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The World Oral Maxillofacial Trauma (WORMAT) project was performed to analyze the causes and characteristics of maxillofacial fractures managed in 14 maxillofacial surgery divisions over a 1-year period.The following data were collected: age, sex, cause and mechanism of maxillofacial fracture, alcohol and/or drug abuse at the time of trauma, fracture site, Facial Injury Severity Scale score (FISS), associated injury, day of trauma, timing and type of treatment, and length of hospitalization. Statistical analyses were performed using SPSS software.Between 30 September 2019 and 4 October 2020, 2,387 patients (1,825 males and 562 females [ratio 3.2:1], 47.6% aged 20-39 years [mean age 37.2 years, median 33.0 years]) were hospitalised. The main cause of maxillofacial fracture was road traffic accidents (RTA), which were statistically associated with male adults as like as assault, sport, and work (p0,05). Half of the fractures involved the middle third of the face, statistically associated with fall and assault (p0.05). Trauma in multiple locations was significantly associated with longer hospital stay (p0.05). The mean length of hospitalization was 3.9 days (95% Confidence Interval 3.7-4.2).This prospective, multicenter epidemiological study confirmed that young adult males were the ones most commonly affected by maxillofacial fracture. RTAs and assaults are statistically associated with the adult population, while falls are associated with females and older population.

Benign intraosseous maxillary tumors, although uncommon among the adolescents, represent a major challenge to the maxillofacial surgeons. Treatment ranges from conservative surgery to radical resection and reconstruction. Maxillary defect reconstruction in adolescents is uncommon. it can be achieved by prosthetic obturators, local and regional flaps, and free-tissue transfer.To investigate the clinical and pathological patterns, treatment, and outcome of benign intraosseous maxillary tumors in adolescents.A 10-years prospective study included patients between 12-18 years who presented with benign intraosseous maxillary tumors and surgically treated (conservative surgery or radical resection) with immediate reconstruction. Cases were followed up to assess functional and aesthetic outcomes and detect complications.Study included 38 patients; 63.2% had non-odontogenic tumors and 36.8% had odontogenic tumors. The most common non-odontogenic tumor was central giant cell granuloma (31.6%). The most common odontogenic tumors were adenomatoid odontogenic tumor and ameloblastoma (10.5% each). Treatment included Conservative surgery (55.3%) and radical resection (44.7%). Reconstruction was performed in 17 cases by temporalis muscle flap (9.83%), obturator (2.46%), and free fibula flap (1.64%). All cases gained accepted functional and esthetic results.Non-odontogenic tumors were more common than odontogenic tumors. Central giant cell granulomas and ossifying fibromas were the most common non-odontogenic tumors. Ade-nomatoid odontogenic tumor and ameloblastoma were the most common odontogenic tumors. Maxillary reconstructions with tem-poralis muscle flap and obturator were simple and satisfactory. Microsurgical reconstruction had high success rates. Aesthetic, and functional results were satisfactory when appropriate reconstruction was performed.

Made available in DSpace on 2022-04-29T08:39:32Z (GMT). No. of bitstreams: 0 Previous issue date: 2022-01-01 Background/Aims: Paediatric maxillofacial trauma accounts for 15% of all maxillofacial trauma but remains a leading cause of mortality. The aim of this prospective, multicentric epidemiological study was to analyse the characteristics of maxillofacial fractures in paediatric patients managed in 14 maxillofacial surgery departments on five continents over a 1-year period. Methods: The following data were collected: age (preschool [0–6 years], school age [7–12 years], and adolescent [13–18 years]), cause and mechanism of the maxillofacial fracture, alcohol and/or drug abuse at the time of trauma, fracture site, Facial Injury Severity Scale score, associated injuries, day of the maxillofacial trauma, timing and type of treatment, and length of hospitalization. Statistical analyses were performed using SPSS software. Results: Between 30 September 2019 and 4 October 2020, 322 patients (male:female ratio, 2.3:1) aged 0–18 years (median age, 15 years) were hospitalized with maxillofacial trauma. The most frequent causes of the trauma were road traffic accidents (36%; median age, 15 years), followed by falls (24%; median age, 8 years) and sports (21%; median age, 14 years). Alcohol and/or drug abuse was significantly associated with males (p

