Abstract Microvascular free flaps, particularly the anterolateral thigh (ALT) flap, are widely regarded as the gold standard for reconstruction following extensive oral cancer resections; however, flap failure, though uncommon, presents a significant reconstructive challenge. We report the case of a 57-year-old male with advanced squamous cell carcinoma of the left buccal mucosa who underwent composite resection followed by reconstruction using a free ALT flap, which subsequently developed partial failure in the postoperative period. Considering the patient’s multiple comorbidities, compromised recipient vessels, and the urgency of soft tissue coverage, a pedicled lateral forehead flap was employed as a salvage reconstructive option. This report describes a failed ALT flap reconstruction in advanced buccal mucosa carcinoma successfully managed with a pedicled lateral forehead flap.
This case report discusses the diagnosis and non-surgical management of a 32-year-old patient presenting with TMJ clicking and difficulty chewing. The TMJ noise, occurring during mandibular movements such as opening, closing, eating, and speaking, had persisted for six years without associated pain. Clinical and radiographic assessments revealed impacted wisdom teeth and variations in occlusal planes, with no periodontal or restorative issues. The treatment plan aimed to reduce TMJ noise, restore functional mandibular movements, and stabilize occlusion. A multidisciplinary approach was employed, including (1) dynamic digital analysis to evaluate mandibular positioning leading to mandibular deprogramming using an appliance and, (2) correction of mandibular alignment combined with sequential wisdom tooth extractions, and (3) functional orthodontic planning for long-term occlusal stability. CBCT imaging, kinesiography, electromyography and joint sonography were integrated to assess mandibular dynamics and occlusal contacts. The use of a rebalancing orthotic device provided immediate functional improvement, allowing the patient to chew without difficulty and eliminating TMJ noise. The patient reported significant symptom relief and satisfaction. This case underscores the value of a comprehensive neuromuscular approach using advanced imaging and functional analysis in the non-surgical management of TMD. Follow-up orthodontic treatment will further enhance occlusal stability and ensure sustained results. Learning Objectives : Understand the role of neuromuscular approaches in non-surgical TMD management. Recognize the importance of advanced diagnostic tools (CBCT, kinesiography, electromyography, joints sonography) in evaluating mandibular function. Develop a stepwise treatment protocol combining deprogramming, occlusal correction, and orthodontics for TMJ disorders.
Abstract Background: Fibre-reinforced composites (FRCs) have been introduced to improve the mechanical properties of conventional composite restorations. However, clinical evidence supporting their use in primary teeth remains limited. Aim: To compare the clinical performance of FRCs and nanohybrid composites (NHCs) as post-endodontic restorations in primary teeth over 12 months. Materials and Methods: A parallel-arm randomised controlled trial was conducted among 66 children aged 5–9 years requiring pulpectomy in primary molars. Participants were randomly allocated into two groups ( n = 33 each): Group A (FRC) and Group B (NHC). Standardised pulpectomy procedures were followed by placement of the respective experimental restorative materials. Clinical evaluation was performed at baseline, 6 months and 12 months using the modified United States Public Health Service criteria by two calibrated examiners. Intragroup comparisons were analysed using the Friedman test and the Wilcoxon signed-rank test with Bonferroni correction, and intergroup comparisons were performed using the Mann–Whitney U test. Results: Both groups showed comparable baseline scores ( P = 0.18), confirming homogeneity. A statistically significant decline in clinical performance was observed within both groups over time ( P < 0.05). However, no statistically significant differences were found between FRCs and NHCs at baseline, 6 months or 12 months ( P > 0.05). Although slightly greater deterioration was noted in the NHC group, it was not significant. Conclusion: Both FRCs and NHCs demonstrated comparable clinical performance over 12 months. Despite improved mechanical properties, FRCs did not show superior clinical outcomes. Restoration success appears to be multifactorial, emphasising the importance of clinical technique and case selection.
Abstract Context: Nasal septal deviation (NSD) is a common anatomical variation that can influence the morphology of adjacent structures, including the maxillary sinus (MS). The relationship between NSD severity and maxillary sinus volume (MSV) remains under debate. Aim: To evaluate the correlation between the severity of NSD and MS dimensions and volume using cone-beam computed tomography (CBCT) imaging. Settings and Design: This retrospective cross-sectional study was conducted using archived CBCT scans from a diagnostic imaging centre. Materials and Methods: CBCT scans of 84 patients were retrospectively analysed. NSD was classified into four types based on severity: normal, mild, moderate, and severe. The MS dimensions measured included width (MSW), height (MSH), length (MSL), and volume (MSV) on both right and left sides by using Romexis software (version 3.8.3). Data were statistically analysed for gender-wise comparisons and across NSD severity subgroups. Statistical Analysis Used: Descriptive statistics, independent t-tests, and ANOVA were used to assess differences. A P value < 0.05 was considered statistically significant. Results: Of the 84 patients, 40.4% exhibited moderate NSD, followed by mild (21.4%), normal (20.2%), and severe (17.8%). Males exhibited higher mean MS volumes than females; however, this difference was not statistically significant. No significant association was found between NSD severity and any of the sinus dimensions or volumes. Left mean MSV was generally higher than right mean MSV in both genders. Conclusion: Although moderate and mild NSD were prevalent, the study did not establish a significant association between NSD severity and MSV or other MS dimensions.
Abstract Aim and Objectives: Oral squamous cell carcinoma (OSCC) is difficult to detect at an early stage using routine imaging or biopsy. Cyclin-dependent kinase inhibitor 2A ( CDKN2A ) is a major tumour-suppressor gene in OSCC, and alterations in its gene expression reflect early molecular changes during carcinogenesis. This study aims to evaluate CDKN2A gene expression in untreated early-stage OSCC patients and assess its potential relevance for early disease detection. Methodology: Sixty participants (30 early-stage OSCC patients and 30 matched healthy controls) were included. From OSCC patients, ribonucleic acid (RNA) was isolated from matched tumour and adjacent normal mucosal tissues. CDKN2A gene expression levels were quantified using quantitative reverse-transcription polymerase chain reaction with normalisation to glyceraldehyde-3-phosphate dehydrogenase (GAPDH). Human papillomavirus status and clinical features were assessed to interpret biomarker performance. Statistical analysis used the Wilcoxon signed-rank test for paired tissue data, with P < 0.05 considered significant. Results: CDKN2A mRNA expression was significantly lower in OSCC tumour tissue than in adjacent normal mucosa in the present cohort (median 0.65 vs 1.15, P < 0.05). The Cancer Genome Atlas head and neck squamous cell carcinoma (HNSCC) data ( n = 520) showed higher CDKN2A transcript levels in tumours compared with normal tissues. However, oral cavity-specific analysis showed no significant difference ( P = 0.693), which was similar to the findings observed in HPV-negative oral tumours in the present study. Conclusion: CDKN2A mRNA is significantly downregulated in early-stage HPV-negative OSCC tissue and may serve as a tissue-based molecular marker. Biofluid CDKN2A mRNA shows low sensitivity for non-invasive screening. Larger cohorts and multi-marker panels may improve its diagnostic performance and clinical utility in early detection.
