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Assessment of stress and micromotions using finite element analysis along both the intraoral and the extraoral distractors devices used in the mandibular distraction of post temporomandibular joint ankylosis deformed mandible patients. The process of finite element analysis was carried out to assess distraction models. The first model was an extraoral mandibular distraction model and the second model was an intraoral mandibular distraction model. To analyze the stress state, 2 vertical loads were applied on the defective and normal side respectively by a 3D finite element ball model. The intraoral system observed lower stress (4.5 MPa) in the mandibular bone compared to the extra-oral system (11.5 MPa). The results revealed that the intraoral system observed higher stress on the distractor fixing points (392.21 MPa) compared to the extra-oral fixing points (12.62 MPa). The results revealed that the extra-oral system reflected higher displacement on the bone surrounding the screws of about 3720 μm compared to the intraoral system 1414.6 μm. Internal devices give better shielding to the bone and induce fewer stresses over the mandibular, so it is more advisable to be used. The external devices permit greater distraction length because the pins and the distractor main body are subjected to fewer stresses.

Purpose Determination of intra-oral surface areas might contribute to our understanding of the physiology of the oral cavity and oral diseases. In previous studies, the intra-oral surface area was determined using a laborious and technically challenging method. Our aim was to develop an easy and non-invasive method to determine the intra-oral surface areas. Methods In this study, we used cone-beam computed tomography (CBCT) and digital analysis in 20 human cadavers to determine various intra-oral surface areas, based on digital segmentation. Next, we explored whether there was a relationship between various intra-oral surface areas and anthropometric measurements of the head using Pearson correlation coefficient. Results Using CBCT and digital analysis, it was possible to determine various intra-oral surface areas. On average, the total intra-oral surface area was 173 ± 19 cm2. Moderate, statistical significant correlations were observed between (1) the length of the head and the palatal surface area, as well as (2) the depth of the head and the surface area of the tongue. These correlations suggest the feasibility of estimating intra-oral surface areas without relying on CBCT imaging. Conclusions This study presents a technique for measuring the intra-oral surface areas by CBCT imaging in combination with digital analysis. The results of this study suggest that anthropometric measurements of the head might be used to estimate the surface areas of the palate and tongue.

Background: In recent years, the number of procedures for buccal fat pad removal has increased. In cases of thinning of the face, bite injuries or bruxism, partial removal of the corpuscle is performed, always taking into account facial harmonization. Objective: The aim of the present study was to demonstrate the post-operative procedure of the removal of the BFP by pain parameters, mouth opening and presence of edema. This longitudinal cohort study was registered in clinical trials and all participants had access to the informed consent form. Methods: Forty BFP removal surgeries were performed with the technique of intraoral access. After the bichectomy procedure, the individuals were followed for 4, 7, 10, 15, 30, and 90 days. Visual pain scale, mouth opening measurements and clinical visual assessment were performed at all times. Results: We observed that the presence of edema and limited mouth opening for about 15 days were the changes most commonly found in surgeries performed. The results showed a significant decrease in painful symptoms after 15 days, regarding mouth opening, the results showed a return to normal levels after 30 days (p Conclusion: We conclude that the BFP removal, when performed following a precise indication, properly and with the recommendations of post-operative care, followed correctly, promotes limitation in mouth opening and painful symptoms by 15 days. The procedure is becoming a new area for the dental surgeon, who can perform the procedure safely, reliably and with aesthetic and therapeutic results.

Teratoma is a most common extra gonadal germ cell tumour of perinatal or neonatal period, but teratomas of nasopharynx and intra oral are rare in neonates. Naso pharyngeal teratoma is a serious condition leading to the respiratory distress in newborn. In present case one day old female newborn female born to a 22 year healthy female by normal vaginal delivery with uneventful antenatal period with intra oral and nasopharyngeal growth protruding from the oral cavity leading to severe respiratory distress. Baby was managed immediately and MRI of head and neck suggested nasopharyngeal mass lesion with left intratemporal and left intra cranial extension suggesting solid cystic, calcified fat components of teratoma. Baby was resuscitated and growth was excised successfully and cleft palate was repaired and patient was discharged on normal bladder and bowel habits. Histopathological examination specimen suggested intraoral and nasopharyngeal benign teratoma. We present the intraoperative and specimen finding and treatment followed in this case. Surgical excision is the treatment of choice for mature teratoma as the excision is complete the recurrence rate decreases.