The purpose of this prospective multicenter study was to analyze the epidemiology, patterns, and management of maxillofacial fractures due to road traffic accidents (RTAs) worldwide.Between Monday September 30, 2019 and Sunday October 4, 2020,1066 patients with RTAs related fractures were admitted to 14 maxillofacial surgery departments. The following data were analyzed: age, gender, mechanism of injury, alcohol or drug abuse at the time of trauma, maxillofacial fracture site, facial injury severity scale (FISS) score, associated injuries, day and month of trauma, time of treatment, type of treatment and length of hospital stay. Data were analyzed using bivaried and multivaried statistical analysis.Eight hundred seventy patients were male, and 196 were female. The most common mechanism of injury was motorcycle accidents (48%). More than half of the patients had fractures of the middle third of the maxillofacial skeleton. In total, 59% of the study sample underwent open reduction internal fixation. The median facial injury severity scale (3 points) and the medial hospital stay (3 days) were significantly lower in patients with seatbelts and helmet (P 0.001).This first prospective, multicenter epidemiological study shows that motorcycle accidents are the leading cause of RTAs related fractures, mostly in young males. Particularly in Australia and Europe, the incidence of RTAs was significantly lower. Moreover, this study found that the severity of maxillofacial lesions was significantly higher in patients without safety devices, with consequent longer hospital stay demonstrating the efficacy of road safety policies in preventing maxillofacial injury.

Made available in DSpace on 2022-04-29T08:39:32Z (GMT). No. of bitstreams: 0 Previous issue date: 2022-01-01 Background/Aims: The growth of the global elderly population will lead to an increase in traumatic injuries in this group, including those affecting the maxillofacial area, with a heavier load on health systems. The aim of this multicentric prospective study was to understand and evaluate the incidences, causes and patterns of oral and maxillofacial injuries in patients aged over 60 years admitted to 14 maxillofacial surgical departments around the world. Methods: The following data were collected: gender, cause and mechanism of maxillofacial fracture, alcohol and drug abuse at the time of trauma, fracture site, Facial Injury Severity Scale score, associated injury, day of trauma, timing and type of treatment and length of hospitalization. Statistical analyses were performed using non-parametric and association tests, as well as linear regression. Results: Between 30 September 2019 and 4 October 2020, 348 out of 2387 patients (14.6%), 197 men and 151 women (ratio 1.3:1; mean age 72.7 years), were hospitalized. The main causes of the maxillofacial fractures were falls (66.4%), followed by road traffic accidents (21.5%) and assaults (5.2%). Of the 472 maxillofacial fractures, 69.7% were in the middle third of the face, 28% in the lower third and 2.3% in the upper third. Patients with middle third fractures were on average 4.2 years older than patients with lower third fractures (95% CI 1.2–7.2). Statistical analysis showed that women were more involved in fall-related trauma compared with males (p

The aim of this work was to study the response of two wheat cultivars with different drought tolerance to PEG (-0.4 Mpa) and SA (0.5 mM). Data of seed germination and seedling growth indicated that Misr-2 cultivar was more drought tolerant than Gemmeiza-12. Under non- stress conditions, Misr-2 had higher values of pigments, soluble sugars (Glu, Fru and Suc) and activities of antioxidant enzymes (CAT, APOX, GPOX and SOD) but lower values of proline than those of Gemmeiza-12. The cultivar with a higher proline content (Gemmeiza-12) compared to the other cultivar had a higher expression of proline synthesizing gene (P5CS) but lower expression of proline degrading genes (PDH and P5CDH). Under drought conditions, the drought-sensitive (Gemmeiza-12) needed more osmoregulators and antioxidants than drought-tolerant cultivar (Misr-2) to minimize the negative effects of water and associated oxidative stresses. Therefore, soluble sugars, proline content and anti-oxidation enzymes were higher in Gemmeiza-12 than Misr-2. Also, under drought stress, up-regulation of P5CS and down-regulation of PDH and P5CDH in Gemmeiza-12 were higher than Misr-2. While treatment of the stressed plants with SA up-regulated P5CS gene in both cultivars, down-regulation of PDH and P5CDH in Gemmeiza-12 was clearer than Misr-2.

