results. Per-operatively, the antrum was involved in 17, aditus in 11 and middle ear in 8 patients. Incus was necrosed in 10 cases and malleus and incus were absent in a single case. Mucoid discharge was found in the middle ear in 12 out of 40 patients. Mucoid discharge ears had antral mucosal hypertrophy in 100%, blocked aditus in 75% and middle ear mucosal hypertrophy in 58% cases; ossicular necrosis in 75% cases. 90% of the cases had graft accepted. In dry ears, graft take up rate was 89% and in ears with mucoid discharge it was 92%. Average air-bone-gap reduced to 13.90 dB as compared to average air-bone-gap (Av. AB Gap1) preoperatively of 38.62 dB. After 5 years, 83.5% patients had >10 dB improvement in hearing. We recommend opening of the mastoid if on inspection of middle ear one finds mucoid type of discharge.

Temporomandibular joint ankylosis fixation technique with ultra thin silicon sheet.

BACKGROUND: Temporomandibular joint ankylosis is a highly distressing condition in which the joint space is obliterated by scar tissue and the patient has an inability to open the mouth. Different autogenous and alloplastic interposition materials have been used after the resection of the ankylotic bone to achieve desirable and long lasting results. The recurrence of disease is most distressing for both patients and surgeon. We have been using ultra thin silicon sheet as our preferred material for providing proper fixation and cover to the joint. We have been encouraged by good patient compliance, no implant extrusion and favourable outcome. MATERIALS AND METHODS: The clinical study included 80 patients with temporomandibular joint ankylosis, treated between April 2001 and March 2009. In all patients, temporomandibular joint ankylosis had resulted following trauma. Diagnosis was based on clinical assessment supplemented by radiographic examination consisting of a panoramic radiograph, axial and coronal computer tomography. The technique of using ultra thin silicon sheet covering whole of the joint space fixed with non-absorbable nylon 3-0 suture both medially to medial pterygoid muscle and laterally to periosteum of zygomatic arch was employed in all patients. RESULTS: A total of 80 patients were in this study (59 males and 21 females). The aetiology of temporomandibular joint ankylosis was post-traumatic in all cases. The patients' age ranged from 5 to 45 years. The disease was unilateral in 61 cases and bilateral in 19 cases. Twelve patients, who had previous surgery done in the form of gap arthroplasty in 6 cases, costochondral graft in 4 cases and temporalis muscle in 2 cases, presented with recurrence on the same side. The pre-op inter-incisal mouth opening ranged from 4 to 12 mm. The intraoperative inter-incisal mouth opening ranged from 28 to 46 mm. An additional procedure was done in 13 patients, including placement of costochondral graft with coronoidectomy in 4 of these cases. There was no immediate complication and no incidence of facial nerve injury. There was no extrusion of the implant in immediate and follow-up period. CONCLUSIONS: The use of alloplastic implants with less volume and proper fixation covering all the raw bone joint space prevents reunion of bone; fixation of the sheet prevents its movement and thus extrusion.

Myringoplasty for chronic otitis media.

METHODS: 25 children in the age group of 8-14 years suffering from chronic suppurative otitis media were taken up for myringoplasty using onlay technique under general anaesthesia. RESULTS: All selected cases had a central type of dry perforation, good cochlear reserve and healthy middle ear mucosa. Cases having enlarged adenoids, infection in nose or throat, any traumatic perforation or previous attempt at closure were excluded from the study. It was found that there was 76% take up of graft after two months who also had improvement in hearing. CONCLUSION: We conclude that myringoplasty stands a good chance in children.