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The aim of the study was to evaluate the effectiveness of buccal fat pad (BFP) in the reconstruction of surgical defects following sequestrectomy in medication-related osteonecrosis of the jaws (MRONJ). A total of ten patients with MRONJ underwent sequestrectomy and reconstruction using BFP. There were 3 males and 7 females. The age range was 20-70 years. Two patients were diagnosed with stage 2, and eight patients were diagnosed with stage 3 disease. Eight defects were present in the maxilla and two in the posterior mandible. Oro-antral communication was present in 8 cases. All patients have undergone sequestrectomy, debridement and reconstruction using BFP under local anaesthesia. Postoperatively, the patients were followed up at 1, 3, 6 and 12 months and evaluated for complete epithelisation of defect, infection, pain and recurrence of the lesion. Complete epithelisation with closure of the defect was achieved in all the cases. None of the patients had residual pain or inflammation at the surgical site. There was no case of postoperative infection. Reconstruction using buccal fat pad is an effective treatment modality to provide symptomatic relief and to prevent further progression of disease in MRONJ patients.

The aim of the study was to evaluate the effectiveness of seagull-shaped nasolabial flap (NLF) along with adjunctive short-term oral pentoxifylline in the surgical reconstruction of oral sub mucous fibrosis (OSMF) following fibrotomy. We retrospectively evaluated 18 patients with grade IV oral sub mucous fibrosis treated by NLF. There were 3 females and 15 males. All patients were classified as stage IV OSMF with a mean preoperative mouth opening of 8.11±3.38mm. Postoperatively, patients were administered 400mg of pentoxifylline (PTX) thrice daily for 3 months. Patients were followed up at one month, six months and one year. Mouth opening, presence or absence of malignant transformation, relapse and complications were recorded at each follow-up. We found statistically significant increase in mouth opening from 8.11±3.3 to 37.67±3.74 in the postoperative period. The complications associated with NLF were very minimal. The PTX was well tolerated by all the patients. There was no incidence of relapse or rebound fibrosis seen in our series. To the best of our knowledge, this is the first time that oral pentoxifylline has been administered along with surgical treatment of oral submucous fibrosis to prevent relapse. The use of oral PTX as an adjunct along with surgical reconstruction in OSMF improves mouth opening, reduces burning sensation and relapse.

Insertion tendinosis of stylomandibular ligament (SML) or Ernest syndrome is a very rare and under reported head and neck pain disorder. The pain originates from the insertion of stylomandibular region and radiates to the temple, lateral side of the neck and temporomandibular joint (TMJ). The diagnosis is confirmed by palpation of SML and local anesthetic block at the insertion of SML. The authors report 4 patients who presented with chronic pain which radiated to the TMJ and temple and did not respond to conservative management. All patients after diagnosed with Local anesthetic block were given methylprednisolone injection at the insertion of SML. Complete remission of pain was seen at 12 months of follow up without any recurrence. Craniofacial surgeons involved in the treatment of various head and neck pain should include this less documented syndrome in their differential diagnosis when treating TMJ disorders.

Purpose To relieve intracranial pressure and save patient inflicted with severe head injury, neurosurgeons restore cranial defects. These defects can be caused because of trauma or diseases (Osteomyelitis of bone) which are treated by cranioplasty, using the preserved bone of patient. In case of non-availability of bone, a cranial implant is generated using a biocompatible synthetic material, but this process is less accurate and time-consuming. Hence, this paper aims to present the use of rapid prototyping technology that allows the development of a more accurate patient-specific template and saves the surgery time. Design/methodology/approach A five-year-old girl patient having cranial defect was taken up for cranioplasty. CT (computed tomography) scans of the patient were used to generate 3D design of the implant suitable to conceal the defect on the left frontal portion using CAD/CAM (computer-aided design/ computer-aided manufacturing) software. The design was used for 3D printing to manufacture a base template, which was finally used to fabricate the actual implant using Simplex® P bone cement material to conceal the defect. Findings Surgery using Simplex® P implant was performed successfully on the patient, giving precise natural curvature to left frontal portion of the patient, decreasing surgery time by about 30 per cent. Originality/value The case demonstrates the development of a convenient, time-saving and aesthetically superior digital procedure to treat cranial defect in the absence of preserved bone flap using CT scan as input. 3D modelling and printing were deployed to produce an accurate template which was used to generate an implant using bone cement biocompatible material.