Introduction Orbital hypertelorism (HTO) is a challenging craniofacial problem seen in association with some congenital deformities. The age of HTO correction is a matter of debate. The aim of the work to evaluate the outcome of HTO correction and determine the optimal timing for intervention, striving for the earliest possible intervention with the lowest relapse. Patients and methods A standard craniofacial approach with medial bone resection, 4 walls orbital box osteotomy and orbital medialization were done for all patients. Skeletal and soft tissue procedures were done as indicated. Results there were 10 patients aging 6 to 19 years. Seven were associated with craniofacial clefts, and 3 with craniosynostosis syndromes. HTO was severe in 8 cases and moderate in 2 cases. It was asymmetric in 2 cases. Frontoorbital remodeling was done in 3 cases with craniosynostosis. Failed surgery was reported in 2 cases. A redo surgery was done for one of them with an excellent outcome, while refused by the other. Nine patients had an excellent outcome. The mean level of satisfaction was 93.37%. Three patients had ugly facial scars. No major complications were recorded. Conclusion The time for surgical treatment of HTO is determined by the severity of the associated deformity. If there is an urgent factor indicating intervention, early correction can be performed exceptionally; otherwise, HTO correction should be performed after the age of 6 years.

Type and source of explant as well as the type of cytokinin were important factors for successful moringa micropropagation. Explants obtained from in vitro grown plant materials were better than others obtained from soil growing seedlings. In addition, nodal segments were better than shoot cuttings in terms of number of shoots/ explants, frequency of shoot formation and number of nodes/shoot. While callus formation on the base of nodal segment on BAP containing media were higher than those of KIN, especially under the influence of high concentration as an aspect of vitrification, BAP was better than KIN in moringa multiplication. Low nutrient medium (half strength MS) supplemented with 0.5 mg l-1 IAA was essential for successful root formation. The suitable conditions for moringa micropropagation on full strength MS or SH may exert low stress and low need to raise the expression of SOD and POX. On the other side, stress due to over increase of chemical components of double MS medium or low nutrient content of half strength MS, B5 or WPM expressed the highest number and staining intensity of SOD and POX bands, vice versa was detected in case of CAT.

BACKGROUND: Carotid body tumor (CBT) is a rare paraganglionic hyper-vascular tumor of the carotid body. The standard treatment for CBTs is surgery, but it involves risk. The study is aimed to assess the CBTs and evaluate the outcome of multidisciplinary management. MATERIALS AND METHODS: A retrospective cohort study included patients with CBTs who were managed by surgical excision between May 2006 and April 2018. A multidisciplinary team was established to excise the tumor completely with minimal neurovascular compromise. RESULTS: The study comprised of 32 patients in the age group of 23–65 years. The main presentation was a unilateral painless neck mass. Six cases (18.75%) were Shamblin I, 10 (31.25%) Shamblin II and 16 (50%) Shamblin III. Complete excision was performed for all cases. Ligation of the external carotid artery was done in 15 cases (46.88%) and repair of the internal carotid artery in 6 (18.75%). Postoperative cranial nerve complications occurred in six patients (18.75%): four transient hypoglossal pareses and two hoarseness of voice. Histopathologically, one case (3.125%) was malignant. No recurrence was detected through the follow-up period. CONCLUSION: A multidisciplinary approach is essential for management of CBTs. Early diagnosis and surgical resection minimize morbidity and carry good surgical outcome. TRIAL REGISTRATION NUMBER: ChiCTR1800018722 (Agency: Chinese Clinical Trial Registry).

