Middle ear pathology and Eustachian tube dysfunction are commonly seen in patients with cleft lip and palate (CLP). Various palatoplasty techniques aim to improve velopharyngeal function, but their impact on middle ear recovery remains incompletely understood. The aim of this study was to compare the recovery of middle ear pathology between two primary palatoplasty techniques through audiometric evaluation. A retrospective cohort study of 211 CLP patients was conducted who underwent primary palatoplasty between January 2023 and December 2024 at a tertiary cleft center. Participants were divided into two groups based on the surgical technique received: Group 1 underwent Modified Two-flap palatoplasty with Intravelar veloplasty, while Group 2 underwent Modified Furlow's palatoplasty. The primary outcome was middle ear status assessed through standardized audiometric evaluation performed preoperatively and 6 months postoperatively. Chi-square test was used for categorical variables and independent t-tests was applied for continuous variables, with p < 0.05 considered significant. After propensity score matching, 76 matched pairs were analyzed with comparable baseline characteristics. Middle ear pathology recovery at 6 months was significantly higher in the Furlow's group (61.8%, 47/76) versus Bardachs group (23.7%, 18/76; p < 0.001). Type A tympanograms increased to 61.8% versus 15.8% respectively. Positive otoacoustic emissions improved to 56.6% versus 22.4% (p < 0.001). Multivariable analysis confirmed Furlow's superiority (OR 5.23, 95% CI 2.58-10.61, p < 0.001). Modified Furlow's palatoplasty demonstrated significantly better recovery of Eustachian tube function compared to Modified Two-flap palatoplasty with Intravelar veloplasty at 6 months post-surgery. This superior outcome is likely attributable to more radical transposition of the Tensor veli palatini muscle in the Furlow's technique, resulting in improved middle ear ventilation and better audiological outcomes in CLP patients.

BACKGROUND:Cleft lip and palate (CLP) affect maxillofacial growth, dentoalveolar development, and speech outcomes. Interventions like maxillary arch expansion using a bonded quad-helix (xBQH) and secondary alveolar bone grafting (SABG) are common. Still, their specific impact on speech outcomes, independent of speech therapy, remains underexplored. PURPOSE:The purpose of this study was to measure the association between maxillary arch expansion followed by SABG for oronasal fistula (ONF) closure and speech outcomes among nonsyndromic unilateral CLP (UCLP) patients who didn't receive concurrent speech therapy. STUDY DESIGN, SETTING, AND SAMPLE:This prospective cohort study was conducted during 2022-2023 at the Nitte Meenakshi Institute of Craniofacial Surgery, Mangalore. Nonsyndromic UCLP patients aged 6 to 10 years were evaluated, and patients with auditory/intellectual impairment and orthodontic appliances covering the palate were excluded. All underwent 6 months of xBQH, followed by 3-month retention and subsequent SABG. PREDICTOR VARIABLE:The predictor variable was time, assessed at baseline and at 1 month after SABG. MAIN OUTCOME VARIABLES:The outcome variable was speech quality (hypernasality, nasal air emission, hyponasality, voice disorders, speech acceptability, and speech understandability) measured using the Henningsson et al universal reporting parameters for cleft palate speech. COVARIATES:The covariates were age and sex. ANALYSES:Dependent speech outcome measures were analyzed using McNemar's test for dichotomous paired data and McNemar-Bowker's test for ordinal paired data. Inter-rater reliability was evaluated using Cohen's kappa coefficient. A two-tailed P value of <0.05 was considered statistically significant. RESULTS:The sample comprised 60 subjects with a mean age of 8.63 years (SD = 1.80), 28 (47%) male and 32 (53%) female. Nasal air emission decreased from 20 of 60 (33.3%) at baseline to 5 of 60 (8.3%) post-treatment (P < .01). Speech understandability improved in 21 of 60 (35%) with initially mild impairment and 9 of 60 (15%) with moderate impairment (P < .01). Speech acceptability improved in 20 of 60 (33.3%) with mildly unacceptable speech and in 5 of 60 (8.3%) with moderately unacceptable speech (P < .01). Hypernasality decreased from 10 of 60 (16.7%) to 5 of 60 (8.3%), but the change was not statistically significant (P = .06). No changes were observed in hyponasality or voice disorders. CONCLUSION AND RELEVANCE:Maxillary expansion using a xBQH appliance followed by SABG reduced NAE and improved speech understandability and acceptability in children with UCLP, even without speech therapy. These findings support early orthodontic-surgical protocols in cleft care.

