Comparative evaluation of dacryocystorhinostomy with retrograde intubation and conjunctivo-dacryocystorhinostomy.

OBJECTIVE: To compare the surgical outcomes of dacryocystorhinostomy with retrograde intubation and conjunctivo-dacryocystorhinostomy for the management of proximal mid-bicanalicular lacrimal obstruction. DESIGN: Randomized, controlled trial. METHODS: The study was conducted in 50 eyes of 50 adult patients with bicanalicular obstruction ≤ 6 mm from the punctum. The etiology, duration of symptoms, and Munk scores were recorded. Group A underwent dacryocystorhinostomy with retrograde intubation, and in group B, conjunctivo-dacryocystorhinostomy was performed. Success was defined as anatomic patency on syringing, a negative fluorescein dye disappearance test, and a Munk score < 2 twelve months postoperatively. RESULTS: There were 23 males and 27 females, 18-66 years of age, with a 6-month to 20-year duration of epiphora. The etiologies were idiopathic, trauma, and allergic conjunctivitis and ocular surface inflammation. In group A, the pseudopunctum was located medial to the diagnosed level of canalicular block by 1.28 ± 0.54 mm and 1.04 ± 0.88 mm in upper and lower canaliculi, respectively. Four post-traumatic cases required intervention following closure of the pseudopunctum, all being located ≥ 7 mm from the true punctum (p = 0.001). The complication rate was higher in group B than in group A (p = 0.001). At 12 months, the success rate was 100% in group A and 88% in group B (22 of 25; p = 0.74), with reduction in Munk scores from preoperative levels in both groups (p = 0.001). CONCLUSION: Dacryocystorhinostomy with retrograde intubation and conjunctivo-dacryocystorhinostomy have comparable success rates in the management of proximal mid-bicanalicular obstructions. Dacryocystorhinostomy with retrograde intubation has lower complication rates and does not require long-term maintenance of the bypass tube, unlike conjunctivo-dacryocystorhinostomy.

Intraosseous solitary myofibroma of the orbit in an adolescent woman.

A 16-year-old woman presented with a painless, progressive, hard swelling in the left inferolateral orbital wall for the past 1 year. There was no diminution of vision or limitation of ocular motility. Imaging revealed an intraosseous, well-defined, expansile, soft tissue lesion in the inferolateral wall of the left orbit. A left anterior orbitotomy with complete surgical excision was performed. Histopathological evaluation of the specimen revealed fascicular pattern of spindle cells with a rich network of slit-like, branching blood vessels. Tumour cells exhibited smooth muscle actin and vimentin positivity but were negative for CD-34 and STAT-6. In absence of any systemic manifestation, a diagnosis of intraosseous solitary orbital myofibroma was made. The case highlights the importance of integrating clinical, radiological and histopathological features in overcoming the diagnostic challenge of differentiating myofibroma from other mesenchymal neoplasms. It also brings forth the importance of complete resection and curettage to prevent recurrence.

Massive Retinal Gliosis in Microphthalmic Globe With Cyst Masquerading as a Neoplasm.

We report a rare case of a bilaterally blind, 33-year-old male, who presented with rapidly progressive, painless swelling in the right orbit for two months, in the absence of ocular trauma. Suspecting an intraocular neoplasm, a contrast-enhanced MRI (CE-MRI) orbit was performed, which was suggestive of a right-sided superomedial eccentric soft-tissue lesion with bilateral rudimentary globes associated with cyst, hypoplastic optic nerves, and focal areas of calcification. Diffusion-weighted MRI demonstrated diffusion restriction and yielded an indeterminate value of apparent diffusion coefficient (ADC). A right enucleation with excision of the cyst was performed. Histopathological examination confirmed the diagnosis of a right-sided massive retinal gliosis (MRG) with bilateral microphthalmia with cyst. This case demonstrates the role of a detailed histopathological analysis along with immunohistochemistry (IHC) in differentiating MRG from a neoplasm.

Clinical Presentation and Management Strategies in Intraorbital Foreign Bodies.