A basal cell ameloblastoma is an uncommon benign neoplasm and has a similar histological appearance to basal cell carcinoma of the skin. This clinical case report will discuss an ameloblastoma originating in the maxilla and of the baseloid variant. The objective of report is to highlight the possibility of misdiagnosis from this challenging case. A 34-year-old male was referred to the maxillofacial department with recurrent nasal regurgitation following dental extraction from the left maxilla 1 year previous. Clinically there was an oro-antral fistula visible and initial CT showed cystic lesion in the left maxilla likely to represent an odontogenic cyst. The patient underwent extraction and enucleation, where the diagnosis of the amelobalstoma was established with need of resection. Partial maxillectomy and primary closure with buccal fadpad was performed in the second stage and histological results showed a 6mm completely excised basal cell carcinoma within the oral mucosa and no bony invasion. Due to this extremely unusual results, secondary histological review was requested, and conclusion was a fully excised basal cell ameloblastoma. Following the procedure and subsequent reviews, the patient has no evidence of oro-antral fistula or recurrence of this rare type of neoplasm. A basal cell ameloblastoma variant is a rare lesion and due to its’ similar histological appearance to a basal cell carcinoma, can lead to a misdiagnosis. The aim of the report is to show the unusual presentation and findings along the way to correct diagnosis in this case.

Introduction There are a spectrum of treatment options available for reconstruction of oral mucosal defects including secondary healing, skin grafts, local flaps and microvascular free flaps. We present the use of an alternative intra-oral reconstruction with Integra® Dermal Regeneration Template. Case Report An 85-year-old patient with a severe gag reflex and history of oral cancer presented with biopsy proven severe dysplasia of the right palate extending to the hamular notch. She was treated with wide local excision, extraction of teeth, buccal fat pad advancement for closure of an oral-antral communication and placement of Integra® Dermal Regeneration Template. Discharge was possible the same day as the patient was able to eat and had minimal pain. Discussion Integra® Dermal Regeneration Template is a bilayer wound matrix consisting of silicone in the outer layer with bovine collagen and glycosaminoglycan from shark cartilage in the inner layer. Oral cancer predominantly affects the older population, and this method can reduce surgical time, remove donor site pain, reduce post-operative pain and avoid use of a cover plate where a strong gag reflex was present. The area heals quickly and aids quick restoration of oral function. Conclusion Integra® Dermal Regeneration Template has been used for head and neck defects with good outcomes. It is being increasingly used intra-orally with good outcomes, suggesting a further application of the material with advantages over traditional techniques in specific patient groups.

Aim To evaluate the quality of intra-oral radiographs taken within two hospitals in South Wales, United Kingdom, and assess the impact of radiographer training, with the aim of reducing the percentage of undiagnostic radiographs to 10% or less in accordance with national performance targets. Method Details of intra-oral periapical and occlusal radiographs taken in the two hospitals between the 1st July 2015 and the 30th June 2016 were retrieved. 100 radiographs were randomly selected and assessed. Change was then implemented in the delivery of radiographer training workshops, which involved two hours of both didactic teaching and hands-on skills training. There were 10 workshops and 52 attendees. A second audit cycle was completed, with a further 100 radiographs randomly selected from the 1st December 2018 and 30th April 2019. Results There was a 33.2% reduction of undiagnostic radiographs, bringing the total down to 6.3%, meeting the standards of the audit. Feedback from the workshops were also extremely positive; 50% of radiographers grading the quality of the workshops at 10/10. Conclusions The workshops were successful in improving the quality of intra-oral radiographs, therefore improving the quality of this service. This blueprint can be shared amongst other hospitals, to sustainably improve the overall quality of dental radiography in the hospital setting. Recent updated guidance in 2020 introduced a new two-point scale radiograph grading system: ‘Acceptable’ and, ‘not acceptable’. Radiographs graded as, ‘not acceptable’, should account for no more than 5% of radiographs. Future audit cycles will follow this new grading system and standard.

BACKGROUND: Gillies temporal approach and intra oral supraperiosteal approach are the most commonly used approaches for reduction of isolated zygomatic arch fractures. PURPOSE: To set forth a less invasive technique for reduction and stabilization of isolated zygomatic arch fractures. MATERIALS AND METHODS: A 24-G stainless steel wire is passed through a 16-G cannula needle and is shaped to form a semi-circle. The precontoured needle was then inserted into the inferior part of the depressed zygomatic arch and the tip passed out through the superior part. The wires are then twisted and pulled laterally to reduce the fracture and are tied over an external splint to stabilize the arch. CONCLUSION: The technique discussed in this article is simple, less time consuming, cost effective and less traumatic than the conventionally performed techniques for reduction and stabilization of isolated zygomatic arch fractures.