Background Thyroid nodules are an important health problem in children and adolescents. They possess a higher risk of malignancy in comparison to adults. This fact forms a great dilemma for clinicians. The aim of this study was to evaluate the reliability of shear wave elastography (SWE) as a non-invasive technique in the characterization of thyroid nodules in children and adolescents. Methods This prospective study included 56 patients with thyroid nodules. All the patients underwent clinical assessment, laboratory investigations, ultrasound, and Doppler examination, followed by an SWE assessment. Statistical analysis was performed and the best cut-off value to differentiate benign from malignant nodules was determined using the ROC curve and AUC. Results Seventy-two nodules were detected in the examined patients (ages ranged from 11 to 19 years, with mean age of 14.89 ± 2.3 years). Fifty-eight nodules (80.6%) were benign, and fourteen nodules (19.4%) were malignant (histopathologically proved). Highly suspicious criteria for prediction of malignancy by ultrasound and Doppler were hypoechoic echopattern, internal or internal and peripheral vascularity, microcalcifications, taller-than-wide dimensions, irregular outlines, and absence of halo (p Conclusion Shear wave elastography is a non-invasive technique that can assist in the diagnosis of malignant thyroid nodules among children and adolescents.

Background Sagittal synostosis is the commonest form of nonsyndromic isolated craniosynostosis. Calvarial vault remodeling (CVR) and spring-mediated cranioplasty (SMC) are the commonly used correction techniques. Aim of the work To study and compare clinical and radiographic outcomes of CVR and SMC in the correction of isolated sagittal suture synostosis. Methods A prospective cohort with the patients were divided into group; I (SMC) and II (CVR), each 15 patients. They were observed to evaluate the outcome and detect complications. Results Mean operative time was 59.2 minutes in SMC and 184 minutes in CVR. Mean intraoperative blood loss was 26 mL in SMC and 64.7 mL in CVR. Intraoperative complications in SMC were dural tear in 1 patient and superior sagittal sinus injury in another patient, while in CVR 2 patients with dural tears and a 3rd with superior sagittal sinus injury. Postoperative complications in SMC were exposed spring, gaped wound, and parietal eminence elevation, while in CVR 2 patients needed blood transfusion. The mean hospital stays was 1.4 days in SMC and 4.1 days in CVR. In SMC, the relative increase in cephalic index varied between 5.5% and 8.2%, while for CVR, it varied between 5.1% and 7.9%. Conclusion The SMC and CVR are safe procedures, with good long-term results and significant objective changes toward normalization of the skull morphology in isolated sagittal craniosynostosis. The SMC is less invasive and associated with reduced hospital stays, decreased blood loss, and can be performed at a younger age than CVR with a lower morbidity.

Background: Routine neck exploration for isolated penetrating neck injuries (PNIs) in hemodynamically stable patients increases the frequency of nontherapeutic surgeries, and complications. Current management protocol involves the no zone approach which uses physical examination and computerized tomographic angiography to guide treatment plans. This work aimed to study the effectiveness and reliability of no-zone approach for management of isolated PNIs in hemodynamically stable patients. Methods: cases of isolated PNIs in hemodynamically stable patients were managed using no zone approach. Detected injuries were managed accordingly. Results: This study included 106 patients. 34.9% of patients were managed conservatively while surgery was done at 65.09%. Vascular management was done in 40.57%, laryngotracheal repair in 29.2%, tracheostomy in 17%, pharyngeal repair in 7.55%, esophageal repair in 6.6%, and accessory nerve repair in 2.83%. Complications occurred in 16.04% of cases in the form of vascular complications (7.5%), respiratory complications (5.7%), pharyngoesophageal complications (1.9%), infections (12.3%), and neurological complications (7.5%). The survivors were 91.5% while deaths were 8.5%. Conclusion: The no-zone approach offers the ideal management for isolated PNIs in hemodynamically stable patients. It is advantageous over traditional approaches. Further studies are required to augment the evidence for its use as the gold standard management for such cases. Trial registration: the study was retrospectively registered at research registry with Research Registry UIN researchregistry5385 on February 26, 2020. Keywords: no zone approach, isolated penetrating neck injuries, hemodynamically stable patients, vascular injuries, laryngotracheal injury.

