Comparative Evaluation of Sinus Complication and Survival Rates of Quad Zygoma versus Bizygoma in Combination with two Regular Implants in Atrophic Maxilla: A Systematic Review and Meta-Analysis.

Aim: To systematically review existing scientific literature to determine, compare and evaluate the sinus complication and survival rates of quad zygoma against two zygomatic implants with combination of two regular implants in atrophic maxilla in adults. Methods: Review was performed in accordance with preferred reporting items for systematic reviews and meta-analysis guidelines and registered in PROSPERO-CRD42023392721 Electronic databases like PubMed, Google scholar and EBSCO host were searched from 2000 to December 2022 for studies reporting treatment of Atrophic maxilla with either quad zygoma or two zygomatic implants in combination with two regular implants. Quality assessment was evaluated using Cochrane risk of bias-2 tool for randomized controlled trials (RCT). The risk of bias summary graph and risk of bias summary applicability concern was plotted using RevMan software version 5.3. The odds ratio (OR) and standardized mean difference (SMD) were used as summary statistic measure with random effect model and p value < 0.05 as statistically significant. Results: Eleven studies fulfilled the eligibility criteria and were included in qualitative synthesis, of which only nine studies were suitable for meta-analysis. The pooled estimate through the odds ratio 0.59 signifies that the quad zygomatic implants on an average has 0.59 (0.18-1.93) times or odds of developing sinus complications while the SMD signifies that better survival rate (SR) on an average is 0.35 (- 0.61 to 1.30) times more by two zygomatic implants with combination of two regular implants as compared to quad zygomatic implants (p > 0.05). Publication bias through the funnel plot showed asymmetric distribution with systematic heterogeneity. Conclusion: Two zygomatic implants in combination with two regular implants provides better survival rate and less sinus complications compared to quad zygoma in atrophic maxilla. Despite the high SR observed, there is a need to conduct more randomized controlled clinical trials to examine their efficacy in comparison with other techniques.

A Rare Case of Oral Cavity Eumycetoma.

Rationale: Mycetoma is a chronic granulomatous infection that involves the skin and subcutaneous tissue which presents as an abscess with multiple draining sinuses. It is common in the tropical and subtropical regions where the conditions favour the growth of the soil saprophytes - fungi and bacteria. Patient Concerns: We report the rare case of a 62-year-old patient who presented with a soft-tissue overgrowth in the mandibular posterior ridge area for eight months. Diagnosis: The patient was diagnosed with eumycetoma, with foreign-body reaction based on clinical and histopathological examination which revealed characteristic brown-coloured amorphous grains. Treatment: The lesion was surgically excised under local anaesthesia. Outcomes: On the seventh day post-operative follow-up, the patient was relieved of pre-operative symptoms and the surgical site had healed well. Take-Away Lessons: This particular case of eumycetoma had an unusual site and appearance, making the clinical diagnosis confusing with other reactionary lesions of the oral cavity.

Vertical Ridge Augmentation Using Distraction Osteogenesis Versus Autogenous Bone Grafting: A Systematic Review and Meta-Analysis.

Aim: The aim of this systematic review was to systematically assess the papers comparing the surgical techniques of Alveolar Distraction Osteogenesis(ADO) and Autogenous Bone grafting (ABG) for Vertical Ridge Augmentation in terms of bone gain, bone resorption and incidences of complications. Metholodology: The review was registered on PROSPERO with the ID : CRD42021237671. A broad electronic survey was conducted in the PubMed, Scopus, Web of Science, Cochrane Library, and Virtual Health Library databases of all studies published till 08/03/2022. Four studies fulfilled the criteria to carry out a meta-analysis a in which a total of 58 patients underwent ADO and 43 patients for ABG. A total of 133 implants were placed in the ABG group and 124 in the ADO group. Statistical Analysis: DerSimonian-Laird estimator of variance was used for Random effect meta-analysis. The estimates of an intervention were expressed as the odds ratio (OR) and standard mean difference (SMD) in millimeters. Results: There was statistically significant difference in terms of bone height gain with SMD of - 0.78 (95% 0.04-1.55) in ABG. Bone resorption and complications were statistically insignificant with SMD of 0.52 (95% - 1.59 to 0.56) and OR 0.55 (95% 0.18-1.70), respectively.PROSPERO Registration ID: CRD42021237671.