Background Cleft lip and palate (CLP) affect maxillofacial growth, dentoalveolar development and speech outcomes. Interventions like maxillary arch expansion using a bonded quad-helix (xBQH) and secondary alveolar bone grafting (SABG) are common. Still, their specific impact on speech outcomes, independent of speech therapy remains underexplored. Purpose The purpose of this study was to measure the association between maxillary arch expansion followed by SABG for Oro-nasal fistula closure (ONF) and speech outcomes among non-syndromic unilateral CLP (UCLP) who didn’t receive concurrent speech therapy. Study Design, Setting, Sample This prospective cohort study was conducted during 2022-2023 at the Nitte Meenakshi Institute of Craniofacial Surgery, Mangalore. Non-syndromic UCLP patients aged 6–10years were evaluated and patients with auditory/intellectual impairment and orthodontic appliances covering the palate were excluded. All underwent six months of xBQH, followed by 3-month retention and subsequent SABG. Predictor Variable The predictor variable was time, assessed at baseline and at 1 month after SABG. Main Outcome Variables The outcome variable was speech quality (hypernasality, nasal air emission, hyponasality, voice disorders, speech acceptability and speech understandability) measured using the Henningsson et al. universal reporting parameters for cleft palate speech. Covariates The covariates were age and sex. Analyses Dependent speech outcome measures were analyzed using McNemar’s test for dichotomous paired data and McNemar-Bowker’s test for ordinal paired data. Inter-rater reliability was evaluated using Cohen’s kappa coefficient. A two-tailed P value of <0.05 was considered statistically significant. Results The sample comprised 60 subjects with a mean age of 8.63 years (SD=1.80); 28(47%) male and 32(53%) female. NAE decreased from 20 of 60(33.3%) at baseline to 5 of 60(8.3%) post-treatment(p<0.01). Speech understandability improved in 21 of 60(35%) with initially mild impairment and 9 of 60(15%) with moderate impairment(p<0.01). Speech acceptability improved in 20 of 60(33.3%) with mildly unacceptable speech and in 5 of 60(8.3%) with moderately unacceptable speech(p<0.01). Hypernasality decreased from 10 of 60(16.7%) to 5 of 60(8.3%), but the change was not statistically significant(p=0.06). No changes were observed in hyponasality or voice disorders. Conclusion and Relevance Maxillary expansion using a bonded quad-helix appliance followed by SABG reduced NAE,improved speech understandability and acceptability in children with UCLP, even without speech therapy. These findings support early orthodontic-surgical protocols in cleft care.

This longitudinal retrospective study evaluated the effects of anterior maxillary distraction (AMD) using the VINK Maxillary Elongator on retropalatal (RPA) and retroglossal (RGA) airway volumes in 77 cleft lip and palate (CLP) patients. Pre-operative (T0) and eight-month post-operative (T1) lateral cephalograms and CBCT scans were analyzed to assess the correlation between antero-posterior maxillary advancement-measured as Effective Maxillary Length (EML) and airway volume changes. Statistical analyses included paired t-tests and Pearson's correlation tests, with p < 0.001 considered significant. The mean EML increased significantly from 79.12 ± 6.14mm to 88.92 ± 6.49mm (p = 0.001), and the mean airway volume rose from 14.01 ± 6.52mm3 to 16.46 ± 6.70mm3 (p < 0.001). A moderate positive correlation was observed between EML and airway volume change (r = 0.33, p = 0.02). The Epiglottis-Pharynx Line (EPL) increased significantly from 12.66 ± 4.31mm to 14.55 ± 4.07mm (p < 0.001), showing a strong correlation with total airway change (r = 0.62, p = 0.001). Notably, BCLP patients demonstrated greater maxillary elongation (11.52 ± 5.79mm) than UCLP (8.82 ± 4.92mm; p = 0.043), though airway and EPL changes were comparable. These findings suggest that AMD-induced maxillary advancement significantly enhances airway volume by altering tongue posture, irrespective of cleft type.

