Purpose: This study was conducted to find the epidemiological characteristics of maxillofacial trauma in the Western region of Nepal. Materials and Methods: All the trauma patients attending the Department of Oral and Maxillofacial surgery in 4 years period at a tertiary center in Western Nepal were included in the study. The incidence, prevalence, age and sex distribution, etiologies and types as well as seasonal and daily variation of maxillofacial trauma were studied. Results: Maxillofacial trauma with male (71.55%) predominance was seen. Road traffic accidents (RTA, 46.5%) were the most common cause, and 41.65% of fracture cases due to RTA were under the influence of alcohol. Accidents were more common on the rural roads (38.9%), and majorities (43.3%) were due to motorcycle accidents. They were more common on Friday (36.7%) and in winter seasons (51.2%). The mandible fractures (65.85%) were more common than midface fractures (53.58%) and 19.44% of the fractures were combined fractures. Parasymphysis in mandible (32.16%) and zygoma (39.09%) in midface were the most common type of fracture. Conclusion: The increased incidence of maxillofacial trauma following RTA under the influence of alcohol noted in this study reveals the need for formulating preventive measures in the Western region of Nepal. Need to aware people to avoid drink and drive proper traffic management, prevention of carrying excessive passengers, especially on the rooftop of vehicles on the highway and disposal of out of date vehicles and timely maintenance of faulty roads is a must.

Objective: The aim was to evaluate the sealing ability of mineral tri-oxide aggregate (MTA) with intact, removed, and modified smear layer. 5.2% sodium hypochlorite was used for irrigation to keep smear layer intact, 17% ethylenediamine tetraacetic acid (EDTA) followed by 5.2% sodium hypochlorite was used to remove the smear layer and 30% potassium oxalate was used for its modification. Materials and Methods: A total of 112 intact single canaled mandibular premolar teeth were selected for the study. Roots were separated from the crown portion. All 112 roots were then randomly placed into one of five groups: Three experimental groups of 28 roots each, one group of 14 roots (negative control), and one group of 14 roots (positive control). All specimens were immersed in 1% methylene blue dye for 72 h and viewed microscopically. The results obtained were subjected to statistical analysis using one-way ANOVA test and unpaired Student's t-test. Results: When group 1a was compared with 2a and 3a, there was a statistically significant difference (P < 0.05) between 1a and 2a and the difference was statistically insignificant (P > 0.05) when 1a and 3a were compared. When groups 1, 2, 3, 4 and 5 were compared irrespective of the subgroups, the results were statistically significant (P < 0.05) between 1 and 2, 1 and 4, 1 and 5, 2 and 3, 2 and 4, 2 and 5, 3 and 4, 3 and 5, and 4 and 5. Conclusion: About 5.2% sodium hypochlorite and MTA produced less leakage than 17% EDTA, followed by 5.2% sodium hypochlorite but more than 30% potassium oxalate.

Aims and Objectives: The aim was to evaluate the feasibility of pectoralis major myocutaneous (PMMC) flap in reconstruction of defects in the head and neck region. The study also outlines types of other tissue required, the donor site morbidity and the technical details of the operative procedure. Materials and Methods: This was a retrospective study undertaken on patient of soft tissue defect of head and neck region either traumatic or after resection of the tumor admitted to author's center. A total of 62 patients was included, among them, 59 patients were of malignancy and 3 patients were of traumatic injury to face. All the patients of malignancy underwent wide local excision of the tumor with modified radical neck dissection type III. After resection, the resultant defect was covered with pectoralis major myocutaneus flap (PMMF) with or without deltopectoral (DP) flap or forehead flap (PMMF or PMMF + DP/forehead flap). The operating time was noted from elevation of the flap to completion of flap insetting. Results: All the flaps survived uneventfully except 4, out of this 1 developed total flap necrosis, 1 partial flap necrosis and 2 experienced epidermolysis. Orocutaneous fistula was noted in 3 patients in initial days and after removal of the intraoral suture the fistula spontaneously resolved in all cases. Conclusion: It was concluded that PMMC is the highly versatile and reliable flap with an excellent vascularity, wide arc of rotation, large flap dimension, easy to harvest, economical and with minimal complications.