Objective Intra-oral minor salivary gland tumors are relatively rare. This study aimed to clarify the frequency and distribution of intra-oral minor salivary gland tumors in Japanese patients. Methods We retrospectively analyzed the histopathological records of 131 patients with minor salivary gland tumors that were surgically treated between 1967 and 2017 at a single institution. Results Of the 131 minor salivary gland tumors, 61 (47%) were benign and 70 (53%) were malignant. The male:female ratio was 1:1.8 for benign cases and 1:1 for malignant cases. Most of the tumors occurred in the palate, followed by the floor of the mouth. The most frequent minor salivary gland tumor was pleomorphic adenoma among benign tumors and adenoid cystic carcinoma among malignant tumors. The rarest minor salivary gland tumors were Warthin tumors and basal cell adenocarcinoma, accounting for only 0.8% of all cases. Conclusions The present study determined the incidence rates of these rare tumors.

Amongst various differential diagnoses possible for intra-oral (palatal) mass, possibility of fibro-lipoma is extremely rare but documented in literature, and hence should be a consideration. Such patient requires thorough evaluation and step-wise approach to treat. This case study documents for a 30-year-old male patient presenting with such mass and chief complaints of post nasal drip, nasal obstruction (right side>left side) and intermittent headache for 3 years. After radiological and endoscopic examination, the mass was surgically removed in toto via dual route (trans-oral and endoscopic). Lipomas are uncommon tumors in the oral cavity, and palate being the rarest amongst them as is our case. It would be strongly advocated to keep lipoma in the differential diagnosis when evaluating a palatal mass. Also, it is worth mentioning and recommending that a careful radiological examination of large lesions arising from the palate is a must before approaching for surgery.

The word hemangioma comes from Greek word, ‘hema’ which translates blood, ‘angio’ means vessel, ‘oma’ refers to tumor.(1) The term hemangioma was first given by Sznejder et al in 1973 & was called “Haemorraghic Hemangioma.It was first described by Poncet and Dor in 1897 as Botryomycose humane.(2) Vascular lesions are classified either as hemangiomas or vascular malformations(1). Keywords: Sclerotherapy ;Hemangioma ;Polidocanol ;Vascular malformations.

Evidence from research and literature suggest that Eagle’s syndrome may present with a variety of symptoms creating diagnostic predicament amongst clinicians. We describe a detailed clinical review of symptomatology, diagnosis and management of hundred and one cases of stylalgia. The aim of our study was to asses effectiveness of intraoral styloidectomy as a definitive modality of treatment in stylalgia. A prospective clinical study was conducted in a tertiary referral centre and included 101 patients presenting with symptoms suggestive of stylalgia. The diagnosis of stylalgia was confirmed by history and clinical examination supplemented by orthopentomogram. All patients underwent intra oral styloidectomy following adequate trial of medical treatment. The success rate of intraoral styloidectomy was found to be 80. 19% i.e. 81 out of 101 patients were considered as cured based on pain assessment using visual analogue scale pre and post operatively. Though medical treatment can provide short term relief of symptoms, styloidectomy is the proven definitive modality of treatment for stylalgia.

The buccal fat pad is a special type of fat tissue, which is located anterior to the masseter muscle and deep to the buccinator muscle. It provides gliding motion between muscles, protects the neurovascular bundles from injuries and maintains facial convexity. The use of the buccal fat pad is promoted for the reconstruction of postsurgical intraoral defects in verrucous carcinoma because of its easy to harvest and rich in vascular supply. Here we present a case of 65 years old male with verrucous carcinoma of left buccal mucosa and retro molar trigone came to the Department of Oral & Maxillofacial Surgery, Dhaka Dental College & Hospital, Dhaka, Bangladesh which was successfully managed by surgical excision of lesion and reconstruction with buccal fat pad. Update Dent. Coll. j: 2018; 8 (2): 26-29

Objectives The reconstruction of extended and complex defects of the alveolar bone is a frequent requirement prior to implant placement. The aim of this study was to assess and compare location, intensity, and experience of pain after bone graft harvesting for dental implants with respect to the donor site. Methods In this prospective non-randomized intervention study, a consecutive sample of 23 patients who received autologous bone grafts from intra-oral (IO; N = 8) or extra-oral (EO; N = 15) donor sites prior to insertion of dental implants for fixed dental prostheses were recruited. All patients completed a self-administered questionnaire regarding pain location, intensity, and experience at baseline (B; before surgery), at the first follow-up (F1; 3 days after surgery), and at the second follow-up (F2; 4 weeks after surgery). Relative Risk Ratios (RRR) were determined for pain locations. For pain intensity and pain experience, 95% confidence intervals were evaluated using percentiles of a bootstrap with 1000 replications to assess statistical significance. Results Both patient groups did perceive pain in the mouth/face after the intervention, but patients in the EO donor site group had additional pain at the hip, felt their pain longer and of higher intensity, and had more negative pain experiences than patients with IO donor sites (all p Conclusions While both IO and EO bone graft harvesting are procedures that are associated with pain in a large proportion of patients, an EO donor site is expected to lead to more pain-related burdens than an IO donor site. Clinical significance Prior to bone graft harvesting, surgeons can now provide patients with tailored information regarding pain perceptions to be expected. This will help the patients with making an informed decision, and on whether or not to agree with surgery.

