Massive expansile ossifying fibroma of the mandible with osteomyelitis

An ossifying fibroma is a benign odontogenic tumor of mesenchymal origin that belongs to the spectrum of fibro-osseous lesions afflicting the craniofacial complex. Although benign, it can be potentially aggressive, reaching very large sizes. The authors report a rare case of an aggressive ossifying fibroma in the mandible of a 30-year-old male patient that reached gigantic proportions with superimposed osteomyelitis, mimicking a malignancy. Differentiation of ossifying fibroma from other fibro-osseous lesions and benign and malignant neoplasms is important for the correct management of this lesion. Proper radiological evaluation and interpretation aids for arriving at a definitive diagnosis are required. The paper also highlights the radiological features of this entity.     

Bisphosphonate Related Osteonecrosis of the Jaw: An Update

Objectives

The aim of this paper is to summarize different diagnostic criteria as well as probable aetiopathogenesis of bisphosphonates related osteonecrosis of the jaw.

Materials and Methods

The electronic search of peer-reviewed journals were performed in MEDLINE (PubMed) database in order to find the relevant articles on bisphosphonates related osteonecrosis of the jaw (BP-related ONJ). The search was restricted to English language articles, published from January 2002 to May 2013. On the basis of these articles, probable aetiopathogenesis and different diagnostic criteria of BP-related ONJ were summarized.

Results

BP-related ONJ is related to the development of avascular necrosis or dead jaw bones. In recent literature many given hypotheses show the aetiopathogenesis and diagnosis of BP-related ONJ which are interlinked and have multifactorial nature. Their diagnosis revolves around four main diagnostic criteria that differentiate it from other conditions which can delay bone healing.

Conclusions

Factors like potency of bisphosphonates, biology of jaw bone, antiangiogenic property of bisphosphonates and soft tissue toxicity in combination with present infection, other drugs, pre-existing pathologies, compromised immune response and dentoalveolar trauma may lead to development of BP-related ONJ.     

Total Alloplastic Temporomandibular Joint Reconstruction for Management of TMJ Ankylosis

Introduction

Temporomandibular joint (TMJ) ankylosis involves the fusion of the mandibular condyle to the glenoid fossa, the skull base. The dilemma with regards to treatment planning whether distraction is done before gap arthroplasty or as a simultaneous procedure or after gap arthroplasty is still a controversy. In an attempt to carry out both the procedures simultaneously there is loss of vector control of the distal segment and the risk of pseudoarthrosis at the osteotomy site. This combined problem could be overcome by the use of total alloplastic joint prosthesis which offers a firm posterior stop for the proximal segment and negates aggressive physiotherapy.

Material and methods

The reference literatures were retrieved from Pub Med and Science Direct database. Three case reports of bilateral recurrent TMJ ankylosis successfully treated with custom made total TMJ by the authors are illustrated.

Conclusion

The purpose of this article is to review the world literature on various alloplastic joints available for TMJ reconstruction and to introduce our indigenous total joint prosthesis in the management of recurrent ankylosis.     

Efficacy of Serum Prealbumin and CRP Levels as Monitoring Tools for Patients with Fascial Space Infections of Odontogenic Origin: A Clinicobiochemical Study

Objectives

Study includes 20 patients with diagnosis of fascial space infections of odontogenic origin to assess efficacy of serum prealbumin and CRP levels as monitoring tools for determining severity of infections, nutritional status, hospital stay and efficacy of treatment.

Methods

Blood samples taken on day 0, 4, and 8 for measuring serum levels of markers. Simultaneously clinical parameters like swelling size, pain etc., were also recorded on day 0, 4, and 8 and appropriate treatment given to each patient. Correlation between markers and parameters was found using regression and paired t test.

Results

Statistical analysis found strong correlation between laboratory values of markers and parameters used to measure severity of infection also. Prealbumin and crp are significant markers for hospital stay (p < 0.01). Prealbumin also found to be a sensitive indicator of nutritional status (p < 0.001).

Interpretation and Conclusion

Prospective analysis indicates prealbumin and crp are effective markers for determining severity of infection, treatment efficacy and hospital stay. Prealbumin is also sensitive marker for nutritional status. Duration of antibiotic usage, intensive unit care, use of nutritional supplements becomes more rationale. Markers also make treatment cost effective and help protecting patients from side effects of excess drug usage.     

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.     

Evaluation of Vertical Bone Gain Following Alveolar Distraction Osteogenesis in the Anterior Edentulous Mandible: A Clinical Study

Aim and Objectives

To calculate the gain in bony height and volume of the distracted upper segment using an extraosseous unidirectional device to improve the retention of the future prosthesis.

Materials and Methods

Ten cases with completely or partially edentulous but severely or considerably resorbed anterior mandibles were managed by vertical alveolar distraction osteogenesis. All the patients were evaluated preoperatively, intraoperatively and post-operatively for various parameters clinically and radiographically i.e. on OPG, lateral cephalogram and on CT scan, at different time intervals. In all cases there was increase in vertical bone height.

