Premalatha Shetty

Options in orbital floor reconstruction in blowout fractures: a review of ten cases

ObjectiveThe purpose of this case series was to assess the aesthetic and functional outcome of orbital floor reconstruction performed with calvarial bone graft, titanium mesh or prolene mesh.MethodsTen cases of orbital blowout fractures treated at our centre from October 2006 to July 2008 were considered for this study. Clinical examination, patient satisfaction and radiographic investigations were used to assess repaired fractures.ResultsProlene mesh was used in four cases, titanium mesh was used in four cases and calvarial graft used in two cases. Nine patients had significant improvement in their esthetic appearance. Symmetry was restored in all cases. All ten cases had a noticeable improvement in the function. Of total ten cases six had diplopia, three recovered completely during the six months after the surgery. Three cases showed improvement later. All ten cases with enopthalmos recovered completely. Of the nine patients with infraorbital numbness, all recovered completely during the six months following surgery. One patient where the reconstruction was done with calvarial bone graft showed mild discrepancy in the ocular level.ConclusionFor small, linear defects measuring less than 2cm with enopthalmos and restricted ocular movements, prolene mesh (four cases) was used. For larger defects and impure blowout fractures involving the infraorbital rim, calvarial graft (two cases) or titanium mesh (four cases) was used. The outcome of surgery with all three materials was satisfactory. No postoperative complications were seen except for mild hypoglobus in a case reconstructed with calvarial graft. All three materials, calvarial graft, titanium mesh, prolene mesh, have the potential to be useful reconstructive materials in orbital floor blowout fractures.

Lipoma of the Floor of the Mouth: Report of an Unusually Large Lesion

Lipomas are among the most common benign tumors affecting the human body. However, they are relatively uncommon in the oral cavity. Oral lipomas are likely to affect cheek, tongue, lips, gingiva and rarely the floor of the mouth. We report a case of huge lipoma of the floor of the mouth, associated with difficulty in speech and mastication in a 72-year-old male. The tumor was completely excised and sent for histopathological examination, which confirmed the tumor to be a simple classical lipoma.

Oral cancer: Link with early coitus.

Sir, a 22-year-old mother presented to us, complaining of a sore area on the left side of her tongue, present for about two weeks. There was no other relevant medical history nor adverse oral habits. She had initially reported to a physician who suspected a local traumatic ulcer arising from an unerupted lower third molar. She was prescribed a topical steroid and chlorhexidine mouthwash. Reviewing the patient one week later with no signs of healing and progressive trismus and dysphagia, she was referred to us for further management. Extra oral examination revealed a tender, hard, enlarged right jugulodigastric and submandibular lymph nodes. Intraoral examination demonstrated a coated tongue, a tender, indurated erosive endophytic ulcer 2 × 3 cm We, as part of our micro-educational opportunities,2 engage with the community by sending our Year 5 dental students and hygiene/therapy students to a variety of community settings together with qualified dental nurses. These include a homeless shelter for young adults, a drug and alcohol detoxification unit, drug and alcohol recovery services, and the Probation Service (community drop in centres). The students talk with the residents and service users disseminating oral health advice, providing oral health screening and free toothbrushes and toothpaste. Patients requiring treatment are then offered an appointment at the Dental Academy where all treatment is provided by students free of charge through our NHS primary care contract. Although our provision of community service is much less comprehensive than that reported, as it is just one element of what we do at the Dental Academy, it does embed in the students a new dimension to their professional career. Despite reducing budgets, we have continued to provide the services due to their significant positive impact on the patients, as well as broadening the experience of our students. Last, we will point students to this excellent paper to give them greater insight into dental care for the homeless and hard to reach, to enhance their understanding in this important area of dental care provision. D. R. Radford, G. Potts, S. Dampier, L. Davda, Portsmouth

A mass spectrometric study for comparative analysis and evaluation of metabolite recovery from plasma by various solvent systems.