The aim of surgical management of benign facial skin lumps is to remove the lesion in its entirety, with minimal damage to adjacent tissue structures, while maintaining facial aesthetics. A method to achieve these goals is to remove peri-oral lesions in the labial and buccal zones via an intra-oral approach. We report an extended cases series of facial skin lumps that were excised using an intra-oral approach. A retrospective analysis was performed on all patients who underwent excisions of benign cutaneous lesions on the face via an intra-oral approach. Patient demographics, indication for surgery and complications were noted. Forty-seven lesions were excised over a 15-year period. Indications for surgery included benign lesion with minimal skin involvement, risks of keloid/scar hypertrophy and cosmetic factors. Lesions were predominantly epidermoid cysts and lipomas. Mean follow-up was 2.9 years with a 6.4% recurrence rate and 2.1% rate of haematoma and transient facial nerve weakness. There are established techniques to remove facial skin lumps. We believe that in selected cases, an intra-oral approach to such lesions, particularly in cases with high risk of scar pathology or where there is strong patient preference, may be an important tool in the oral and maxillofacial surgeon’s armamentarium.

Platysma myocutaneous flap is a versatile flap that has been used for head and neck reconstruction since more than three decades. It is a versatile flap based on an axial blood supply used for reconstruction of many intra oral defects like cheek mucosae, floor of the mouth etc. We report here a case of Oral submucous fibrosis Grade III treated with a superiorly based Platysma Myocutaneous flap for reconstruction of the post fibrotomy defect. The patient was followed up for a period of one year with excellent functional and aesthetic outcomes.

Maxillary cysts are a common finding in maxillofacial surgery, dentistry and otolaryngology. Treatment is surgical; a traditional approach includes Caldwell-Luc and other intra-oral approaches. In this article, we analyse the outcomes of 9 patients operated on using a combined intra-oral and trans-nasal approach to the aforementioned disease. Although the number of patients is small, the good results of this study suggest that the combined approach might be a reliable treatment option.Approccio combinato trans-nasale endoscopico e intra-orale alle cisti odontogene.Le cisti mascellari sono un’evenienza comune nella pratica clinica degli specialisti del settore Odontoiatrico maxillo-Facciale e Otorinolaringoiatrico. Il trattamento della patologia è esclusivamente chirurgico. Tradizionalmente gli approcci chirurgici descritti per il trattamento di questa patologia sono di tipo intra-orale (ad esempio la chirurgia secondo Caldwell-Luc, mutuata dalla chirurgia per la sinusite). In questo articolo basato sulla revisione retrospettiva di 9 pazienti operati con approccio combinato per cisti del seno mascellare, abbiamo analizzato i risultati di questa procedura. Anche se il numero dei pazienti è esiguo e i risultati sono da validare su un campione più ampio, il risultato di perfetta guarigione, i dati sul tempo di ospedalizzazione e la mancanza di gravi complicazioni suggeriscono che il trattamento sia valido.

In this paper, we present a modified set-up of a 20 ml syringe in the use of intra-oral sinus lavage via oroantral perforations of patients. With the addition of a smallbore Tport extension, clinicians can easily replenish the syringe with saline without repeatedly re-inserting the non-bevelled needle via the oroantral perforation during multiple rounds of sinus lavage This simple method can potentially improve the efficiency and reduce patient's discomfort during intra-oral sinus lavage.

Introduction: Surgery to resect intra-oral malignancy is a well-established mode of primary treatment. The tissue requirement in this area is for a thin, pliable flap with minimal bulk and this has historically been provided by free tissue transfer with a radial forearm free flap (RFFF). More recently, a role for the anterolateral thigh free flap (ALTFF) has been described, although in populations with a westernized diet, body habitus may preclude use of an ALTFF due to flap thickness, relative to a radial forearm free flap. Methods: An analysis of data was performed retrospectively for 90 consecutive patients with intra-oral malignancy, requiring immediate soft tissue reconstruction by the senior author, at Addenbrooke's Hospital between July 2008 and April 2016. Cases requiring bony reconstruction were excluded. Data on patient age, sex, indication for surgery, tumor location and defect type, complications, success rates, and length of stay were recorded. Results: The majority of patients received an ALTFF (n = 56) with 38% receiving a RFFF (n = 34). Surgical resection took place in the floor of the mouth most frequently. These were closed with ALTFF and RFFF in 41 and 28 occasions, respectively. A success rate of 97% was observed in the RFFF group; 1 flap developed partial necrosis and required complete revision. In the ALTFF group, there was a 100% flap success rate. ALTFF usage resulted in a reduction in the number of intraoperative (p = 0.021) in addition a reduction in the number of days in ITU (p = 0.01) and post-operative clinic visits (p = 0.025). Conclusion: We present a series that used predominately the ALTFF to reconstruct intra-oral defects following resection of squamous cell carcinoma in a Western population. The results demonstrate that this treatment can produce at least as comparable results as to the use of a RFFF repair in this population, whilst avoiding the donor site morbidity and aesthetic compromise of a RFFF.

