OBJECTIVES:We aimed to evaluate long-term survival and identify predictors of mortality among patients hospitalized with mucormycosis. METHODS:This prospective, multicentre cohort study included patients hospitalized for mucormycosis across 26 sites in India from March to July 2021. Follow-up data were collected at 1-, 3-, 6-, and 12-month intervals post-discharge through telephonic or in-person interviews with patients or caregivers. Primary outcomes were survival, sequelae, and quality of life, assessed using the EURO-QOL 5D-5L scale. Survival analyses were performed using the shared frailty Cox proportional hazards model for predefined subgroups. Additional sensitivity analyses using inverse probability of censoring weights and marginal structural modelling were conducted to account for loss to follow-up and the time-varying nature of the treatment and confounders. RESULTS:Of the 686 patients, 101 deaths (14.7%) occurred within 1 year, with a median survival time of 230 days. The majority of deaths (64.3%) occurred early, i.e. during hospitalization. Independent predictors of mortality included orbit involvement (hazard ratio [HR]: 2.0, 95% CI: 1.2-3.4), intracranial/cerebral involvement (HR: 2.6, 95% CI: 1.5-4.4), admission to an intensive care unit (HR: 6.4, 95% CI: 3.5-11.6), poor glycaemic control (HR: 2.3, 95% CI: 1.1-4.7), and other comorbidities (HR: 1.6, 95% CI: 1.0-2.5), and those associated with lower mortality were combination antifungal therapy (HR: 0.2, 95% CI: 0.1-0.4) and receipt of surgical treatment (HR: 0.1, 95% CI: 0.07-0.2). Survivors demonstrated improved quality of life, especially those who were gainfully employed. Sensitivity analysis indicated no major impact of loss to follow-up on survival. DISCUSSION:Poor glycaemic control, severe disease, and involvement of the orbit or intracranial/cerebral regions predict higher mortality in mucormycosis. Aggressive therapeutic strategies, including combination of antifungal therapy and surgical interventions, substantially improved survival. The study highlights the importance of integrating psychological rehabilitation and socioeconomic support into management protocols to enhance the quality of life among survivors.

In India, the incidence of mucormycosis reached high levels during 2021-2022, coinciding with the COVID-19 pandemic. In response to this, we established a multicentric ambispective cohort of patients hospitalised with mucormycosis across India. In this paper, we report their baseline profile, clinical characteristics and outcomes at discharge. Patients hospitalized for mucormycosis during March-July 2021 were included. Mucormycosis was diagnosed based on mycological confirmation on direct microscopy (KOH/Calcofluor white stain), culture, histopathology, or supportive evidence from endoscopy or imaging. After consent, trained data collectors used medical records and telephonic interviews to capture data in a pre-tested structured questionnaire. At baseline, we recruited 686 patients from 26 study hospitals, of whom 72.3% were males, 78% had a prior history of diabetes, 53.2% had a history of corticosteroid treatment, and 80% were associated with COVID-19. Pain, numbness or swelling of the face were the commonest symptoms (73.3%). Liposomal Amphotericin B was the commonest drug formulation used (67.1%), and endoscopic sinus surgery was the most common surgical procedure (73.6%). At discharge, the disease was stable in 43.3%, in regression for 29.9% but 9.6% died during hospitalization. Among survivors, commonly reported disabilities included facial disfigurement (18.4%) and difficulties in chewing/swallowing (17.8%). Though the risk of mortality was only 1 in 10, the disability due to the disease was very high. This cohort study could enhance our understanding of the disease's clinical progression and help frame standard treatment guidelines.

Background: This study aims to describe the clinical and imaging spectrum of neurological involvement in rhino-orbital cerebral mucormycosis (ROCM) following COVID. In this observational study, all patients with confirmed COVID associated mucormycosis were recruited. Consecutive patients with neurological signs and symptoms or patients with evidence of neurological involvement based on imaging were evaluated. MRI of brain and paranasal sinuses were done in 3T MRI scanner and evaluated by a radiologist. Results: A total of 182 patients were recruited into the study out of which 72 (39.56%) patients had neurological involvement. The mean age of the patients was 50.31±11.06 (Range: 33-83) years. A male preponderance was noted with 56 (74.67%) patients being male. The commonest symptom reported was unilateral vision impairment and periorbital swelling. Patients were noted to have both fulminant and indolent course of illness. Clinical evidence of neurological and orbital involvement was observed in 33 and 55 patients, respectively. Meningeal involvement (50%) was the commonest imaging finding noted in our study. Other common findings noted were skull- based osteomyelitis (44.44%), cavernous sinus thrombosis (29.17%), intracranial abscess (27.78%), cerebritis (22.22%), infarcts (33.33%), neuritis and intracranial haemorrhage (2.78%). Conclusion: This study reports one of the largest single centre cohorts with neurological findings in COVID associated mucormycosis. COVID associated mucormycosis can present with plethora of neurological manifestations in imaging, such as infarct, intracranial and extracranial abscess, neuritis and nerve abscess, sinus thrombosis that may or may not be accompanied by focal neurological deficit corresponding to the anatomical involvement.

