The Local Route of Administration of Dexamethasone in Impacted Mandibular Third Molar Surgery: A Systematic Review and Meta-analysis of Randomised Controlled Trials and a Critical Narrative Review on the Claimed Advantages of the Local Route.

Introduction: The proponents of local route of Dexamethasone (DXM) administration for impacted mandibular 3rd molar (MM3) surgeries claim advantages over the traditional systemic routes. This systematic review and meta-analysis were aimed to determine whether the route of perioperative administration of DXM influences the inflammatory outcomes of MM3 surgeries. Methodology: An electronic database search over a 25 year period of randomised trials of DXM in MM3 surgeries was conducted. The mean differences or standardised mean differences were extracted and pooled using the fixed or random-effects model. Results: Of the sixteen selected trials, four were considered for a meta-analysis. There were no statistically significant differences in the inflammatory outcomes between the local and systemic routes of DXM. Conclusion: The claimed advantages of the local route of DXM do not appear to be scientifically valid. Clinical trials supported with DXM plasma measurements are needed to confirm the absence of a systemic effect when DXM is administered locally.

A Stepwise Guide to Freehand Bending of Orbital Floor Mesh.

Orbital fractures can often result in enophthalmos or diplopia. Orbital reconstruction with titanium meshes is the current treatment modality. Adapting the titanium orbital floor mesh is often challenging due to the complex anatomy of the orbital floor. Here, a stepwise free hand bending technique of a titanium orbital floor mesh is described. The bending can be done preoperatively, and mesh fit can be checked against a dry anatomical skull before sterilization. The methodical approach to free hand bending of titanium orbital floor mesh minimizes the intraoperative adjustments and permits quick orbital reconstruction. Trainees and less-experienced surgeons can benefit from the methodical approach to free hand bending of titanium orbital floor mesh.

Retraction of Orbital Soft Tissue During Orbital Surgery: A Technical Note.

INTRODUCTION: Orbital fractures may be either isolated or part of midface fractures. These injuries may cause disruption of the orbital walls and herniation or entrapment of orbital contents resulting in enophthalmos or diplopia. METHODS: Surgical exploration of the orbit is the definitive mode of management of such injuries. A common problem encountered during such exploration is the prolapse of orbital soft tissues which hamper the visualization of the defects. CONCLUSION: Here, we suggest an adjunct to the orbital retractors in control prolapsing soft tissues.

Spontaneous Rupture of a Huge Splenic Artery Aneurysm: A Case Report.

BACKGROUND Splenic artery aneurysm is uncommon in a healthy young male patient. With spontaneous rupture, it can quickly become life-threatening. Our aim is to highlight the possibility of splenic artery aneurysm among healthy young patients and its presentation as recurrent abdominal pain, while pending rupture is possible, which can present a diagnostic challenge. The rare occurrence and spontaneous rupture of a splenic artery aneurysm are often fatal outside an inpatient setting. CASE REPORT Here, we present the case of a 32-year-old patient who visited the Emergency Department with recurrent epigastric pain. While undergoing inpatient evaluation, had a spontaneous rupture of a splenic artery aneurysm with hypovolemic shock and a double-rupture phenomenon, necessitating emergency surgery. CONCLUSIONS With advances in modern imaging in recent years, the incidence of splenic aneurysm has increased 7-fold; therefore, being informed and considering it in the differential diagnosis might provide a window of opportunity and save lives.

Endoscopic-Assisted Intraoral Open Reduction Internal Fixation of Mandibular Subcondylar Fractures: Initial Experiences from a Tertiary-Care Maxillofacial Center in India.

Management of condylar fractures is a highly controversial and debatable area. Open reduction and internal fixation (ORIF) using an extraoral approach has certain benefits over the nonsurgical treatment. Risk of damage to the facial nerve and an extraoral scar remains constant deterrents. An endoscopic-assisted ORIF offers an intraoral approach, thus eliminating consequences such as scarring. Though this technique offers unparalleled advantages, it is associated with a steep learning curve. Surgical results improve only with patience and experience. Patients with condylar fractures reported to SDM Craniofacial Unit, Dharwad, India, from 2013 to 2015 are included. Patients were treated with endoscopic-assisted ORIF and were evaluated for functional outcomes that included occlusion, maximal interincisal opening, and deviation of mouth and complications such as facial nerve pareses, postsurgical infection, and morbidity. Fifteen patients included in the study: 4 left sided and 11 right sided fractures. Nine patients had associated other mandibular fracture. Mean age of the patients was 28.2 years. Mean mouth opening at the end of 1 week, 6 weeks, and 6 months was 32.6, 37.8, and 40.5 mm, respectively. Transient facial nerve pareses were noted in one patient, and an extraoral draining sinus was noted in another. Endoscopic-assisted ORIF has a definite scope in management of condylar fractures. Results are more predictable with appropriate case selection due to a steep learning curve and intraoperative technical challenges. An initial experience in ORIF using extraoral approaches would greatly benefit a surgeon in utilizing this novel and alternate tool.