Purpose : The literature and experience of high-dose-rate (HDR) surface mould brachytherapy (SMB) in head and neck cancer is sparse. We report our institutional experience of SMB for such tumours. Material and methods: Thirty-five patients with malignant localized early T1/T2, N0 (21 intra-oral and 14 skin) tumours treated with SMB during 2008-2014 were analyzed. Treatment was delivered using HDR 192Ir source to a median dose of 49 Gy (range, 38.5-52.5 Gy) as radical brachytherapy and 18 Gy (range, 15.5-30 Gy) as boost with 3-4 Gy/fraction twice daily using customized surface mould. Results : Median follow-up was 52 months (range, 6 to 98 months). Local control (LC) for skin tumours and intra-oral malignancies at 5 years were 92% and 76%, respectively. Five-year cause specific survival was 92%. For T1 and T2 tumours, 5 year LC was 94.2% and 68.2%, respectively. T stage (p < 0.04) and dose/fractions (p < 0.003) were the only significant prognostic factors for LC on univariate analysis. Conclusions : Surface mould brachytherapy results in excellent LC rates for skin tumours and T1 intraoral tumours when considered as radical treatment, and preferable to consider it as a boost for T2 intraoral tumours. Surface mould brachytherapy results in excellent organ and function preservation.

The mucoepidermoid carcinoma (MEC) is considered the most common malignant tumor of salivary gland and represents 3 to 5% of all tumors glands. For its aggressive behavior, it must be considered among the diagnostic hypotheses in regions where they can have salivary glands. Early diagnosis and appropriate tumor management are a priority for good survival, quality of life and even cure. This work reports a case of MEC of hard palate in a 12 years child. Early diagnosis, multidisciplinary evaluation and intra oral surgical treatment were key determinants of good outcomes in patients with MEC of minor salivary gland.

Back ground. Oral Cavity Cancers are most common cancers in our country, India. After undergoing wide excision they all require reconstruction. Radial forearm free flap in one of the reliable free vascularised flap. Material and methods. In this study we have retrospectively analyzed results of 38 patients who underwent reconstruction by Radial forearm free flap. Patients underwent primary reconstruction following reconstruction. Results: The Total Number of 38 patients underwent reconstruction in which 8 were females and 30 were males. In 27 patients primary site was buccal mucosa, 6 were lip, tongue were 4 and 1 patient had floor of mouth cancer. Overall success rate was ( 89.4% ). Flap failures were in 4 cases(10.5%). 2 patients required reexploration due to venous thrombosis. one patient had late graft failure. Donor site healed well in all patients except one where partial loss of skin graft was present . Conclusion. Its pliable skin, relatively less hair makes RFFF a reliable flap for reconstruction for intra oral Cancers.

Background There is a limited availability of suitable microvascular free flap options for the reconstruction of small to medium-sized facial and intraoral defects. The purpose of this report is to present a new free temporal artery based posterior auricular skin (TAPAS) flap in facial and intraoral reconstruction. Patients and Methods Four patients were deemed suitable for TAPAS flap reconstruction and consisted of two males and two females with a mean age of 43 years (range 22–66). Defect aetiology and location comprised of post-traumatic lower eyelid scarring, late lower lip scarring post tumour resection, and floor of mouth and tongue defects following tumour resection. The dimensions of the resultant defects ranged from 25 × 50 mm (smallest) to 40 × 70 mm (largest). All patients underwent microvascular reconstruction using a free fasciocutaneous TAPAS flap raised from the retroauricular region based on the superficial temporal vessels. Results The maximal pedicle length was 60 mm and the maximum flap size measured 40 mm by 70 mm. The latter patient required skin grafting of the postauricular donor site. Postoperatively, there was one case of mild transient venous congestion that spontaneously resolved after 2 days and one case of minor partial flap dehiscence that required re-suturing. Follow-up time ranged from 6 to 14 months. Overall, all flaps survived with good aesthetic and functional outcome. Conclusion The TAPAS flap is a small flap with exceptional qualities and may be a useful addition to the armamentarium of free flaps in facial and oral reconstructions. © 2016 Wiley Periodicals, Inc. Microsurgery, 2016.