Background: Descending necrotizing mediastinitis [DNM] is a serious complication of odontogenic infections, being associated with a high mortality rate. The diagnosis, classification, and managemen...

Introduction: Thyroglossal duct cyst (TGDC) is a congenital malformation caused by failure of obliteration of the thyroglossal duct. It presents at any age and often requires surgical excision. This study was done to study our cases of TGDC to get some conclusions that may help the management of such cases.Patients and Methods: This is a prospective study done at the Maxillofacial Surgery Unit, General Surgery Department, Sohag University Hospital, Sohag, Egypt in collaboration with Vascular, Neuro and Interventional Radiology Departments, Faculty of Medicine, Al-Baha University, Kingdom of Saudi Arabia. It included patients with the diagnosis of TGDC who were managed between July 2011 and June 2017. Their charts were reviewed for the demographics, clinical presentations, radiological investigations, management, and outcome.Results: The study included 60 patients; 41 (68.3%) men and 19 (26.7%) women. The age of the patients ranged between 2 and 29 years; 45 (75%) patients were under 10 years. The complaint was neck mass in 49 (81.6%) patients, discharging opening in 11 (18.4%) patients. All cases were primary cases. The cyst or fistula opening was located adjacent to the hyoid bone in 51 (85%) patients, infrahyoid in seven (11.7%) patients, and suprahyoid in two (3.3%) patients. Neck ultrasonography in all patients detected the cyst and its location and assured that the thyroid gland was present in its normal location. These patients were treated by the classical Sistrunk procedure. The follow-up period ranged between 3 and 30 weeks. One patient had recurrence and operated on 1 year later.Conclusion: TGDC is the most common cervical congenital anomaly. It can be found in all age groups, with the highest incidence in pediatric males. Although, it is diagnosed clinically in most of the cases, the use of radiological investigations can improve the diagnosis. The knowledge of embryology, meticulous dissection along anatomical planes, and excision of the core of the hyoid bone is essential to decrease recurrence of TGDC.

PURPOSE Thyroid diseases are common yet serious in children that lead to many metabolic and growth disorders; the most common among these are diffuse thyroid diseases (DTD). This study aimed to evaluate the reliability of shear wave elastography (SWE) to differentiate and diagnose DTD from normal thyroid tissue. METHOD This prospective study included normal participants and patients with DTD. The subjects were assessed by clinical evaluation, laboratory investigation, conventional ultrasound, and Doppler examination, followed by SWE assessments. Statistical analysis was performed using the t-test and one-way ANOVA test, as appropriate. Receiver operating characteristic (ROC) curves were used to determine the best cutoff values to differentiate healthy participants from those with DTD and to differentiate between different types of DTD. RESULTS The study included 74 patients with DTD and 20 healthy participants. The mean SWE values were 10.9 ± 1.78, 12.8 ± 2.1, 15.31 ± 2.95, and 17.26 ± 4.2 kPa for the normal participants and for patients with simple goiter, Hashimoto's thyroiditis (HT), or Grave's disease (GD), respectively. Statistically significant differences were noted between the mean SWE of the normal participants and that of patients with DTD, as well as between the mean SWE of patients with different types of DTD (P

Background: Routine neck exploration for isolated penetrating neck injuries (PNIs) in hemodynamically stable patients increases the frequency of unnecessary interventions and complications. Current management protocol involves the no zone approach which uses physical examination and computerized tomographic angiography (CTA) to guide treatment. The aim was to assess the validity of the no-zone approach in the management of isolated PNIs in hemodynamically stable patients.Methods: This retrospective study included patients with isolated PNIs with soft signs who were hemodynamically stable. They were classified into patients with negative CTA findings and were managed conservatively and patients with positive CTA findings suspecting aerodigestive tract injuries (ADTIs) who were submitted to further selective investigations to confirm or rule out these injuries. Detected injuries were managed accordingly.Results: This study included 106 PNIs patients who had soft signs and were hemodynamic stable. 37 cases (34.9%) had negative CTA findings and were managed conservatively. Sixty nine patients (65.1%) had positive CTA findings and were subjected to subsequent selective investigations and revealed 3 patients with negative endoscopic findings who passed without need for any surgical intervention. Therefore, 40 (37.7%) patients were saved from surgery with no missed injuries. Patients with definitive injuries (66 patients) underwent neck exploration and managed accordingly. No missed injuries were recorded in this study. Complications were detected in 6 cases (5.7%) while death was recorded in 2 cases (1.9%).Conclusions: No-zone approach offers a safe management protocol for isolated PNIs in hemodynamically stable patients. It provides no missed injuries, negligible rates of negative exploration and minimal complications and mortality.