Sialolthiasis is one of the most common benign pathologies of the salivary glands. It is associated with frequent bacterial infections and significant discomfort. Large &/or multiple stones are traditionally treated by ductal marsupialisation or gland excision. Sialendoscopy, a relatively new minimally invasive technique is a useful technique which can preserve a functioning gland and reduce postoperative morbidity. The current report demonstrates the successful use of sialendoscopy in evacuating 13 stones from a submandibular gland.

Objectives To comprehensively analyse the disease presentation and mortality of COVID-associated rhino-orbito-cerebral mucormycosis. Methods A retrospective analysis of the demographics, clinical and radiographic findings was performed. A binary logistic regression analysis was performed to examine the survival of patients with mucormycosis from hypothesised predictors. Results A total of 202 patients were included in this study. Statistical significance was demonstrated in the predilection to the male gender, recent history of SARS-COV-2, history of use of corticosteroid and hyperglycemia in this cohort of CAM. The mortality rate was 18.31%. Advanced age, raised HbA1c and intra-orbital extension were found to be predictors adversely affecting survival. Conclusion Early diagnosis, aggressive surgical therapy, early and appropriate medical therapy can help improve outcomes. Level of evidence Level 4.

Background A Sialocele is a subcutaneous extravasation of saliva from the salivary gland secondary to traumatic disruption of its duct or parenchyma. It is observed after ablative head and neck surgery or due to trauma. Though there are several techniques described, there is no universal consensus on how to treat postoperative sialoceles. Purpose This paper describes a simple technique which was used to successfully treat 11 patients with postoperative sialoceles. Methods In this paper we have described the use of an indigenously designed tapered stent used to decompress the sialocele. The decompression allows natural healing and fibrosis to occur over 4-6 days thereby resolving the sialocele. Results 11 patients with postoperative sialoceles were successfully treated using our technique. Conclusion The technique described by the authors is a simple, easy to perform procedure that can be managed in the outpatient office under local anesthesia with minimal equipment.

Purpose: To analyze and assess the results of treating obstructive salivary gland pathology by sialendoscopy or sialendoscopic-assisted surgery and analyze the difference in submandibular and parotid gland pathology. Patients and Methods: Between December 2012 and March 2020, 211 patients (236 procedures) underwent sialendoscopy/sialendoscopic-assisted surgery for treatment of obstructive salivary gland pathology. The cases were retrospectively analyzed for type of pathology, symptomatic relief, type of intervention (endoscopy alone or combined with open surgery), recurrence of symptoms, number of gland excisions, and complications encountered. Sialolith cases (n = 117) were treated by sialendoscopic/sialendoscopy-assisted surgical sialolithotomy using basket or graspers. Strictures (n = 69) were treated by serial dilatation or balloon dilatation with or without intraductal steroid. Mucous plugs (n = 26) were managed by sialendoscopic lavage and occasional retrieval using wire baskets. Results: There were 123 submandibular sialendoscopies in 118 patients and 113 parotid sialendoscopies in 95 patients. Of the 123 submandibular sialendoscopies, 99 were treated for sialolithiasis, 14 for strictures, 3 for mucous plugs, and 2 for foreign bodies. Of the 95 parotid sialendoscopies, 18 were treated for sialolithiasis, 55 for strictures, 23 for mucous plugs, and 1 for foreign body. The success rate was 85.3% for submandibular gland treatment and 92% for parotid gland treatment. About 62.7% of cases were treated by combined method (sialendoscopy with open approach) in submandibular gland and 50% in parotid gland. The number of gland excisions performed was 5 (2.1%). Conclusions: Sialendoscopy although associated with a gradual learning curve can be used for all cases of obstructive salivary gland pathology with excellent success rate and minimum morbidity. Parotid gland obstructive pathology is distinct from that seen in the submandibular gland, with strictures and mucous plugs contributing to most cases. Diagnosing and treatment planning for strictures and mucous plugs should therefore be as seamless as that for sialoliths. (C) 2020 American Association of Oral and Maxillofacial Surgeons.

AbstractObstructive salivary pathologies most commonly manifest as salivary stones (sialoliths), mucous plugs and sometimes due to narrowing of the duct (stricture/stenosis). Saliva produced by salivary glands flows into oral cavity by means of ducts. Blockage of these ducts due to the reasons mentioned above leads to sialadenitis (inflammation).Sialendoscopy is a minimally invasive technique to manage salivary duct pathologies, including sialolithiasis, sialadenitis & strictures. It is fast becoming the investigating procedure of choice for such conditions.In the last 25 years, Sialoendoscopy has gradually seen a rise in popularity for diagnostic and therapeutic means of dealing with obstructive salivary gland pathologies.