Comparison of the effectiveness of 5-Fluorouracil and modified Carnoy's solution in reducing the recurrence of odontogenic keratocyst.

Introduction: Odontogenic keratocysts (OKC) has a high potential for recurrence. Resection is currently the only fool-proof method to ensure that recurrence does not occur; however, it drastically affects the patient's function and aesthetics. Application of modified Carnoy's solution (MCS) as an adjunct to reduce the recurrence rate is currently in vogue. 5- Flurouracil (5-FU) is an anti-metabolite that has been used in the treatment of basal cell carcinoma and is relatively safer than MCS. The present study aims to compare the effectiveness of 5-UC and MCS in reducing the recurrence rate in OKC.. Material and methods: A total of 42 OKCs were enucleated followed by application of MCS (control group, n = 21) or 5-FU dressing (study group, n = 21) following enucleation. Pain, swelling, temporary and permanent paresthesia paresthesia, bone sequestrum formation, osteomyelitis and recurrence in both groups were evaluated at periodic intervals up to 12 months post-surgery. Results: There was no significant difference in terms of pain, or swelling in both groups. Permanent paresthesia and recurrence rates were higher in patients treated with MC but the difference was not statistically significant. Conclusion: 5-FU is an easy-to-use, feasible, biocompatible and cost-effective alternative for MCS in the management of OKCs. Treatment with 5-FU, therefore, reduces the risk of recurrence and also the post-surgical morbidity associated with other treatment procedures.

Protocols in the management of cleft lip and palate: A systematic review.

AIM: To identify clinical decisions on surgical as well as non-surgical modalities for the treatment of CLP patients based on randomized controlled trials (RCTs). MATERIALS AND METHODS: PubMed, Ebscohost, and Cochrane Library were searched and 20 articles based on RCTs conducted on cleft patient management were identified. RESULTS: The topics explored were infant orthopedics, lip and palate repair, alveolar bone grafting, and management of cleft maxillary hypoplasia. Nasoalveolar molding (NAM) was found to have great benefits when carried out within one month of birth. Fisher and Mohler's lip repair technique and use of recombinant human bone morphogenetic protein-2 (rh-BMP2) for alveolar bone grafting showed promising results. rh-BMP2 for alveolar bone grafting appears to be a promising alternative to autografts. CONCLUSION: Early commencement of NAM in neonatal life is of great benefit to cleft patients. There is a need for more multicentre collaborations, mainly to identify the ideal surgical technique to reduce the variability in treatment and to ensure that the patient receives appropriate evidence-based treatment.

Oral and Maxillofacial Surgeon's Perspective on Gorlin-Goltz Syndrome - A Report of Two Cases.

Rationale: Gorlin-Goltz syndrome (GGS) is an autosomal dominant disorder and is associated with multisystem involvement, multiple cysts, neoplasms and other developmental anomalies. The purpose of the study was to highlight the incidental findings of GGS and to lay emphasis on its early diagnosis. Patient Concerns: Two patients complaining of pain, swelling and at times pus discharge from the oral cavity were reported with a coincidental finding of odontogenic keratocysts and positive family history. Diagnosis: Upon thorough examination, a diagnosis of GGS was made. Treatment: The patients were managed by enucleation and chemical cauterisation using Carnoy's solution and were maintained on follow-up semi-annually. Outcomes: Both patients showed no signs of recurrence post six months follow-up. Lessons: The role of an oral and maxillofacial surgeon is of utmost importance in the early diagnosis of this syndrome to render good quality of life to these patients.