INTRODUCTION Postablative palatomaxillary defects (PAPMDs) represent a challenging reconstructive problem. Temporalis muscle flap (TMF) has been widely used for reconstruction of these defects with minimal morbidity and satisfactory outcome. AIM OF THE STUDY To presents the authors' experience in the reconstruction of PAPMDs with TMF and to evaluate the validity of TMF in the reconstruction of such defects. METHODS This prospective study was conducted between July 2011 and July 2016 on selected patients for primary reconstruction of PAPMDs with TMF. Temporalis muscle flaps were assessed during surgery and postoperatively. Patients were followed up to evaluate functional and esthetic outcomes and detect complications. RESULTS This study included 32 patients with mean age 48.3 years. The pathology was squamous cell carcinoma in 15 patients (46.9%). Twenty-one patients (65.6%) had type II maxillectomy. Mean time of flap harvesting was 43 minutes. Zygomatic arch osteotomy was done in 3 patients while Coronoid osteotomy in 4 patients. Postoperatively, flaps were viable in 31 patients (96.9%) with good healing of recipient site. Flap epithelization completed within 28 to 59 days. Follow-up period was 13 to 55 months. Satisfactory functional and esthetic outcomes were reported in most of patients with no recurrence. Transient temporal nerve palsy occurred in 2 patients, limited mouth opening in 5 patients. One patient had Transient diplopia with enopthalmos and hypophthalmos. Flap failure occurred in another patient. CONCLUSIONS Temporalis muscle flap is still a valid reliable and versatile reconstructive tool in palatomaxillary reconstruction after ablative surgery. It has a good cosmetic and functional outcomes and minimal morbidity.

BackgroundSurgical treatment of lymphatic malformations (LMs) in the head and neck is challenging. The aim of this study was to evaluate the outcome of surgical excision of head and neck LMs in children.Patients and methodsThis prospective study included cases of head and neck LMs treated primarily

Introduction the diversity of the causes of trauma produces different patterns of fractures depending on sociodemographics, lifestyle, industry, and outdoor activities. Mandibular fractures (MFs) are the commonest facial fractures. Reconstruction aims to restore the preinjury anatomy and function as much as possible. Aim of the study to evaluate the demographics, etiologies, patterns, treatment modalities and outcomes of management of MFs in southern Egypt. Patients and methods records of 1371 patients with MFs were reviewed to study the incidence, causes, patterns, treatment modalities and outcomes of surgical management. Results the study included 1152 (84.03%) males and 219 (15.97%) females. The second and third decades were the most vulnerable groups. Isolated MFs appeared in 75.49% of patients while in the others either zygoma and/or maxilla were affected. The commonest causes were road traffic accidents (66.89%) and fall from height (15.1%). The body was the commonest involved region (30.98%), followed by parasymphyseal region (24.33%). In 66.16% of patients, the treatment was open reduction and internal fixation while in 22.17%, closed reduction and intermaxillary fixation were used. 20.24% of the cases had 1 or more postoperative complications, mainly temporomandibular joint dysfunction in 64 cases, malocclusion in 58 cases, and paresthesia in 42 cases. Conclusion the MFs are common in the youth. The road traffic accidents are the most common etiology. This can be reduced by simple measures like compulsory seat belts and wearing the helmet. Open reduction and internal fixation is the commonest treatment modality.