Results

The study showed mean vertical bone gain (VBG) on OPG as 8.2 mm. The mean VBG on lateral cephalogram was 8.1 mm. The mean VBG on CT scan at right canine was 8.35 mm, at left canine was 8.2 mm and at midline was 8.27 mm.

Conclusion

Alveolar distraction osteogenesis is a predictable method for restoring alveolar ridges prior to implant placement or prosthesis. Distraction osteogenesis is ideally suited for recreating missing tissue in the anterior esthetic zone by increasing vertical bone height as well as good width and soft tissue growth.     

Homeostasis of functional maps in active dendrites emerges in the absence of individual channelostasis

The maintenance of ion channel homeostasis, or channelostasis, is a complex puzzle in neurons with extensive dendritic arborization, encompassing a combinatorial diversity of proteins that encode these channels and their auxiliary subunits, their localization profiles, and associated signaling machinery. Despite this, neurons exhibit amazingly stereotypic, topographically continuous maps of several functional properties along their active dendritic arbor. Here, we asked whether the membrane composition of neurons, at the level of individual ion channels, is constrained by this structural requirement of sustaining several functional maps along the same topograph. We performed global sensitivity analysis on morphologically realistic conductance-based models of hippocampal pyramidal neurons that coexpressed six well-characterized functional maps along their trunk. We generated randomized models by varying 32 underlying parameters and constrained these models with quantitative experimental measurements from the soma and dendrites of hippocampal pyramidal neurons. Analyzing valid models that satisfied experimental constraints on all six functional maps, we found topographically analogous functional maps to emerge from disparate model parameters with weak pairwise correlations between parameters. Finally, we derived a methodology to assess the contribution of individual channel conductances to the various functional measurements, using virtual knockout simulations on the valid model population. We found that the virtual knockout of individual channels resulted in variable, measurement- and location-specific impacts across the population. Our results suggest collective channelostasis as a mechanism behind the robust emergence of analogous functional maps and have significant ramifications for the localization and targeting of ion channels and enzymes that regulate neural coding and homeostasis.Channel homeostasis, or channelostasis, refers to the regulation of the density, kinetics, voltage dependence, binding interactions, and the subcellular localization of individual ion channel types within a given cell [compared to proteostasis (1)]. Hippocampal CA1 pyramidal neurons are endowed with complex dendritic morphology and express numerous voltage-gated ion channels (VGICs), which govern critical neuronal functions across their somatodendritic arbor (2–6). Channelostasis in such neurons is an exceptionally complex puzzle, given the enormous morphological and molecular complexities accompanied by a myriad of subcellular channel localization profiles, resulting in an immense combinatorial diversity in channel expression profiles (4, 7–11). A further conundrum that compounds this complex puzzle is that neurons, despite these underlying complexities, exhibit amazingly regular gradients in several functional properties that manifest as maps along a continuous neuronal topograph (3). The coexistence of all these topographically continuous maps along the same neuronal topograph is mediated by intricately regulated subcellular localization of various VGICs.In this study, we asked whether the topographically connected structure of a complex dendritic arbor, constrained to sustain these continuous functional maps, imposes rules on the individual and collective channelostasis of underlying ion channels. Specifically, the sustenance of the coexistent functional maps has to account for observations that several VGICs govern and modulate any given functional property within a single neuron (12–15) and that there are spatially widespread, distance-dependent influences of ionic conductances across the dendritic arbor (16, 17). Do these requirements impose constraints on the expression profiles and properties of somatodendritic ion channels, if several functional maps were to be coexistent and continuous on the same neuronal topograph? Do spatial and kinetic interactions among channel gradients across the neuronal topograph facilitate or hamper robustness of the several functional maps? Does the connected dendritic structure impose strong pairwise correlations on the expression profiles of different channels that mediate the coexistence of these functional maps? What are the location-dependent contributions of different channels to the several functional maps expressed by hippocampal neurons?We addressed these questions by using the powerful global sensitivity analysis methodology on morphologically realistic neuronal models and dissected six functional maps with reference to 32 passive and active parameters that governed the neuron’s somatodendritic properties. We used detailed quantitative experimental measurements of channel distributions and of physiological properties from the soma and dendrites of CA1 pyramidal neurons to resolve the validity of 20,420 models generated by randomly assigning values for these 32 parameters. We found that disparate model parameters resulted in topographically analogous populations of these valid neuronal models with weak pairwise correlations between parameters, implying collective, and not individual/pairwise channelostasis as a mechanism behind homeostasis in functional maps. Finally, we derived a methodology, within the global sensitivity analysis framework, to assess the relative contribution of the different channel conductances to the various functional measurements, using virtual knockout simulations on the valid model population. Results from our study suggest that neural mechanisms involved in regulating functional homeostasis of topographically continuous maps need not maintain the density and properties of individual channels at fixed values at specific locations.     

Single-stage earlobe reconstruction: a simple method with promising results

Various methods have been described in the literature for earlobe reconstruction in one or many stages. Authors describe here a simple, single-stage technique to reconstruct the loss of the earlobe. The technique is clearly illustrated in a step-by-step manner and produces a natural-looking earlobe without an unpleasant secondary deformity with desirable texture and color match. Level of Evidence: Level IV, therapeutic study.