Facial nerve palsy is an exceedingly debilitating condition, incapacitating functional and aesthetic facets of the face. Orthodromic transfer of temporalis muscle is an easy and predictable technique which offers early animation of oral commissure and lower face. A retrospective chart review of 6 patients of facial palsy treated with orthodromic temporalis tendon transfer for facial reanimation is presented. The technique consisted of intra-oral coronoidectomy followed by attachment of fascia lata grafts from the coronoid to the commissure, the upper and lower lips via small cutaneous incisions. Contraction of the temporalis, pulls the fascia lata extensions thereby reanimating the lower face. 4 male and 2 female patients with an age range of 25 to 49 years were treated. Simultaneous fat grafting (2 patients), depressor labi inferioris muscle resection (2 patients) and wedge excision of nasolabial fold (2 patients) was done as ancillary procedures. Post-operative smile evaluation was carried out using the Terzis and Noah facial grading system. Patients were asked to smile with and without biting, and photographs and video were taken. The results were graded from 1 to 5 based on a 5-point scale (ie, poor, fair, moderate, good, and excellent) by an independent observer. The results were excellent in 1 patient (Terzis grading 5/5) and good in the remaining 5 patients (Terzis grading 4/5). Excursion of the oral commissure ranged from 6 to 10 mm. Our experience indicates that temporalis tendon transfer for facial reanimation has a short learning curve and provides early predictable outcome without significant complications. This single-stage, day-care procedure can be easily incorporated by maxillofacial surgeons to expand their surgical spectrum.

Improvised explosive device blast injuries frequently report at our center and showed the maximum amount of contamination and damage, both in the facial soft tissues and the skeletal tissues with impregnation of splinters with size ranging from 2 mm to 10 mm. Should splinters be always explored is questionable and varies with every case. The reconstruction in such cases was done with titanium mini-plates along with extensive use of local vascular flaps for soft tissue repair in majority of the cases. Soldier who sustained splinter injuries wrt orbital floor were managed with splinter exploration using C-arm and orbital floor reconstruction using titanium mesh.

Pterygoid hamular bursitis is a rare craniofacial pain syndrome used to describe palatal and pharyngeal pain due to an enlarged pterygoid hamulus. The pterygoid hamulus is a hook-shaped bony process located bilaterally on each medial pterygoid plate of the sphenoid bone, posterior and medial to each maxillary tuberosity. These processes project downward and anterolaterally; serve as attachment for ligaments and a network of muscles. It can be palpated in patients with a finger palpating the posteromedial to maxillary tuberosity. The pathogenesis is elusive and varies from bursitis of tensor veli palatine, elongated pterygoid hamulus, persistent trauma to the mucosa overlying the pterygoid hamulus. The clinical features include strange chronic sensation, burning, swelling, and erythema of the pterygoid hamulus region. The pain often radiates to pharynx, ipsilateral face and sometimes radiating to temporal region making it difficult to diagnose from headache, temporomandibular disorders, and dental infections like pericoronitis. The anatomical neighboring structures in relation to oropharyngeal region may give a misleading diagnosis to dentist in case of pterygoid hamulus bursitis. The understanding of pterygoid hamulus anatomy and its relation to surrounding structures is necessary to get the correct diagnosis of the inflammatory or traumatic pain in oropharyngeal region.