Summary Background The medial sural artery perforator (MSAP) flap is a fasciocutaneous flap that is gaining popularity for intra-oral reconstructions. The aim of this two-centre review was to evaluate the use of the MSAP flap in intra-oral reconstructions and report our experiences. Methods Data were collected prospectively on 35 consecutive intra-oral reconstructions using the free MSAP flap. Patient details and intraoperative flap details were recorded. Results Thirty-five patients underwent intra-oral reconstruction with a free MSAP flap (26 males and nine females). The average flap dimensions were a length of 8.03 cm, a width of 5.0 cm and a thickness of 7.1 mm. Twenty-two flaps had two perforators, and the average pedicle length was 11.1 cm. There were no flap losses. Ninety-one per cent of donor sites were closed primarily. There were two minor complications related to donor-site wound dehiscence, which required delayed skin grafting. The overall complication rate was 5.7%. Conclusions The MSAP flap is a good choice for intra-oral reconstruction. It has reliable anatomy and provides thin, pliable skin with a long pedicle. In addition, donor morbidity is low as the donor site can be closed directly in most cases. It is currently our flap of choice for small intra-oral soft tissue defects.

Post-operative healing following oral cancer resection and reconstruction can lead to distortion of oral anatomy, interruption of function and extensive scar contraction. We present what is to our knowledge the first reported and successful use of a one stage dermal regeneration template system (Integra®, Integra Life Sciences Corp, Plainsboro, NJ, USA) to assist in the oral rehabilitation of a group of oral cancer patients.

Summary We present the case of unanticipated airway ignition during hard palate biopsy. Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) and monopolar diathermy were utilised for the procedure, during which an arc arose from the diathermy tip to a titanium implant, causing a brief ignition on the monopolar diathermy grip. This case highlights the need for maintained awareness of fire risk when using diathermy in the presence of THRIVE during airway surgery.

We report a case of a 23-year-old woman with xeroderma pigmentosum (XP) and a painless endophytic ulcer on the mouth floor, measuring approximately 2 cm, with 8 months of evolution. She had a family history of a brother with XP who underwent lower lip resection and denied neurologic disturbances or prior surgical procedures. Weak photophobia and numerous hyperpigmented ephelides throughout the body were observed. Histopathologic examination of the incisional biopsy confirmed the diagnosis of squamous cell carcinoma. It is known that intra-oral carcinomas are uncommon in XP individuals and, when present, are located mainly at the tongue tip. The patient was referred to the oncologist and 2 months after surgical resection underwent a single chemotherapy and radiotherapy session. However, she died in less than 72 hours after this procedure. Considering the unexpected outcome of this case, we also investigated possible exacerbated adverse effects of antineoplastic treatments in XP patients.

Pleomorphic adenoma (PA) is the most common salivary glands tumor, mainly involving the parotid gland. The aim of this study was to report a PA series of cases, which were diagnosed intra-orally, and their relation to clinical, epidemiologic data and histopathologic findings. The age ranged from 30 to 60 years, being observed mainly in the female gender. All cases were located on the palate, and only 1 was painful. The most common histopathologic findings were epithelial and myoepithelial cells distributed in several morphologic patterns of mesenchymal differentiation. Epithelial cells formed ducts and cystic structures and had islands or sheets of neoplastic cells. Excisional surgery was the treatment of choice, with excellent prognosis. In conclusion, it is always necessary to perform incisional biopsy in intra-oral PAs, because these lesions occur preferentially on palatal minor salivary glands, which could be a challenge to diagnosis due to their similarity with malignant salivary glands tumors.

Epiglottic entrapment is a condition in racing horses, associated with abnormal respiratory noises and exercise intolerance. Epiglottic entrapment has been linked to both poor and superior athletic performance, leading to concerns regarding whether surgery is indicated, and whether surgical correction may have a deleterious effect on future race performance. The objective of the current study was to assess the race-day performance of horses racing with epiglottic entrapment and the effect of surgical correction on performance outcomes using an intra-oral technique in anaesthetised horses. A case-control study was conducted at the Singapore Turf Club from 2008 to 2011. Controls were selected 1:1 to cases, based on Malaysian Racing Authority number. The performance of horses racing with epiglottic entrapment was recorded and post-surgery race performance was described. Further, post-surgery race performance was compared between cases and with non-case controls. Twenty horses raced with epiglottic entrapment were retrospectively enrolled. There was a significant difference in racing performance in case horses racing with and without epiglottic entrapment (P 0.001). Fourteen horses finished in the top three post-surgery, compared to one horse finishing in the top three when running with epiglottic entrapment present. There was no significant difference between the performance of case horses (n = 33) post-surgery and controls (number of wins P = 0.20; and places P = 0.62). The intra-oral release of epiglottic entrapment is a suitable technique to resolve epiglottic entrapment. This study may assist veterinarians advising clients in the decision-making process when epiglottic entrapment is diagnosed in a racehorse.