Modified orthopedic wire twister for fixing and removing screws in craniomaxillofacial osteosynthesis.

Internal fixation is the routinely performed surgical procedure in craniomaxillofacial surgery. At present, available kit for internal fixation includes large number of armamentarium. To overcome and reduce this, we have modified orthopedic wire twister for fixing and removing screws. This single device can replace self-holding screwdrivers with different sizes.

An Unusual Observation During Neck Dissection.

External jugular vein (EJV) is a major superficial vein in the neck which drains deeper parts of face and posterior scalp region. Although it follows a predicted pattern in formation, course and termination in general unusually it also exhibits variations which are clinically important. Gross variations in the incidence of these variations in EJV are noted. We report an anomalous course of EJV which drains into internal jugular vein in our case report. Knowledge about EJV and its origin, course and termination is important for surgeons, interventional radiologist, anaesthesiologist, clinicians in general to avoid inadvertent complication.

Localization and identification of crustacean hyperglycemic hormone producing neurosecretory cells in the eyestalk of blue swimmer crab, Portunus pelagicus.

This study intensely focuses on to the localization and identification of crustacean hyperglycemic hormone (CHH) producing neurosecretory cells in the eyestalk of the blue swimmer crab Portunus pelagicus. Anti-Carcinus maenas-CHH was used to identify the location of CHH neurosecretory cells by immunohistochemistry. Ten pairs of eyestalks were collected from intact adult intermoult female crab and fixed in Bouin's fixative. Eyestalks were serially sectioned and stained with chrome-hematoxylin-phloxine stain. Histological studies show the presence of different types of neurosecretory cells namely A (multipolar), B (tripolar), C (bipolar), D (unipolar), E (oval), and F (spherical) in the medulla interna, externa, and terminalis regions based on their size, shape, and tinctorial properties. The neurohemal organ, sinus gland (SG) was observed laterally between medulla interna and terminalis regions. Immunohistochemical studies showed the presence of distinct CHH-like immunoreactivity in the optic ganglia. Divergent group of neurosecretory cells with varying degree of immunoreactivity with Anti-Carcinus maenas-CHH (low, moderate, and intense reactivity) were identified in medulla terminalis, medulla interna, medulla externa, and sinus gland. The present study maps the various types of neurosecretory cells in the optic ganglia and also shows the presence of CHH-like immunoreactivity in various regions of optic ganglia in P. pelagicus. The presence of these unique neurosecretory cell types with larger cell diameter in medulla terminalis, a region that bears the neurosecretory cell bodies, suggest high secretory activity.

Induced thermal stress on serotonin levels in the blue swimmer crab, Portunus pelagicus.

The temperature of habitat water has a drastic influence on the behavioral, physiological and biochemical mechanisms of crustaceans. Hyperglycemia is a typical response of many aquatic animals to harmful physical and chemical environmental changes. In crustaceans increased circulating crustacean hyperglycemic hormone (CHH) and hyperglycemia are reported to occur following exposure to several environmental stress. The biogenic amine, serotonin has been found to modulate the CHH levels and oxidation of serotonin into its metabolites is catalysed by monoamine oxidase. The blue swimmer crab, Portunus pelagicus is a dominant intertidal species utilized throughout the indo-pacific region and is a particularly important species of Palk bay. It has high nutritional value and delicious taste and hence their requirements of capture and cultivation of this species are constantly increasing. This species experiences varying and increasing temperature levels as it resides in an higher intertidal zone of Thondi coast. The present study examines the effect of thermal stress on the levels of serotonin and crustacean hyperglycemic hormone in the hemolymph of P. pelagicus and analyzes the effect of the monoamine oxidase inhibitor, pargyline on serotonin and CHH level after thermal stress. The results showed increased levels of glucose, CHH and serotonin on exposure to 26 °C in control animals. Pargyline injected crabs showed highly significant increase in the levels of CHH and serotonin on every 2 °C increase or decrease in temperature. A greater CHH level of 268.86±2.87 fmol/ml and a greater serotonin level of 177.69±10.10 ng/ml was observed at 24 °C. This could be due to the effect of in maintaining the level of serotonin in the hemolymph and preventing its oxidation, which in turn induces hyperglycemia by releasing CHH into hemolymph. Thus, the study demonstrates the effect of thermal stress on the hemolymph metabolites studied and the role of pargyline in elevating the levels of serotonin and CHH on thermal stress in the blue swimmer crab, P. pelagicus.