INTRODUCTION:Cleft lip and palate (CLP) is a common congenital defect where dental anomalies are seen at a higher rate compared to the general population. The study aimed to identify, compare and correlate dental anomalies in non-syndromic cleft lip and palate subjects. MATERIAL AND METHODS:A total of 100 patients with cleft lip and palate were evaluated for the presence of dental anomalies. After informed consent, clinical and radiological examination of the patients was performed. Cone beam computed tomography sections were analysed and dental anomalies present were recorded. The observations were tabulated and the data was subjected to statistical analysis. RESULTS:Ninety six percent of the cleft population had at least one dental anomaly. Patients with unilateral cleft lip and palate showed the highest prevalence of dental anomalies. Missing teeth (87%) were the most common dental anomaly followed by ectopic eruption, microdontia, enamel hypoplasia and impacted teeth. Other dental anomalies like odontomes and pulp stones were found at a lower prevalence rate. CONCLUSION:Patients with CLP are highly susceptible to the occurrence of dental anomalies. Thorough clinical and radiographic examination, careful planning and implementation of specialized services are needed in an effort to provide early diagnosis and comprehensive treatment.

A male patient in his 50s presented with complaints of pain, swelling and restriction of movement in his right knee for 7 years. Examination revealed a 10 degree flexion deformity with diffuse swelling and tenderness, as well as a range of motion (ROM) of 10–30 degrees. X-ray showed a ‘ring and arc’ appearance. MRI showed circumferential disease extending into the subcutaneous plane and encasement of posterior compartment vessels by 270 degrees, extending through the knee joint. The patient underwent open synovectomy and excision of the mass, which measured 15×7×4 cm. At 2 years postoperative follow-up, the patient has had no recurrence of disease and achieved a Musculoskeletal Tumor Society score of 28/30 on clinical examination. The patient reported no flexion deformity and demonstrated knee ROM of 0–90 degrees.

Aim: This study aimed to evaluate acetabular anteversion following total hip arthroplasty (THA) using cross- table lateral radiographs and CT scans and to determine the reliability of cross-table lateral radiographs compared to computed tomography (CT) scans for measuring acetabular anteversion. Materials and methods: We conducted a cross-sectional study of patients undergoing THA at Justice K.S. Hegde Charitable Hospital, Deralakatte, Mangalore, from January 2020 to June 2021. Radiographs are typically taken in both anteroposterior (AP) and lateral views after THA. However, for this study, a cross- table lateral view was used instead of the usual lateral radiograph to measure the angle of anteversion. The anteversion was calculated using the method described by Woo and Morrey. Additionally, CT scans were performed on all patients as part of the study protocol. The anteversion measured in these scans was compared to that in the cross-table radiographs to assess the latter's reliability for routine use. The risk of radiation exposure from CT scans was minimized by adhering to the ALARA (As Low as Reasonably Achievable) principle, with only axial sections of the acetabular cup being scanned. Results: The results show that the radiographic acetabular anteversion and CT scan measurements have a mean difference of 0.3036. There is a positive correlation between these measurements. The p-value is not statistically significant (p=0.698). Therefore, the measurements are correlated with each other with a linear relationship (r=0.919). For anteversion measurements using the X-ray method, the mean was 27.16 degrees with a standard deviation of +/- 9.49. The median was 27.26 degrees, ranging from 10.27 to 42.58 degrees. In comparison, the CT method yielded a mean anteversion of 27.40 degrees with a standard deviation of +/- 8.50 degrees. The median was 27.64 degrees, ranging from 12.35 to 43.11 degrees. Conclusion: Cross-table lateral radiographs are a reliable and comparable method to CT scans for measuring acetabular anteversion following total hip arthroplasty.