Acute temporomandibular joint (TMJ) dislocation is distressing for patients and treatment can often be a challenge for clinicians. This report describes the use of intra oral local anaesthetic (LA) to aid reduction of the joint, reducing the need for conscious sedation, muscle relaxants or general anaesthetic.

Item does not contain fulltext AIM: To assess the feasibility of a new method to augment the three-dimensional virtual skull model with a detailed surface model of the dentition produced by intra-oral scanning, compared to the conventional triple scan procedure. MATERIALS & METHODS: In four patients who were planned for bimaxillary orthognathic surgery, the conventional triple scan procedure was carried out to create an augmented model. During scanning the patient wears a modified wax bite containing radio-opaque markers. An additional CBCT and laser scan of the wax bite and an intra-oral scan of the dentition were acquired. Surface-based and marker-based matching procedures were performed to integrate the intra-oral scans into the CBCT scan of the patient. The accuracy of the proposed method was assessed by measuring the distance between the occlusal surfaces of the registered intra-oral scans and the augmented model. RESULTS: Mean distances between the ios-dental cast registration and the augmented model were 0.30 mm (SD 0.20) and 0.27 mm (SD 0.20) for the upper and lower jaw, respectively. CONCLUSION: Intra-oral scans provide an accurate representation of the dental arches compared to the AlgiNot-dental casts and can be fused with CBCT scans. 01 februari 2016

An array of genetic syndromes has been associated with intra-oral adhesions in neonates. The primary medical issues arise from airway obstruction, feeding difficulties and poor oral development, specifically with cleft palate lateral synechia syndrome (CPLSS). Despite this, a paucity of data exists for the clinical management of intra-oral adhesions in this population. We report the cases of a father and daughter diagnosed with CPLSS who presented with respiratory and feeding difficulties at birth undergoing surgical correction. Early surgical ligation of intra-oral bands allows for a stabilization of the airway, improved feeding and oral development with a good long-term outcome.

Morphea is an inflammatory disorder of the skin and underlying tissues characterized by an overabundance of collagen leading to fibrosis. The prevalence of this disease is estimated at around 0.4-2.7/100,000 people. When the process occurs in the gingival tissues, it induces traction, which can cause gingival recession. A 19-year-old woman was referred to the clinic for a progressive recession on teeth 11 and 12. A pale, atrophic, linear region extending from her nose to her upper lip on the right-hand side of her face was diagnosed as morphea en coup de sabre. Cone beam computed tomography, quantitative polymerase chain reaction and histologic evaluation were used to assess the pathology. Treatment with methotrexate was conducted. After 12 months, no progression of the recession could be observed.

Various methods have been reported in the literature for treating mandibular angle fractures comparing extra oral, intra oral and transbuccal approaches for achieving the goals of restoration of anatomic form, maintenance of segment position and bony union. This study was conducted to assess the simple and effective surgical approach in treating mandibular angle fractures and the outcome by means of three approaches i.e. intra oral, transbuccal and extra oral approaches. A total of 45 patients with mandibular angle fracture were divided into three groups. Group I—intra oral approach—15 patients, Group II—transbuccal with intraoral approach—15 patients, Group III—extra oral approach—15 patients. The results of our study found intraoral approach to be much better because it is simple, precise, duration is short, and post operative complications are less with minimal morbidity and pain.

To describe a novel approach for continuous measurement of intra-oral pH and temperature in individuals carrying out normal daily activities over 24 h. We designed, validated and constructed a custom-made appliance fitted with a pH probe and a thermocouple. Six subjects wore the appliance over a 24-h period for two non-consecutive days, while the intra-oral pH and temperature were measured continuously and recorded. Intra-oral pH and temperature were very similar across different recording days, the difference being not statistically significant (P ≥ 0.14). There was a noticeable difference in the pattern of variation of pH between day and night. During the day, the mean pH was 7.3 (±0.4) and dropped markedly only after consumption of acidic food and drinks. The intra-oral pH decreased slowly during sleep with an average pH of 6.6 (±0.4) being recorded. The difference between day and night was statistically significant (P = 0.002). The mean intra-oral temperature was 33.9 °C (±0.9) during daytime and 35·9 °C (±0·5) during sleep (P = 0.013) with minor fluctuations occurring over 24 h. The continuous and simultaneous intra-oral pH and temperature measurement system described in this report is reliable, easy to construct, able to measure variables over a sustained period and may serve as a future diagnostic tool in a number of applications.