INTRODUCTION Fibrous dysplasia (FD) is a non-neoplastic developmental fibro-osseous disease. It represents 2.5% of all bone tumors and 5% to 7% of the benign bone tumors. Orbitocranial region is involved in about 20% of the patients. The main presentations are craniofacial deformity and headache. Loss of vision is the most devastating result of this disease. There is no medical treatment to cure or prevent FD. Radiation therapy is contraindicated. Surgery for the orbitocranial FD is often challenging because of the proximity of neurovascular and ocular structures. Conservative surgical shaving and recontouring is always associated with suboptimal results. Radical excision is potentially curative with no extra morbidity. Orbital hypertelorism, dystopia, or proptosis can be corrected only by radical excision and reconstruction. AIM The aim of the study was to evaluate the outcome of radical excision of the orbitocranial FD and immediate reconstruction using titanium mesh and pericranial flap. PATIENTS AND METHODS This prospective study had been conducted on 22 patients with orbitocranial FD with age range from 17 to 52 years (mean 29.5). Radical excision of the lesions was done for all patients through transcranial approach. Immediate reconstruction was achieved using titanium mesh and pericranial flap. RESULTS Intraoperative dural tears and cerebrospinal fluid leak were reported in 2 patients and repaired with galeal graft. Supraorbital anesthesia occurred in 6 patients. Of these, 2 patients were transient, while the remaining 4 patients were permanent. Wound infection was noticed in 1 patient who improved by medical treatment. Temporary postoperative diplopia occurred in 1 patient and temporary postoperative impaired vision in 1 other patient. In all patients, acceptable or good aesthetic results were observed. No recurrence was detected in our series during the follow-up period that ranged from 24 to 58 months (mean 37.5 months). CONCLUSION Radical excision of orbitocranial FD is potentially curative with no extra morbidity. It can achieve good aesthetic and functional results with no recurrence.

Our study indicates that jojoba is suitable plant for cultivation of the Egyptian marginal soils, in the desert area, where the seeds were germinated and grown in sandy soil of marginal fertility. To study the effect of NaCl and mannitol on seeds germination, jojoba seeds were placed on cotton layer flooded with solution containing different concentrations of them. Salinity stimulated seed germination, especially, when the seeds were subjected to relatively low concentration of NaCl (0.5 – 3 gm/l). Increase the concentration of NaCl over 3 gm/l resulted in inhibition of seed germination as well as radicle growth. Application of 2 or 3 gm/l mannitol in germination medium improved the seed germination, vice versa was detected under progressive increase of mannitol in germination medium. Mannitol as same as NaCl delayed seed germination of jojoba plant. On the other hand, jojoba seeds can be germinated in low frequency under high concentration of mannitol, up to 100 gm/l, when seeds were placed on three cotton layers just wetted by distilled water containing mannitol. Temperature may be the most critical factor during jojoba seed germination, therefore summer was the best season for seed germination; also, 30 oC was the best temperature degree for seed germination and emergence of radical in the shortest time.

INTRODUCTION Frontoethmoidal meningoencephalocele (FMEC) is a rare congenital anomaly characterized by herniation of brain tissue and meninges through a defect in the cranium and associated with facial dysmorphism. Treatment modalities include extra cranial, transcranial, or combined craniofacial approaches. The combined approach is considered the best treatment choice. METHODS Twelve patients with FMEC aging from 6 months to 4 years were treated by single-stage combined craniofacial approach between July 2011 and July 2015. They were followed up for evaluation of outcome and detection of complications. RESULTS Seven patients (58.3%) were males and 5 patients (41.7%) were females. Eight patients (66.7%) were less than 2 years while 4 patients (33.3%) were between 2 and 4 years. The main presentations were external mass, telecanthus and hypertelorbitism, radiologically, frontobasal bone defect and herniated dural sac with brain tissue were detected in all patients. Excision of the mass with dural repair, craniofacial reconstruction, and medial canthopexy were done for all patients. Orbital translocation was done for 8 patients (75%), nasal reconstruction for 7 patients (58.3%), while dacryocystorhinostomy in 3 patients (25%). Venticuloperitoneal shunt was done before correction of FMEC in one patient (8.3%). The follow-up period ranged from 6 to 48 months with mean 29.2 months. The esthetic results were satisfactory in 9 patients (75%). Ugly facial scars were recorded in 3 patients (25%). CONCLUSION Early surgical management for FMEC is advisable to avoid deleterious effects on facial growth. Meticulous perioperative care is important for successful surgery. The authors recommend combined craniofacial approach to achieve good outcome and decrease the incidence of complications.