Objective To evaluate the posterior superior alveolar canal (PSAC) in individuals with cleft lip and palate (CLP) by comparing them with individuals with no cleft lip and palate (NC) using cone beam computed tomography (CBCT). Setting This is a cross-sectional, analytical study with a prospective sample. Patients, Participants CBCT scans of 29 individuals with no cleft and palate (Group I) and 29 individuals with cleft lip and palate (Group II) were used. Interventions PSAC was evaluated and compared for its position, diameter, and distance between the individuals with CLP and NC using CBCT scans. Results The mean age of individuals in Group I and II were 12.93 and 11.82 years, respectively. The distribution of individuals based on gender comprised of 51.7% males and 48.3% females in both the study groups. PSAC was present in both right and left maxillary sinus in 100% of the study subjects of Group I and Group II. The most prevalent position of PSAC in Group I and Group II was on the lower third and middle third of lateral wall of maxillary sinus, respectively. The mean diameter was higher in Group II (1.2962 mm) when compared to Group I (1.0897 mm) which showed statistically significant value ( P = .008). Conclusion The promising results obtained from the present study demonstrates the importance of knowing the precise anatomical location of the PSAC in individuals with cleft lip and palate by using CBCT which is reliable, less time consuming and cost effective imaging tool.

][12] As patients are mostly satisfied with the esthetic enhancement postorthognathic surgery, the concept of occlusion in orthognathic surgery is overlooked.

The study intends to compare the efficiency of the Modified Tragus Edge Approach and the Retromandibular Transparotid Approach in patients who underwent open reduction and internal fixation of low-level condylar fractures. A prospective study was carried out to assess the efficiency of two novel methods to approach low-level condylar fractures, the Modified Tragus Edge Approach and the Retromandibular Transparotid Approach. Efficiency in accessibility and visibility of fractured segments and duration of approach were analysed intraoperatively, whereas facial nerve involvement and complications were analysed postoperatively. The findings were statistically analysed using the Mann–Whitney U test. The frequency of unilateral condylar fractures was seen to be more common than bilateral condylar fractures in the study. The mean duration of surgery, accessibility and visualisation of the fractured segments showed good results but were not statistically significant. Transient facial palsy seen in two patients of Group B resolved within the 3rd month of follow-up, whereas in 2 patients from Group A, parotid fistula was noted and managed surgically. Comparison of the two novel techniques on multiple intraoperative and postoperative parameters showed excellent positive results in both groups. It was also observed that Modified Tragus Edge Approach could access condylar head and subcondylar fractures with better visualisation.

This paper aims to review the utility of I- gel as a successful airway management device for infants with Pierre robin sequence (PRS) undergoing glossopexy. A prospective study was conducted on PRS neonates. The algorithm followed was putting a ‘Tongue traction stitch’ followed by the following sequence – two trials with direct laryngoscope intubation, two attempts with fiberoptic endoscope intubation followed by insertion of I-gel™ to manage difficult airway during glossopexy procedure. 6 patients were intubated with direct laryngoscope, 12 patients were intubated with fibreoptic endoscope and the rest 13 patients were intubated using I-gel™. Successful management of difficult airway was achieved with this airway management protocol during glossopexy and nil postoperative complications were encountered. Within the limitations of the study it seems that, I-gel™ is a relevant alternative toprovide a reliable and secure airway access to carry out glossopexy procedure in such patients.