Aim: Oral submucous fibrosis (OSMF) is a high risk premalignant condition predominantly seen in the Indian subcontinent. The aim of the present study was to evaluate the efficacy of newer drug pentoxifylline in the management of OSMF. Materials and Methods: A total of 106 subjects with clinic-pathologically diagnosed OSMF were included in the study and divided equally in two groups, Group A (pentoxifylline group) and Group B (placebo group). Group A was administered 400 mg pentoxifylline twice daily and Group B was given multivitamins for 3 months. Evaluation for different clinical parameters was done at regular intervals and data were analyzed using the Chi-square test. P < 0.05 was considered to be statistically significant. Results: The patients in Group A showed significant improvement (P < 0.05) in all the parameters measured, mouth opening, tongue protrusion, pain associated with the condition, burning sensation and difficulty in speech and swallowing. However, few patients from Group A complained of bloating, nausea, anxiety and dyspepsia. Conclusion: Pentoxifylline can bring about significant clinical improvements in the symptoms like mouth opening and tongue protrusion, thereby improving the quality of life of the affected individuals.

Background: PIK3 and K-ras are signal transducing proteins involved and mediating many responses related to cell cycle growth regulation. Until date, there has been only limited evidence about the expression of K-ras and PKI3CB in oral squamous cell carcinoma (OSCC). AIMS : This study aimed to examine both proteins in OSCC and their relation to clinic- pathological findings. Setting and Design: A total of 31 formalin-fixed paraffin-embedded specimens of OSCC were selected in this study. PIK3CB and K-ras expressions were detected using standard immunohistochemical techniques. Materials and Methods: PIK3CB and k-ras immune reactivity was semi-quantitatively evaluated in at least five representative fields at 400X magnification and recorded as percentage of PIK3CB and k-ras positive tumor cells over the total number of cells examined in the same area. Results and Conclusion: All examined specimens of OSCC were positive for monoclonal antibodies directed against PIK3CB and K-ras proteins especially at advanced stage of the disease. No significant relation was observed between the tested proteins and the clinic-pathological findings of OSCC; however a highly significant direct relationship was observed between K-ras and PIK3CB. This lead to conclusion that both K-ras and PIK3CB signaling pathway were activated in the advanced stage of OSCC, and possibly a cross-talk between them. This could make these mutant proteins a potential target for an effective molecular therapy.

Background: Pemphigus is an autoimmune blistering disease with three subtypes, which includes pemphigus vulgaris (PV), pemphigus foliaceus (PF) and paraneoplastic pemphigus (PP), which are characterized by circulating autoantibodies to the desmosomal glycoproteins desmoglein 3 (Dsg 3) and Dsg 1. Detection and quantification of these antibodies can be useful in diagnosis of PV. Aims: The purpose of this study was to evaluate the practical application of ELISAs for diagnosis of PV based on immunological reactivity of Dsg 1 and Dsg3. Materials and Methods: Based on clinical presentation and histopathologic confirmation, 10 patients previously diagnosed of PV were included in the study, out of which, five were with active lesions and five were under medication and hence were at remission stages. Sera of the patients were tested for Dsg 1 and Dsg 3 titres by Desmoglien enzyme-linked immunosorbent assay (ELISA) test. Results: Desmoglien ELISA was positive in all the patients, with higher values of Dsg antibody titers in patients with active disease. Dsg 3 titers exceeded the cut off value in patients with oral lesions and titers of both Dsg 1 and Dsg 3 were greater than cut value in patients with mucocutaneous involvement. Conclusion: Thus, the Dsg 1 and Dsg 3 provided objective and quantitative data which allowed differentiation of PV, and in view of these advantages; they are likely to become a routine technique in diagnostic laboratories.

Background and Objectives: Oral Submucous Fibrosis (OSF) is a potentially malignant oral disorder causing fibrosis of the oral mucosa. Commonly associated with the habit of chewing areca nut in its raw or refined forms, the progressive fibrosis causes intense debility and probable malignant transformation. Arecoline, flavinoids and tannins in the areca nut may activate pro-fibrotic cytokines like transforming growth factor beta (TGF-β) leading to fibrosis. TGF-β and its isoforms probably represent the major pathway in the deposition of collagen fibers in this condition. Very little is known of the role of TGF-β2, as compared withTGF-β1, in OSF. The present study aims to evaluate TGF-β2 immunohistochemically in OSF with a view to understanding its role in the pathogenesis. Materials and Methods: TGF-β2 antibody was detected immunohistochemically on archival paraffin sections of 70 cases of various grades of OSF, 10 cases of normal oral mucosa and five cases of scar tissue. The presence and distribution of the antibody was noted and a quantification of the positive areas was also done using image analyses software and correlated in proportion to the rest of the tissue. Results: Expression of TGF-β2 was more in all grades of OSF when compared with that of normal oral mucosa but less than that expressed in scar tissue. The antibody was detected in epithelium, around the blood vessels, in areas of inflammatory infiltrate, fibroblasts and in muscles. The intensity and proportion of expression paralleled increasing grades of OSF. There was increased expression of the antibody in the epithelium, which is probably the source, but no correlation to epithelial changes (hyperplasia, atrophy or dysplasia) was noted. Conclusion: TGF-β2 is a prominent cytokine in the TGF-β induced pathway of fibrosis but probably plays a contributory role to the main isoform TGF-β1. Its role as a marker of malignant transformation, as seen in other systemic malignant lesions, remains inconclusive in OSF.

