Primary Oral Mucosal Melanoma: A Case Series.

Mucosal melanoma is an exceedingly rare and aggressive neoplasm with high mortality rate. In contrast to the cutaneous melanomas, the risk factors and pathogenesis are poorly understood. It is predominantly localized in the region of the hard palate and maxillary alveolus. Surgery is the mainstay of treatment, but it may turn out to be challenging depending on the anatomic location, extent and size of the tumor and presence of metastasis. Presented here is a series of two cases of maxillary mucosal melanoma with varied presentation.

Role of structured rehabilitation protocol in post surgical cases of restricted mouth opening.

BACKGROUND: Long term effectiveness of surgical management of chronically restricted mouth opening in OSMF or TMJ ankylosis depends largely on postoperative physiotherapy. This in turn is dependent on patient's compliance. Use of adjunctive aids besides pharmacotherapy that reduces patients pain and improves compliance with exercise is warranted. AIMS: To evaluate the role of TENS and structured rehabilitation programme in postoperative physiotherapy in OSMF and TMJ ankylosis patients. METHODS AND MATERIALS: A pilot study was conducted in which 6 patients of restricted mouth opening were put on a structured rehabilitation protocol in which TENS, heat and cold therapy with structured mouth opening exercise regimes. Interincisal opening, VAS score and a subjective assessment of post surgical discomfort was evaluated. RESULTS AND CONCLUSIONS: Results revealed an improved compliance and cooperation by patients. Pain on VAS scale also reduced from mean of 7.8 on day 1 to 3.6 on day 5 in this group. The mean discomfort on day 3 was reported as mild to moderate. An early attainment of passive mouth opening closest to intraoperative mouth opening was also reported on day 5 which is usually not achievable without any physiotherapy intervention.

Systematic Review of Lesser Known Parasitoses: Maxillofacial Dirofilariasis.

BACKGROUND: Dirofilariasis is an endemic disease in tropical and subtropical countries caused by about 40 different species of dirofilari. Dirofilariasis of the oral cavity is extremely rare and is usually seen as mucosal or submucosal nodules. We also present a case of dirofilariasis of the mandibular third molar region submucosally in a 26 year old male patient. PURPOSE: To identify, enlist and analyze the cases of dirofilariasis in maxillofacial region reported worldwide so as to understand the clinical presentation and encourage the consideration of helminthic infections as a possible differential diagnosis in maxillofacial swellings. METHODS: Two authors KC and SK independently searched the electronic database of PUBMED, OVID, Google Scholar and manual search from other sources. A general search strategy was planned and anatomic areas of interest identified. The search was made within a bracket of 1 month by the independent authors KC and SK who assessed titles, abstracts and full texts of articles based on the decided keywords. The final selection of articles was screened for the cases that were reported in the maxillofacial region including the age, gender, site of occurrence and region of the world reported in. A geographic distribution of the reported cases was tabulated. RESULTS: A total number of 265, 97, 1327, 3 articles were identified by PubMed, Ovid, GoogleScholar and manual search respectively. The final articles were manually searched for duplicates and filtered according to the inclusion/exclusion criteria which led to a final list of 58 unique articles that were included in the study. In total 99 cases were identified. CONCLUSION: Although intraoral dirofilarial infections are extremely uncommon, it should be considered in the differential diagnosis of an intraoral or facial swelling that does not completely respond to routine therapy especially in patients from endemic areas.

Knowledge, Attitude, and Practices regarding Pharmacovigilance and Adverse Drug Reaction reporting among Dental Students in a Teaching Hospital, Jodhpur, India: A Cross-sectional Study.

INTRODUCTION: This is a cross-sectional knowledge, attitude, and practices (KAPs) study on pharmacovigilance (PV) and adverse drug reaction (ADR) reporting among dental students in a teaching hospital in India. AIM: The aim of this study was to assess the KAP of dental students regarding PV, ADR reporting, and barriers toward the same. MATERIALS AND METHODS: A cross-sectional survey using a self-administered, investigator-developed, close-ended questionnaire was conducted in an academic dental hospital in India. All prescribers including third year students, final year students, and house surgeons of the same institute were included for assessment of KAP regarding PV using 16, 8, and 8 items respectively. Data regarding barriers toward ADR reporting and demographics were also collected. Mann-Whitney U-test and Kruskal-Wallis test were applied followed by post hoc test. RESULTS: A total of 241 of 275 respondents participated in the study with a response rate of 87.5%. Overall, 64% reported that they had no idea about the term PV. Age was significantly associated with knowledge (p = 0.045) and attitude (p = 0.016). Barriers contributing to underreporting were difficulty in deciding whether or not an ADR has occurred (52.0%), concerns that the report may be wrong (37%), lack of confidence to discuss ADR with colleagues (29%), and almost no financial benefits (24%). CONCLUSION: Participants had a comparatively favorable attitude toward PV, but their knowledge and practice need considerable improvements. This study highlights the need for appropriate dental curriculum changes and further multicentric studies to shed more light on important issues of PV among dentists in India. CLINICAL SIGNIFICANCE: This study explores dentists' knowledge, attitude, and behavior regarding PV, which could help to improve patient's safety and care. The favorable attitude of dentists is an indication that PV could be added in depth in the curriculum and in general practice. Information on barriers for reporting the ADRs could help to find possible solutions for removing the barriers precisely.