A solvent system that extracts a maximum number of metabolites belonging to diverse chemical classes from complex biofluids, such as plasma, may offer useful inputs to understand the metabolic and physiological state of an individual. The present study compared seven solvent systems for extraction of metabolites from plasma. The extracts were analyzed by mass spectrometry (MS) and MS/MS (MS2) using a quadrupole time-of-flight liquid chromatography/MS system in positive and negative modes of ionization. Metabolites with molecular mass below 400 were identified using Human Metabolome Database MS2 and MS search interfaces. The acetone/isopropanol (2:1) system yielded promising results in positive ionization mode, as the maximum number of MS and MS2 features was detected in the extract. It was found to be superior in extraction of various classes of metabolites, especially organic acids, nucleosides and nucleoside derivatives, and heterocyclic molecules. Glycerophosphocholines in the mass range of 400-700 were found to be efficiently extracted by the methanol/chloroform/water (8:1:1) system. In negative mode as well, the maximum number of MS2 features was detected in methanol/chloroform/water and acetone/isopropanol extracts. The fingerprints of molecular features obtained in the negative and positive modes differed from each other to a significant extent.

Tumour-Associated Tissue Eosinophilia in Oral Squamous Cell Carcinoma- A Boon or a Bane?

INTRODUCTION The infiltration of tumour stroma by eosinophils, Tumour-Associated Tissue Eosinophilia (TATE) is known to modulate the evolution of Oral Squamous Cell Carcinoma (OSCC). Identification of eosinophils in the inflammatory stroma has been proven to be an important factor in prognostication of malignant tumours including cancers of mouth, oesophagus, larynx, pharynx, breast, lung, intestine and genitourinary tract. AIM Our study aimed to assess the role of TATE as a prognosticator in OSCC as visualized by Haematoxylin and Eosin (H&E) and congo red staining. MATERIALS AND METHODS Thirty histologically-proven cases of OSCC were retrieved from the archives of Department of Oral Pathology, Manipal College of Dental Sciences, Mangalore, Manipal University, Karnataka, India. Two serial sections of 4μm thickness were made and subjected to routine staining with H&E and modified congo red staining, where eosinophil granules stained red and nuclei stained blue. In 40x magnification, 10 HPF at invasive tumour front were assessed for counting eosinophils by placing a 49 square grid (measuring 0.0289 sq mm). STATISTICAL ANALYSIS The TATE was compared with the prognosticators using Mann-Whitney U-test. The grades of carcinoma were correlated with TATE using Kruskal-Wallis test followed by Post-hoc Bonferronis correction. Agreement of the number of eosinophils counted in the two staining techniques (H&E and Congo red) in OSCC was achieved using interclass correlation coefficient, and Friedmans test. A value of p< 0.05 was considered statistically significant. RESULTS Our results showed that tissue eosinophil counts were higher in well-differentiated cases of OSCC, cases with lymph node involvement, decreased survival, without margin involvement and in cases that did not recur. H&E stain showed significantly better visualization of eosinophils resulting in higher eosinophil counts than when seen with Congo red (p=0.008). CONCLUSION Thus, TATE can be used as a surrogate marker in prediction of survival and recurrence in OSCC. H&E proved to be a better stain for evaluation of eosinophils.

Facial Atrophy in Oral Submucous Fibrosis: An Association or a Coincidence

The anecdotal clinical presentation of OSMF that includes vesicle formation, burning sensation, intolerance to hot and spicy food, and trismus due to circumoral fibrous bands has been ringing in our ears for decades but the current paper flags novelty by portraying a rare presentation of an advanced stage of OSMF.

Primary Small Cell Undifferentiated (Neuroendocrine) Carcinoma of the Maxillary Sinus

Primary small cell neuroendocrine carcinoma (SNEC) of the paranasal sinuses is an extremely rare and distinctive tumor with aggressive clinical behavior. Moreover, SNECs originating in the head and neck region have been reported to be highly aggressive and to have a poor prognosis. This report describes a patient with a maxillary sinus SNEC who was successfully treated with neoadjuvant chemotherapy and concurrent chemoradiotherapy.

HYDROPHOBIC INTERACTION CHROMATOGRAPHY ON OCTYL SEPHAROSE—AN APPROACH FOR ONE-STEP PLATFORM PURIFICATION OF CYCLODEXTRIN GLUCANOTRANSFERASES

Cyclodextrin glucanotransferase (CGTase) from Bacillus circulans ATCC 21783 was concentrated by ultrafiltration and subsequently purified by hydrophobic interaction chromatography on Octyl Sepharose 4 fast flow. The matrix was able to bind selectively to the enzyme at a very low ammonium sulfate concentration of 0.67 M and enzyme desorption was performed by decreasing gradient of the salt. The overall recovery was 80% with 689-fold purity. CGTases derived from four soil isolates and Toruzyme, the commercial preparation of CGTase, also bound to Octyl Sepharose under similar conditions at 0.67 M and eluted at 0.55–0.5 M of ammonium sulfate. Octyl Sepharose chromatography can thus be used as a platform approach for purification of CGTases from various bacterial sources. Long stretches of sequence predominated by hydrophobic amino acids are reportedly present in the starch binding domains of CGTases. Starch binding experiments indicated the binding of the enzymes to the octyl matrix through these domains.