Radical surgery is the mainstay for the treatment of recurrent ameloblastomas; however, it leads to large, complex defects. In this case report, we present an innovative technique of digitally aided resection and reconstruction. A massive histologically confirmed acanthomatous ameloblastoma of the skull-base was digitally mapped with the help of three-dimensional (3D) computed tomography and a custom resection template was fabricated. Digital resection of the skull-base tumor with intracranial extension was done virtually and the resultant defect was reconstructed to create an anatomical replica of the contralateral unaffected side. The tumor was successfully resected with adequate margins guided by the resection template to avoid injury to adjacent vital structures. Subsequent reconstruction was performed by first adapting polymethyl methacrylate bone cement into a series of custom-made 3D molds. Once set, this bone cement served as a reconstructive implant to bridge the ablative defect. The implant offered a precise fit and was secured to healthy adjacent bone using titanium microplates. We present a 6-month follow-up of the case with satisfactory aesthetic results. 3D printing technology has the potential to revolutionize the arena of craniofacial resection with excellent cosmesis and no donor site morbidity if applied appropriately as described here.

Mandibular second premolars with three canals (Type V, Vertucci) and separate foramina are very infrequent. The incidence of three canals in mandibular second premolar has been reported to be 0.46–0.5%. The present report describes non-surgical endodontic treatment of mandibular second premolar with three canals. In this case, three orifices were located in mesiobuccal, distobuccal, and lingual. The clinicians must be aware of such anatomical variations and be able to use a variety of tools for adequate diagnosis and management.

Objective: To evaluate the long-term effect of timing of 1-stage palatoplasty on midfacial growth in patients with cleft lip and palate (CLP). Design: Retrospective observational cohort study. Study Setting: Institutional hospital. Patients: One hundred twelve patients with CLP who underwent palatoplasty and were divided into 3 groups: group I: operated between 9 and 11 months; group II: operated between 18 and 20 months; and group III: operated between 21 and 24 months. Interventions: All patients underwent von Langenbeck palatoplasty technique, which was converted to a Bardach 2-flap technique in case of any technical difficulties. The patients were followed up between 8 and 9 years when they reported for secondary alveolar bone grafting. Postsurgical cephalometric and dental casts measurements were taken for midfacial growth analysis. Main Outcome Measures: The cephalometric measures were analyzed for midfacial growth and compared within the groups. Results: Statistically significant difference (P < .01) was found on comparing the cephalometric parameters such as sella–nasion–A point angle (SNA), A point–nasion–B point angle (ANB), n toperpendicular to point A (N-perpA), condylon to point A (Co-A), anterior nasal spine to posterior nasal spine (ANS-PNS), nasion to Anterior nasal spine (N-ANS), nasion to menton (N Me), and witts appraisal (Witt (AO-BO)) in group I when compared to both group II and group III patients, implying deficient midfacial growth in group I. No statistical difference was found in the cephalometric values between group II and group III. Group II had better cephalometric measurements than group III, showing better growth in group II than group III. Overall, there was less incidence of midfacial hypoplasia in patients treated between 18 and 20 months (group II). Conclusion: We conclude that palatal closure carried out at 18 to 20 months and 21 to 24 months is associated with better midfacial growth when compared to closure at 9 to 11 months. The best time to operate would be between 18 and 20 months to avoid speech disturbances. Midfacial growth can be greatly influenced by the timing of 1-stage palatoplasty.

Spindle cell/sclerosing rhabdomyosarcoma (RMS) is an uncommon type of RMS and has been classified as a separate entity by the WHO in 2013. It affects both children and adults with a greater incidence in males. These tumors can pose a diagnostic challenge and can be difficult to differentiate from other spindle cell malignant tumors in the head and neck. Here, we report a case of spindle cell/sclerosing RMS in a young woman presenting with a swelling on the left side of the face of 3 months duration. A careful correlation with the radiographic images, histopathological findings and immunohistochemistry helped to arrive at a diagnosis.