The aim of the study was to evaluate the effectiveness of sublingual gland flap in the reconstruction of surgical defect following sequestrectomy in medication induced osteonecrosis of jaws (MRONJ), osteomyelitis (OML), and osteoradionecrosis (ORN) of mandible. A total of 6 patients with MRONJ (n = 4) osteomyelitis (n = 1) and ORN (n = 1) underwent sequestrectomy and reconstruction with sublingual gland flap. There were 03 males and 03 females. The age range was 45-71-70 years. All defects were present in the posterior mandible. All patients' undergone sequestrectomy, debridement, and reconstruction with sublingual gland flap under local anesthesia. Postoperatively patients were followed up at 1, 3, and 6 months. Patients were monitored for complete epithelization of defect, infection, pain, and recurrence of the lesion. Complete epithelization with closure of the defect was achieved in all cases. None of the patients had residual pain or inflammation at the surgical site. None of our patients experienced any donor site morbidities. There was no case of postoperative infection. Reconstruction of intraoral defects using sublingual gland flap is an effective treatment modality to reconstruct small to medium sized defect of oral cavity.

We report a case of a two day old female child with congenital facial palsy, bilateral microtia, congenital heart disease, renal ectopia and unilateral hypoplasia of depressor anguli oris muscle. These constellation of symptoms have not been found together in any case before. This unknown syndrome could be considered to be in a gray zone between Caylers Cardiofacial syndrome and Pearls syndrome.

Context: Maxillary posterior region is a problem area for the placement of implants. The advanced resorption of alveolar bone is combined with an increase in pneumatization of maxillary sinus because of higher intra-antral pressure, giving rise to severely atrophied alveolar ridges with reduced bone height. Materials and Methods: A total of 26 implants were placed in 21 patients using indirect sinus lift with simultaneous implant placement without using bone grafts. Intra-oral periapical radiographs were taken to determine residual bone height, endosinus bone (ESB), and crestal bone level. Results: All the implants were clinically and radiographically stable at the end of 6 months follow-up. All the implants showed ESB gain, with mean being 1.97 mm and 1.99 mm on mesial and distal sides, respectively. Conclusion: The findings of this study indicate that successful osseointegration is predictable using osteotome sinus floor elevation without bone graft. Spontaneous new bone formation seemed to be expected with implants placed using indirect sinus lift.

not availableBangladesh J Child Health 2016; VOL 40 (3) :183-185

Thalassemia is the most common inherited hemoglobin disorder around the world. It is usually associated with normal serum lipid profile. However, there are a few reports in literature that hypertriglyceridemia has an association with beta-thalassemia major. We report a case of hypertriglyceridemia associated with beta-thalassemia major, in a 9-month-old female baby.

Patients with skull and/or facial injuries resulting in bone damage require artificial models in order to replace the originally damaged bone portion. Traditionally, surgeons use the inaccurate method of estimating the size and shape of the bone to be replaced. The task of manual reconstruction is highly subjective in nature and may involve human errors and hence the same task when performed with the use of software provides highly accurate results. Eventually, there has been a transition from manual methods to CAD/CAM software and 3D printing technique to fabricate these models. These 3D printed models would provide assistance to surgeons performing aforementioned surgeries. The motive of this study is to: (a) propose a suitable methodology to fabricate the damaged portion of the craniofacial bone and (b) guide complex craniofacial surgery and implantology procedures.

Orthodontic treatment is a critical issue. The application of dental braces is both painful as well as displeasing to the eye. Hence, there has been a transition from the usage of dental braces to clear dental aligners. There are multiple software available in the market which provides a platform for manipulation of teeth and development of dental aligners. The demand for orthodontic treatment has resulted in the rapid evolution of software for proper treatment plans. The motive of this study is to (a) compare two different CAD/CAM software: Maestro 3D Ortho Studio and 3-Shape Ortho Analyzer® and (b) examine their methodology and respective approaches in the generation of clear dental aligners. The manipulation done using Maestro 3D is a cumbersome task as each stage needs to be manually generated whereas in 3-Shape Ortho Analyzer, only the final stage is generated manually and intermediate stages are automatically generated with appropriate manipulations in each stage. In case of 3-Shape Ortho Analyzer®, the aligners are fabricated using thermoforming while in Maestro 3D Ortho Studio, they are directly printed using the 3D printer with no involvement of making a 3D model of maxilla and mandible.