Neutrophil-to-lymphocyte ratio: A surrogate marker for prognosis of oral squamous cell carcinoma

Context: Recent studies show that enzymatic contents of the neutrophil granules have a remarkable ability to modulate the tumor microenvironment by causing apoptosis of T-lymphocytes which leaves the hosts cell-mediated immunity at stake. The preoperative neutrophil to lymphocyte ratio (NLR) is considered to be an indicator of the immune status of the patients with oral squamous cell carcinoma (OSCC), which will thereby help in predicting the course of the disease. Aims: The aim is to assess the NLR and histopathological prognostic factors pertinent to infiltration of the surrounding structures and correlate them with the clinical prognostic outcomes of OSCC. Settings and Design: This retrospective study involved the retrieval of formalin-fixed, paraffin-embedded, hematoxylin, and eosin-stained sections of 55 cases of OSCC from the departmental archives from 2006 to 2014. Subjects and Methods: Grading of each case was done by Brynes grading system. The preoperative complete blood counts, relevant case history, and clinical data of the patients involved in the study were collected from the institutional medical records. The NLR was calculated by dividing the serum neutrophil count by the serum lymphocyte count. Statistical Analysis Used: The median NLR was compared between the controls and OSCC cases using Wilcoxon-signed rank test, and the Kaplan-Meier survival analysis was carried out to predict the survival and recurrence status of OSCC. Results: Higher NLR was seen in lymph node and margin-involved cases and also in patients who had tumor recurrence. Kaplan-Meier survival analysis showed that the mean survival dropped from 26 to 4.5 months when NLR ≥5 (P = 0.052). Conclusion: Neutrophil-to-lymphocyte ratio can be used as a prognosticator of survival, recurrence, lymph node status, and margin status in OSCC.

Comparison of surgical outcome after impacted third molar surgery using piezotome and a conventional rotary handpiece

Background and Aim: One of the most commonly performed surgical procedures by oral and maxillofacial surgeons all over the world is the removal of impacted teeth. The most critical and important steps in third molar extraction are bone cutting or osteotomy. Many techniques are used for this purpose including chisels and mallet, rotary instruments, and ultrasonic-based bone cutting instruments. Piezotome is newer and innovative device for osteotomy based on piezoelectric vibrations. Piezotome is considered very efficient in performing osteotomy because of its selective cutting; being inert against soft tissues, including nerves and blood vessels. The aim of this study was to compare the surgical outcome of third molar surgery using conventional handpiece and piezotome with all other criteria remaining same for all the individuals. Materials and Methods: All patients reporting to the Department of Oral and Maxillofacial surgery, Manipal College of Dental Sciences, Mangalore, for impacted mandibular third molar removal were screened. A total of 30 patients with same Pederson difficulty index for bilateral impacted third molar were selected for the study. The study involved the use of piezotome on one side (Side A) and rotary technique (Side B) on the other side for osteotomy on the same patient with an interval of 1 month. Therapeutic management was same for both the sides. Operating time was recorded in each surgery. Patients were examined postoperatively on 1st, 3rd, and 7th day and pain, edema, trismus, paresthesia, and dry socket were evaluated and compared on both the sides. Data collected were analyzed statistically. Results: The mean operating time was 48.13 min in piezotome (Side A) and 32.90 min in conventional handpiece (Side B) which was statistically significant (P < 0.001). Furthermore, there was statistically significant difference (P < 0.001) in the level of pain (P < 0.001), number of analgesics taken (P < 0.001), and trismus (P < 0.01) on 1st, 3rd, and 7th days postoperatively. There was no statistically significant difference in edema between the two sides. Paresthesia was present in one patient (3.3%) in Side B, while no paresthesia was present in Side A. No incidence of alveolar osteitis was reported on both the sides. Conclusion: Operating time with piezotome was more than that of conventional handpiece, but the postoperative responses such as pain, trismus, and edema were less in piezotome. Hence, despite being a slower procedure, piezotome can be an effective alternative for osteotomy in impacted third molar surgery. We recommend using piezotome for bone cutting and conventional rotary handpiece for tooth sectioning in order to obtain favorable outcomes as well as decreasing the operating time.