Objective Facial dysostosis is a group of rare craniofacial congenital disabilities requiring multidisciplinary long-term care. This report presents the phenotypic and genotypic information from South India. Design The study is a case series. Setting This was an international collaborative study involving a tertiary craniofacial clinic and medical genetics unit. Patients, Participants The participants were 9 families with 17 affected individuals of facial dysostosis. Intervention Exome analysis focused on known genes associated with acrofacial and mandibulofacial syndromes. Main Outcome Measure The outcome measure was to report phenotyptic and genetic heterogeneity in affected individuals. Results A Tessier cleft was seen in 7 (41%), lower eyelid coloboma in 12 (65%), ear anomalies in 10 (59%), uniolateral or bilateral aural atresia in 4 (24%), and deafness in 6 (35%). The facial gestalt of Treacher Collins syndrome (TCS) showed extensive phenotypic variations. Pathogenic variants in TCOF1 (Treacher Collins syndrome) were seen in six families, POLR1A (acrofacial dysostosis, Cincinnati type) and EFTUD2 (mandibulofacial dysostosis with microcephaly) in one each. One family (11.1%) had no detectable variation. Five out of six probands with Treacher Collins syndrome had other affected family members (83.3%), including a non-penetrant mother, identified after sequencing. Conclusion Our report illustrates the molecular heterogeneity of mandibulofacial dysostosis in India.

To evaluate and compare the outcomes of two different surgical protocols for palatoplasty for midfacial growth in patients with cleft lip and palate. A retrospective observational cohort study was conducted in 80 patients with cleft lip and palate, who were divided into two groups. Group 1 comprised patients who underwent operation between 9 and 11 months of age using the Bardach two-flap technique without a palatal pushback. Group 2 comprised patients who had undergone operation between 18 and 20 months of age using either a Bardach two-flap technique with a palatal pushback or a von Langenbeck technique. Patient follow-up was done between 8 and 9 years of age when they reported to the centre for secondary alveolar bone grafting. Post-surgical cephalometric measurements were taken for midfacial growth analysis. Group 1 underwent palatoplasty at significantly younger ages than Group 2 (p < 0.01). A statistically significant difference(p < 0.01) was found between the two groups of patients on comparison of cephalometric parameters such as SNA, ANB, CoA, NperpA ANS-PNS, N-ANS, N-Me, Witt's (AO-BO). Group 2 had more positive cephalometric values as compared to Group 1, thereby implying that there was less incidence of midfacial hypoplasia in patients treated at the age of 18-20 months. Between the types of palatoplasty techniques within Group 2, i.e., Bardach two-flap and von Langenbeck, there was no statistical difference found in the post-opertative cephalometric values, i.e., SNA, ANB, CoA, ANS-PNS, N-ANS, N-Me, Witt's (AO-BO) except for Nperp-A, which showed a statistical difference (p = 0.03). Within the limitations of the study which is only a single center experience it seems that palatal closure should be carried out at 18-20 months of age for better midfacial growth, leading to decreased incidence of maxillary hypoplasia at a later stage in life. Repair at less than 18 months of age is also associated with mid-facial hypoplasia.

The basis of the problem: Parry Romberg syndrome (PRS) is a rare developmental disorder manifesting as a slow and progressive atrophy of the face which is often unilateral, hence also termed as rpogressivehemifacial atrophy. The extent of the atrophy may vary, involving the superficial skin extending upto the underlying bone. The clinical features of PRS include craniofacial, neurologic, ophthalmic and dermatological manifestations, which result in various functional and psychological problems. PRS and linear scleroderma belong to the same disease spectrum. There can be demarcating line between the normal and abnormal skin seen in PRS, termed as "en coup de sabre". PRS is most commonly seen in females and involves the left side of the face. Method: We hereby report a case of PRS in a young girl presenting with en coup de sabre appearance on the right side of face. Results: Microsurgical facial reconstruction of the affected side is known to be the gold standard method for correction of the facial symmetry. In our case, the patient is currently kept under long term follow up and cosmetic surgical treatment will be planned once the atrophy attains stability. Conclusion: The association of PRS with linear scleroderma may present difficulty in its diagnosis. Hence, careful recording of the history and clinical examination with appropriate investigations can aid in establishing the correct diagnosis.