Finger and partial finger amputations are some of the most frequently encountered forms of partial hand loss. A high quality esthetic prosthesis with passive function can be helpful to the patient since loss or congenital absence or malformation have both a social and psychological impact on the patient. Prosthetics is an art and science, which provides lifelike appearance to the lost structures of the patient. This case report presents the fabrication of a silicone finger prosthesis, which had good suspension, adequate function, was comfortable to use and esthetically acceptable to the patient.

Oral-facial-digital syndrome (OFD) is a collective term describing thirteen distinctive, rare genetic disorders based on inheritance pattern and phenotypic expression. OFD is characterized by malformations of the oral cavity, the maxillofacial region and the arms and legs. Central nervous system anomalies, include intracerebral cysts, agenesis of the corpus callosum, hydrocephalus, cerebral/cerebellar atrophy, and berry aneurysms. Some degree of compromised intellectual ability and speech are present in affected individuals that correlate with the degree of central nervous system involvement. Furthermore, renal involvement in the form of polycystic kidney disease is evident in affected individuals in adulthood. In this article, we present a 37-year-old female patient that presented to the Rutgers School of Dental Medicine with oral-facial-digital syndrome, type 1.

Tooth transposition is a rare developmental anomaly in which the adjacent teeth switch/swap their positions and may create problems both esthetically and functionally. The maxillary permanent canine is the tooth most frequently involved, which is often transposed with the first premolar followed by transposition between the maxillary permanent canine and maxillary lateral incisor. This paper reports two cases of tooth transposition, one in mandibular arch involving the right lateral incisor and canine; and the other bilateral transposition in maxillary arch involving the first premolars and canine. It also focuses on the etiology and the prevalence of this interesting phenomenon called transposition.

Branchial cleft cysts are the most common congenital neck masses. The other name for Branchial cleft cyst is Benign cervical lymphoepithelial cyst, which occurs on the lateral aspect of the neck. These cysts originate from remnants of the branchial arches or branchial pouches. The lesions presents as an asymptomatic circumscribed movable mass on the anterior border of the sternocledomastoid muscle. Many cases have been reported at the angle of the mandible, in the submandibular area and even in the pre-auricular and parotid areas. Dentist should be aware of this entity, because it can be easily confused with an odontogenic infection or parotid pathology, especially, if it develops high up in the neck. A solitary, 1 month old swelling on the right submandibular region, in a 13-year-old girl, caused diagnostic dilemma with clinical presentation. Diagnosis was done after all the investigations and treated accordingly.

Williams-Beuren Syndrome (WBS) is a rare, most often sporadic, genetic disease caused by a chromosomal microdeletion at locus 7q11.23 involving 28 genes. It is characterized by congenital heart defects, neonatal hypercalcemia, skeletal and renal abnormalities, cognitive disorder, social personality disorder, and dysmorphic facies. A number of clinical findings has been reported, but none of the studies evaluated this syndrome considering oral cavity. We here report a fissured and geographic tongue in association with WBS.

The calcifying odontogenic cyst (COC) is a rare odontogenic lesion representing about 1% of all jaw cysts. There is a wide age range from 1 to 82 years with a first peak in the second decade and the second in the sixth/seventh decade. This lesion is characterized by the presence of "ghost" cells. The pathogenesis of the lesion is from the reduced enamel epithelium or the remnants of odontogenic epithelium. Here, we report two cases, both in 18-year-old male patients; previously diagnosed as dentigerous cyst and residual cyst respectively. But histologically, both the cases turned out to be COCs. Confocal laser scanning microscopy (CLSM) has become an invaluable tool for a wide range of investigations in the medical sciences for imaging thin optical sections of tissues. The COCs were evaluated using CLSM to analyze the properties of the cystic lining and the ghost cells.

Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma encountered in childhood and adolescence. The common sites of occurrence are the head and neck region, genitourinary tract, retroperitonium and the extremities. Orbit, paranasal sinuses, cheek, and the neck are the common affected site in head and neck region. RMS is relatively uncommon in the oral cavity, and the involvement of the jaws is extremely rare. Multidisciplinary approaches surgery, chemotherapy and radiotherapy, are use for treatment. Here, we report an aggressive form of RMS at palate of a 9 months old female child which did not respond to chemotherapy.