The authors present a retrospective, observational case study of seven patients, who presented with retained Intra-Orbital Foreign Bodies (IOrbFBs) following penetrating orbital injury at a tertiary eye hospital over a period of one year. Cases were reviewed for epidemiological features, mechanism of injury, nature of foreign body, clinical features, imaging modality, associated complications, management outcomes, and the final prognosis. The mean age of presentation was 27.43 years. Amongst the seven patients, two were children (aged <10 years). The male : female ratio was 4 : 3. Of the seven retained IOrbFBs, two were plastic, two wooden, and three metallic in nature (one gunshot injury, one ball projectile (commonly referred to as BB) injury, and one with knife). Two out of seven had no light perception at presentation. The periocular location of the foreign bodies was inferior in 4 cases and medial in 3 cases. Computed Tomography scan confirmed the diagnosis in five cases and Magnetic Resonance Imaging (MRI) was diagnostic in one. Surgical intervention was done in five cases, and two cases were managed conservatively. The authors conclude that favourable outcome can be achieved even without surgical removal in cases of inert metallic/inorganic IOrbFBs. The properties of plastic FBs can frequently render them invisible on imaging, or they may mimic chronic inflammatory conditions like tuberculosis. Long-standing wooden IOrbFBs evade identification radiologically due to prolonged hydration. The ultimate choice of intervention must be individualised, weighing the risks of retention against the risk of iatrogenic damage.

Assessment of Reliability of Cone-beam Computed Tomography in Skeletal and Dental Discrepancy.

AIM: The present study was conducted to evaluate the reliability of cone-beam computed tomography (CBCT) in dental asymmetry with skeletal midline deviation. MATERIALS AND METHODS: This study was conducted on 124 patients (males 52, females 72) who underwent orthodontic treatment. The CBCT scan was obtained with the Planmica machine. Three maxillofacial radiologists evaluated 10 landmarks and 12 distances on maxillary and mandibular arches on CBCT images in all patients. RESULTS: Interobserver mean difference at point 1 was 0.33; point 2, 0.34; point 3, 0.32; point 4, 0.58; point 5, 0.56; point 6, 0.44; point 7, 0.28; point 8, 0.22; point 9, 0.54; point 10, 0.21; point 11, 0.34; and point 12, 0.36. The discrepancy between intra- and interobserver was not considerable (p > 0.05). CONCLUSION: Cone-beam computed tomography is useful for diagnosis of skeletal asymmetry. CLINICAL SIGNIFICANCE: Cone-beam computed tomography is a reliable and reproducible tool for diagnosis of skeletal asymmetry for successful orthodontic treatment.

A Rare Presentation of Orbital Castleman's Disease.

Castleman's disease (CD) is an uncommon group of atypical lymphoproliferative disorders. Extranodal involvement such as the orbit is extremely rare. We aim to report a case of a 62-year-old male who presented with left painless proptosis for the past three years. Examination revealed a firm, lobulated mass in the left superotemporal orbit, displacing the globe inferomedially. A well-defined extraconal orbital lesion encasing the left lateral rectus muscle with intraconal extension was seen on Magnetic Resonance Imaging (MRI) that led to the provisional diagnosis of left solitary encapsulated venous malformation. Excision of the mass via lateral orbitotomy was performed. However, on histopathology, the features were consistent with a mixed-cell variant of Castleman's disease. A detailed systemic workup was unremarkable. Proptosis resolved after surgery and no recurrence was noted in the three-year follow-up. To the best of our knowledge, this is the first case report of a mixed-cell variant of unicentric orbital CD without any systemic features. This case highlights the importance of including CD in the differential diagnosis of well-defined orbital lesions so as to enable its early detection and timely management.

Role of Text Message Reminder on Oral Hygiene Maintenance of Orthodontic Patients.