The current century is an era of microsurgical reconstruction. However, there are situations when free tissue reconstruction is not possible due to extremes of age, their associated co morbidities and dearth of microsurgical expertise and equipment. The significance of local and regional flaps in such reconstructive scenario is paramount. These flaps are well vascularised, easy to master, quick to perform and can be used in both primary as well as salvage reconstruction. The Lateral forehead flap (LFF) is one such useful option. The LFF is an axial myocutaneous flap spanning the entire forehead aesthetic subunit. Herein we describe the operative technique of LFF elevation, advantages and disadvantages of the use of this flap in the reconstruction of facial and intra oral defects reconstruction, both in primary and salvage settings. We describe our experience in the use of this handy flap for various facial reconstructions in our institute. This versatile “forgotten” flap which is easy to master can be handy to all general plastic surgeons who indulge in such reconstructions.

The present report describes the case of a patient who underwent maxillary sinusitis right after dental implant installation with sinus lifting. Computed tomography scan revealed a dental implant (#16) was protruded inside the right maxillary sinus and confirmed the obstruction of ostium. A symptom remission was gained with the dual approaches combined by functional endoscopic sinus surgery and an intra-oral approach. Fully recovered function and healing of sinus were identified after 10 months follow-up. We report the case of sinusitis caused by protrusion of implants with sinus floor lift procedures and propose that practitioners should be aware of the possible its complications and management.

Reconstructive requirements of medium to large sized oral mucosal defects following oncological resection include restoration of mucosal continuity with prevention of salivary leak and fistula formation, predictable soft tissue healing, and ensuring optimal oral function and cosmetic restoration. Such defects frequently mandate the use of microvascular free tissue transfer of fasciocutaneous flaps such as the radial forearm or anterolateral thigh flaps, or, for larger defects incorporating significant dead-space, muscle flaps such as rectus abdominis or latissimus dorsi. Commonly described techniques for re-establishing continuity of the epithelial component include using native mucosa, split skin graft, or a myocutaneous flap skin paddle. Few case series reports exist of non-epithelial reconstructive approaches. Here, the authors report a large series of muscle only flaps for oral defect reconstruction following oncologic resection. The current study demonstrates that mucosalised muscle is an effective additional method for intra-oral mucosal defect reconstruction.

The aim of this study is to conceive a method of raising an island PMMC flap, so as to circumvent its drawbacks of bulk, flap length and the difficulty of developing this flap in female patients. And to consider island PMMC flap as a viable reconstructive option in head and neck surgeries, especially in peripheral centres. Ours is an experimental case series. The study was done at Sri Devaraj URS Medical college, Tamaka, Kolar. Between 2009 and 2010, head and neck reconstruction was performed using this method in 20 patients who had oral cancer (18), carcinoma supraglottis (1) and mucoepidermoid carcinoma parotid (1). The patients age ranged from 16 to 75 years, and there were 15 women and 5 men. Nineteen of our patients underwent primary surgery and one patient was operated for residual disease. In (16) patient, island pmmc flap was used for intra oral closure. In (4) patients the flap was spiraled for providing skin cover. Four patients developed complications. Three were minor complications of margin necrosis and wound dehiscence, which were managed conservatively. One patient developed orocutaneous fistula, which required secondary suturing. None of our patients had a total necrosis of the flap. Island PMMC flap is still a very useful and viable option for reconstruction in head and neck surgeries, especially in lateral gingivo buccal tumours and other head and neck tumours. In institutions where microvascular expertise is not available, island PMMC flap can be an alternative with results comparable to that of free tissue transfer.

Aim: To evaluate the response of intraoral soft tissue by low level laser light, histologically and bio-chemically. Materials and methods: The study was performed on (20) healthy rats. A clean two sided mucoperiosteal flap was raised opposite to the area of lower incisors. The rats were divided into two groups, ten for each. Histological specimens were taken at days 5th,9thand 11th postoperative period .The dose of laser therapy in each session was 0.75 J/cm2. Each rat in each group received this dose daily for 11thdays at an interval of 15 minutes. Histopathological analysis were made for both groups detecting number of blood vessels (neovascularization),collagen arrangements and number of fibrob-lasts. Biochemical analysis of C-reactive protein(CRP) was also conducted. Results: Laser therapy showed enhancement of neovasculazation at days 5and 9 postoperatively .While collagen arrangement showed significant changes at the 5th ,9th and 11th postoperative days. Biochemical analysis showed significant increase of CRP at the 5th postoperative day. This increase was followed by a significant decrease at the 7th postoperative day in comparison with the control group. Conclusion: The present results indicated that low level laser therapy at a dose of 0.75 J/cm2 enhanced wound healing .