AbstractOral and Maxillofacial surgery, like any surgical specialty, has two vital requirements. First, having the right armamentarium, and, second, acquiring appropriate skills and knowledge of the patients’ disease process, including comorbidities. With the changing demographic in India, the profile of Indian patient has undergone a sea change in the last few decades. From acute conditions that had little impact on subsequent health of the patient, we have arrived at a scenario where a large proportion of patients present with chronic disorders like diabetes, ischemic heart diseases, etc. that affect many elective procedures we undertake and require optimization of the overall physical status of the patient before proceeding with any surgery.Trainee surgeons need to be aware and updated and should be able to recognize, treat, or appropriately refer patients to the requisite specialty in case of complex conditions beyond their remit or ability. In this chapter, readers will get a very brief overview of the different organ systems that play crucial role in homeostasis and how to modify the treatment when there’s an imbalance in either of these systems.

Submandibular sialadenitis is a common ailment in otorhinolaryngological and oral surgical practice. Some of the common causes of sialadenitis include sialolithiasis, inspissated mucous plugs, strictures and anatomical ductal variations. Very rarely do foreign bodies cause obstructive sialadenitis. Fish bone as a foreign body is routinely seen, with the most common locations being oropharynx, hypopharynx, oseophagus and tongue. We report an intriguing case of a 40 year old male with sialadenitis of the right submandibular gland due to an intra-ductal fish bone.

INTRODUCTION:Oral submucosal fibrosis (OSMF) is a chronic debilitating fibrotic disease of the oral cavity and is a serious health hazard in south Asia and, increasingly, the rest of the world. The molecular basis behind various treatment modalities to treat OSMF still remains unclear. In this study, we have investigated the in vitro ability of the buccal mucosal cells to reduce the proliferation of the fibroblasts of the fibrotic area in co-culture of cells and also at the molecular levels to reduce the level of connective tissue growth factor (CTGF) in the OSMF fibroblasts (SMF-F).MATERIALS AND METHODS:The study compares isolation, morphological and proliferation kinetics of SMF-F and BMF cells with and without co-culturing with BMEs. In addition, we have compared the mRNA expression levels of CTGF in SMF-F co-cultured BME and non-co-cultured SMF-F cells using validated real-time quantitative PCR (RT-qPCR) method.RESULTS:The basic morphological characteristics of SMF-F were similar to BMF, but the former cells had higher proliferation rate in early passages compared to late passage state. We also observed that the CTGF expression levels in SMF-F under co-culture conditions of BME were consistently and significantly downregulated in all four different SMF-F-derived cells from four different patients.CONCLUSION:Rapid proliferation and collagen synthesis in SMF-F as against BMF cells are the factors that confirm the innate nature of fibrosis fibroblasts (SMF-F). Further, the CTGF expression level in SMF-F was significantly suppressed by BME in co-culture conditions against controls (BMF). Considered together, this suggests that the cell therapeutic candidate of BME could be used in treating OSMF.

INTRODUCTIONMandibular cysts may require enucleation, resulting in large cavities compromising mandibular strength and functions. We investigated the effects of hyperbaric oxygen therapy (HBOT) on healing after enucleation of mandibular cysts.PATIENTS AND METHODSFourteen healthy individuals in whom no modifiers of wound healing were present received a median of 20 post-operative HBOT. The rate of filling of the defect was derived from the number of pixels in the residual cavity after transformation of the area of the lesion in orthopantomograms taken immediately after surgery and at six months postoperatively. Modifications in bone density, detected on panoramic radiographs, were defined through a gray scale of 256 tonalities. The radiolucency of a healthy tooth was used as a reference to control for differences between radiographs taken at different times in the same patient. Both the rate of filling and changes in bone density were compared with corresponding data from a previous study of 27 healthy subjects who healed spontaneously without HBOT.RESULTSAt six months postoperatively, the HBO-treated group showed 55 ± 9% reduction in the size of the residual cavity and 55 ± 17% increase in bone density compared to immediate postoperative values. Corresponding values in the control study were 12 ± 4% and 37 ± 23%, respectively. These differences were significant (t = -16.95; P = 1.21E-11 [x 10-11] for the reduction in cavity size and t = -2.39; P = 0.029 for bone density).CONCLUSIONSHBOT merits a place as a useful adjunct in the surgical management of defects of the mandible.

Objective: This was a study conducted to examine the effect of hyperbaric oxygen therapy (HBOT) on the quality, quantity and rate of bone regeneration in surgically created mandibular defects following cyst enucleation. Methods: Patients with mandibular bony defects greater than 3 cm were considered for the study. Postoperatively, the patients underwent one cycle of HBOT over a period of 4 weeks; each cycle consisting of 20 dives of 90 min each to a depth of 2.4 ATA. The patients were then evaluated clinically and radiologically on a monthly basis for 6 months to assess the rate of regeneration and the quality of the regenerate. Results: The bone filling in the defects at the end of 6 months was significantly faster than normal. Dental implants could be placed in two patients demonstrating the quality and the quantity of regenerated bone. Conclusions: Hyperbaric oxygen therapy significantly accelerates the rate of healing of surgically created defects of bone. HBOT provides an excellent therapeutic option for regeneration of lost or diseased bone especially in surgical defects of the mandible. The regeneration seen in the cystic defects of the mandible follows a natural predictable course.