Purpose: The recent advent of osseointegration has led to a major transformation in implantology and increased demand for methods for accurate placement of dental implants. Guided surgery using CAD/CAM (Computer-Aided Design/Computer-Aided Manufacturing) software is the most accurate way to accomplish this. Materials and methods: In this study, one edentulous test case was taken whose dentition was scanned using high-quality desktop scanner for Gypsum dental models. The STL (Standard Triangulation Language) file was generated and passed into 3 Shape Implant Studio® software where implant was planned and surgical guide model generated. The generated STL file was then printed by FDM (Fused Deposition Modelling) printer using different types of materials such as PLA (Polylactic Acid), ABS (Acrylonitrile Butadiene Styrene), PETG (Polyethylene Terephthalate with a Glycol) and Nylon. Results: The internal and external diameter and depth of all models were calculated and compared with STL file. Variation of each parameter from original was evaluated. PLA showed a deviation of −0.88, 0.83 and −1.37% for internal, external diameter and depth, respectively. For ABS, the values were 4.2, −2.28, −1.53%. Nylon showed greater deviations from original file with a variation of −10.8, 0.73 and −5.51% for the parameters. The values for PETG were 5.09, 1.76 and −0.92% respectively. Conclusion: It was concluded that PLA is the most accurate material for printing surgical guides using FDM printer, closely followed by ABS and PETG. Nylon is the least suited.

Introduction: The current Indian neonatal mortality rate is 28 per 1000 live births. Whilst the leading cause of mortality is prematurity and its complications, the second is neonatal sepsis. Objectives: To describe spectrum of isolates in neonatal sepsis together with their antibiotic sensitivity pattern and significance of routine blood investigations for diagnosis of early onset septicaemia. Method: A cross-sectional study was performed in 100 neonates with risk factors for septicaemia after obtaining informed consent. Routine blood investigations such as complete blood count and C-reactive protein (CRP) were done on the first day of life. Specificity, sensitivity, positive predictive value and negative predictive value of total leucocyte count, absolute neutrophil count and CRP were calculated. Blood culture was done using Bactec Peds Plus/F culture as a gold standard to diagnose septicaemia. The study was approved by the Institutional Ethics Committee. Results: Out of 100 neonates with suspected sepsis, 40 were found to have culture proven sepsis. CRP had the highest sensitivity (45%) and negative predictive value (71%), leucopenia had the highest positive predictive value (72%) and neutropenia had the highest specificity (91.7%). The common bacteria for early onset sepsis (EOS) were Klebsiella, Pseudomonas and methicillin resistant Staphylococcus Aureus (MRSA) contributing 17% each to the bacteriological profile. All the gram negative bacteria in our study were sensitive to gentamicin and gram positive bacteria were sensitive to nitrofurantoin, tigecycline, tetracycline, vancomycin, teicoplanin, and linezolid. Conclusions: This study showed that leucopenia, neutropenia and CRP are good indicators of sepsis, when used in combination. A negative CRP can exclude sepsis as it has the highest negative predictive value. This study also showed that gram negative bacilli (Klebsiella and Pseudomonas) were the common organisms associated with early onset neonatal sepsis.

Background: Neonatal sepsis is one of the main causes of mortality and morbidity, especially in very low birth weight neonates (birth weight 24 hours (67%) and bleeding/petechia/pupura (72%) respectively. The major cause of mortality was pulmonary hemorrhage.Conclusions: Gram negative organism were more common and associated with higher mortality. Blood culture positivity increases with increase in number of risk factors in neonatal septicemia. A detailed history and thorough clinical examination is vital for early recognition of sepsis.

Quantitative non-experimental, cross sectional survey design was used to assess the level of knowledge on use of Body mechanics and Safety measures among 100 ward attendants working in selected hospital. Samples were selected from 29 wards through simple random sampling technique. The data was collected through knowledge questionnaire after validating the tool from various experts in the field. The results showed that out of total number of subjects 53% participants were between the age group of 21-30years. Majority 79% of the study participants were male and about 45% participants were having bachelor education. Most of 74% participants were experience between 4months-7years. Majority 79% of the study participants were no back pain and rest of the 21% were suffering from back pain due to heavy lifting 62% with thin body built 77%. The 70% study participants had an average level of knowledge.