Management of Recurrent Odontogenic Myxoma of Mandible: A Clinical Case Report.

Odontogenic Myxoma (OM) is a slow growing painless locally aggressive tumor seen in gnathic bones and is generally asymptomatic. OM is characterized by spindle, wedge or stellate shaped cells loosely arranged in an abundant mucoid stroma. It is found incidentally on radiographs and may vary from a unilocular radiolucency to a multilocular lesion with well-defined or diffuse margins. Treatment includes surgical management that may range from simple enucleation and curettage to surgical excision including peripheral osteotomy, segmental resection, hemimandibulectomy and maxillectomy. Here we are presenting a case report on odontogenic myxoma with recurrence after conservative treatment.

A Comparative Study of 3-Dimensional Titanium Versus 2-Dimensional Titanium Miniplates for Open Reduction and Fixation of Mandibular Parasymphysis Fracture.

INTRODUCTION: Three dimensional titanium plating system was developed by Farmand in 1995 to meet the requirements of semi rigid fixation with lesser complication. The purpose of this in vivo prospective study was to evaluate and compare the clinical effectiveness of three dimensional and two dimensional Titanium miniplates for open reduction and fixation of mandibular parasymphysis fracture. MATERIALS AND METHODS: Thirty patients with non-comminuted mandibular parasymphysis fractures were divided randomly into two equal groups and were treated with 2 mm 3D and 2D miniplate system respectively. All patients were systematically monitored at 1st, 2nd, 3rd, 6th week, 3rd and 6th month postoperatively. The outcome parameters recorded were severity of pain, infection, mobility, occlusion derangement, paresthesia and implant failure. The data so collected was analyzed using independent t test and Chi square test (α = .05). RESULTS: The results showed that one patient in each group had post-operative infection, occlusion derangement and mobility (p > .05). In Group A, one patient had paresthesia while in Group B, two patients had paresthesia (p > .05). None of the patients in both the groups had implant failure. There was no statistically significant difference between 3D and 2D miniplate system in all the recorded parameters at all the follow-ups (p > .05). CONCLUSION: 3D miniplates were found to be better than 2D miniplates in terms of cost, ease of surgery and operative time. However, 3D miniplates were unfavorable for cases where fracture line was oblique and in close proximity to mental foramen, where they were difficult to adapt and more chances for tooth-root damage and inadvertent injury to the mental nerve due to traction.

Joint line restoration in a contemporary revision knee system.

We investigated a new revision total knee arthroplasty device and associated instrumentation to determine if it could reduce intraoperative complexity and restore the joint line through the arc of motion. In a prospective multicenter study, a total of 95 consecutive patients undergoing a revision knee arthroplasty were evaluated. Medical history, functional health scores, and intraoperative data were collected. The joint line was restored to 28 mm ± 5 mm in full extension and 90-degree flexion. Significant improvements were noted in all functional and general health scores. The anatomic boss position may allow for a reduction in instrumentation, as the need for femoral offset adapters was limited. Joint line restoration with proper posterior condylar offset correlated with positive functional outcomes.

Two-stage reimplantation for periprosthetic knee infection involving resistant organisms.

BACKGROUND: Two-stage reimplantation is the most accepted mode of treatment for patients with a periprosthetic infection following total knee arthroplasty. Most studies, however, do not stratify their results on the basis of the type of infecting organism. The purpose of this study was to determine the outcomes for patients who had two-stage reimplantation for the treatment of infection with a resistant organism, methicillin-resistant Staphylococcus aureus or methicillin-resistant Staphylococcus epidermidis, at the site of a total knee replacement. METHODS: A multicenter study was performed to review the cases of all patients treated between 1987 and 2003 because of an infection with methicillin-resistant Staphylococcus aureus or methicillin-resistant Staphylococcus epidermidis organisms at the site of a total knee replacement. The prevalence of reinfection following two-stage reimplantation was determined. Variables that may influence the outcome, such as the duration and type of intravenous antibiotics administered, previous surgery, and comorbidities of the host, were analyzed. RESULTS: We identified thirty-seven patients who had an infection with a resistant organism. All patients had negative cultures at the time of reimplantation. Four of the thirty-seven patients had a reinfection with the same organism, while five had a reinfection with a different organism. None of the variables noted above were found to be significantly associated with reinfection, on the basis of the numbers available. CONCLUSIONS: Reports in the literature have discouraged reimplantation for the treatment of an infection with a resistant organism at the site of a total knee replacement. While 24% of the patients in this series had a reinfection, 14% had a reinfection with a different organism. We believe that two-stage reimplantation remains a viable treatment option for patients who have an infection with a resistant organism at the site of a total knee replacement. LEVEL OF EVIDENCE: Therapeutic Level IV.