Banana shoot tips extracted from in vitro grown plant materials were encapsulated in different types of alginate beads. The results obtained after conservation for one month at 4?C indicated that single layered synseeds (where the encapsulated shoot tip was covered by one layer of the artificial endosperm) containing activated charcoal were the best construction in stimulating conversion of synseeds, where they expressed the highest; conversion frequency, number of shoots/synseed, length of shoot and fresh weight/shoot cluster. These parameters decreased when the shoot tips were encapsulated within two layers of endosperm, except the ex vitro conversion. Conversion of banana synseeds was influenced by explant orientation inside the alginate beads, the highest conversion frequency was obtained when the shoot tip was directed upward inside the synthetic endosperm. Synthesis of seed coats around the artificial endosperm improved the conversion frequency, number of shoots/synseed and shoot length.

Shoot regeneration on cotyledon or hypocotyl explants excised from tomato seedlings and obtained from seeds germinated on MS medium without growth regulators was used to establish tomato shoot culture. Tomato regeneration was influenced by the physiological condition of the donor of explants as well as the explants type. Comparison between the morphogenesis type, SDS and native PAGEs indicated that gene expression can be used to differentiate between tomato cultivars and early determination of the differentiation type, where conditions stimulated shoot organogenesis increased the number and/or the staining intensity of peroxidase and indophenol oxidase bands as well as induced the expression of specific polypeptides. Shoot cultures were used to study gene expression under the influence of stress conditions. Increase in isoenzyme activity under the influence of relatively high concentration of NaCl, manniol or cupper CuSO4 as well as high temperature treatment resulted from increase the number of isoenzyme forms and/or increase the staining intensity of some isoenzyme forms. SDS PAGEs indicated that stress conditions caused an induction or inhibition of the synthesis of some polypeptides. Shoot culture established ideal condition to study gene expression under the influence of biotic and abiotic stress factors in tomato.

Purpose During surgery for major maxillofacial fractures, orotracheal intubation can interfere with some surgical procedures and nasal intubation can be contraindicated or impossible. That is why tracheotomy is presented as a solution, although it carries a relatively high incidence of complications. In this study, the use of submandibular tracheal intubation is basically evaluated as an alternative to tracheotomy in such circumstances. Materials and Methods This prospective study was performed in patients undergoing surgery for major maxillofacial fractures in which oral intubation and/or nasal intubation have been unsuitable, impossible, or contraindicated. The technique of submandibular intubation was assessed intraoperatively and in the postoperative period. The outcomes and complications are presented. Results The study included 26 patients aged between 14 and 57 years. All patients had mandibular fractures, with 19 midface fractures (73.1%), 11 nasal bone fractures (42.3%), 10 zygomatic bone fractures (38.5%), 9 naso-orbito-ethmoidal fractures (34.6%), and 9 frontobasilar fractures (34.6%). The procedure time ranged from 5 to 12 minutes (mean, 7 minutes 4.6 seconds). Delayed extubation was performed in 15 cases (57.7%) in which the tube was left in place for a period ranging from 8 to 50 hours (mean, 30 hours 24 minutes). The technique has proved to be straightforward and satisfactory. A postoperative superficial infection occurred in 2 patients, whereas hypertrophic scars occurred in another 2 patients. Conclusions Submandibular endotracheal intubation is straightforward, safe, and quick to carry out. It can be an alternative to tracheotomy as it allows operative techniques and postoperative airway protection without the risks and side effects of tracheotomy.