INTRODUCTION: Fixed orthodontic treatment is frequently associated with increased plaque accumulation leading to gingivitis and white spot lesions (WSLs). AIM: This study evaluated the role of text message reminder on oral hygiene of orthodontic patients. MATERIALS AND METHODS: A total of 60 patients under fixed orthodontic treatment were randomly divided into two equal groups as control group and study (text message) group. Text message group received reminders about oral hygiene, while the control group did not receive any messages. Oral hygiene of both the groups was evaluated at baseline, 2, and 3 months using plaque indices (PIs) along with WSL status. Data were statistically analyzed using Statistical Package for the Social Sciences (SPSS) statistical software, version 19, with chi-square test and t-test. RESULTS: At the baseline, plaque score was higher in the study group over control group (p > 0.038), whereas it was decreased after 3 months in the test group (p > 0.001). For WSL, there was no significant difference at baseline, but it was significantly lower in study group (p > 0.003). CONCLUSION: Oral hygiene status improved with text message reminder.

Comparative Evaluation of Dimensional Accuracy of Elastomeric Impression Materials when Treated with Autoclave, Microwave, and Chemical Disinfection.

BACKGROUND: Impression materials during impression procedure often get infected with various infectious diseases. Hence, disinfection of impression materials with various disinfectants is advised to protect the dental team. Disinfection can alter the dimensional accuracy of impression materials. The present study was aimed to evaluate the dimensional accuracy of elastomeric impression materials when treated with different disinfectants; autoclave, chemical, and microwave method. MATERIALS AND METHODS: The impression materials used for the study were, dentsply aquasil (addition silicone polyvinylsiloxane syringe and putty), zetaplus (condensation silicone putty and light body), and impregum penta soft (polyether). All impressions were made according to manufacturer's instructions. Dimensional changes were measured before and after different disinfection procedures. RESULT: Dentsply aquasil showed smallest dimensional change (-0.0046%) and impregum penta soft highest linear dimensional changes (-0.026%). All the tested elastomeric impression materials showed some degree of dimensional changes. CONCLUSION: The present study showed that all the disinfection procedures produce minor dimensional changes of impression material. However, it was within American Dental Association specification. Hence, steam autoclaving and microwave method can be used as an alternative method to chemical sterilization as an effective method.

A Comparison of Parental Satisfaction in the Quality of their Child's Orthodontic Treatment by Orthodontists and Pedodontists.

BACKGROUND: The aim was to evaluate satisfaction of the parents of children who have undergone orthodontic treatment provided by their orthodontists and pediatric dentists in their private practice. MATERIALS AND METHODS: A total of 412 parents were interviewed with the help of a questionnaire containing information such as demographic part, experience of braces, motives for orthodontic treatment, complications faced during the procedure and reasoning for satisfaction. Student's t-test was applied to analyze the results. The level of significance was set at P = 0.05. RESULTS: A higher level of satisfaction was seen in parents of children treated by pedodontists (mean score of satisfaction = 0.752) when compared with those treated by orthodontists (mean score of satisfaction = 0.631) which was statistically significant. Parents of girl patients showed a higher mean score of satisfaction (1.021) when compared with those of boy patients (0.321), which was also statistically significant. CONCLUSION: It can be concluded that the pedodontists performed orthodontic treatment to a similar standard as orthodontists, in fact they proved to be better in terms of patient care and behavior management as the parental satisfaction in the quality of orthodontic care was more with pediatric dentists than with orthodontists in this study.

Soft tissue cephalometric norms for central India (malwa) female population.

BACKGROUND: The various soft tissue traits that contribute to an aesthetically pleasing face. This should be considered during orthodontic treatment. The aim of the present study was to propose soft tissue norms for Central Indian (Malwa) female population. MATERIALS AND METHODS: Facial photographs of 78 patients of age group 18-26 years were taken in Department of Orthodontics, Rau, Indore, which were then subjected to a selection process and 30 top scorers (30 females) were selected. Lateral cephalograms of individuals were taken and soft tissue profile as well as related osseous and dental structures standard tracing were made on the acetate matte tracing paper. Then eighteen soft tissue traits were studied as described by Bergman. RESULTS: The present study showed that, a mild convexity of the face and the resulting tendency toward Class II in females is acceptable esthetically. A fuller upper lip is considered balanced and esthetic. Increase in lip incompetency is considered unaesthetic. CONCLUSION: A mild convexity of the face and the resulting tendency toward Class II in females is acceptable esthetically. Individual norms are necessary for a population in order to plan and deliver quality treatment.