Here we report a case of inferior alveolar nerve (IAN), which had variability in its formation. IAN was formed by dual roots, which were branching out from the posterior division of mandibular nerve. The observed roots were forming a loop around the pterygoid part of arteria maxillaris (MA). One of the roots was superficial to the MA and the other was deep to it. It is believed that this type of morphological variation in the formation of IAN can have clinial implications, which include compression by adjacent structures and nerve entrapment. The knowledge of this variation is important to anaesthesiologists and dentists, while administering local anaesthesia. This is also enlightening to the maxillofacial surgeons, neurologists and radiologists.

Although the surgical management of spontaneous intracerebral hematoma (SICH) is a controversial issue, it can be life saving in a deteriorating patient. Surgical techniques have varied from the open large craniotomy, burr hole and aspiration to the minimally invasive techniques like stereotactic aspiration of the SICH, endoscopic evacuation and stereotactic catheter drainage. The authors report their experience with a keyhole craniectomy for the surgical evacuation of SICH. Ninety-six cases of SICH were treated using the keyhole craniectomy technique. A small craniectomy of 2-2.5 cm diameter was made using a vertical incision over a relatively ‘silent area’ of the cortex closest to the clot. Using a small cortical incision the hematoma was evacuated and decompression was achieved. Hemostasis was achieved using standard microneurosurgical techniques. Good to excellent outcome was achieved in 55 cases. Mortality was noted in 23 patients. Blood loss was minimal during the procedure. Good evacuation of the clot was seen in all but 5 cases as judged by the postoperative CT scan. The keyhole craniectomy technique is minimally invasive, safe and can achieve good clot evacuation with excellent hemostasis. It can be combined with microscopic or endoscopic assistance to achieve the desired result.
Hematoma ; Methodology ; Good ; desires <1> ; Hemostasis procedure

INTRODUCTIONWe aim to study and elucidate the safety profile of the antiepileptic doses of gabapentin during pregnancy, and to evaluate gabapentin-induced murine fetotoxicity at different dose levels.

METHODSA total of 60 pregnant mice, divided into 12 groups of five mice each, were exposed to gabapentin in four different doses of 0 (control), 113, 226, or 452 mg/kg body weight per day, at three different gestational stages including early gestation (1-6 days), mid-gestation (7-12 days), and late gestation (13-17 days). The pregnant mice were euthanized on day 18 of gestation, and foetuses were examined for teratogenic manifestations. Their brains were dissected and examined for gross changes, malformations, histological changes, and quantitative protein estimation.

RESULTSFoetal resorptions were observed in all treated groups with gabapentin administration at early gestation (1-6 days), and mid-gestation (7-12 days). On the other hand, growth retardation along with stunting in size of live foetuses were observed in all the mid-gestation (7-12 days), and late gestation (13-17 days) treated groups. Various gross malformations were observed with all the three doses (113, 226, and 452 mg/kg body weight per day) when gabapentin was administered at mid-gestation (7-12 days). The same trends were confirmed by gross and microscopic examination of brains along with quantitative protein estimation.

CONCLUSIONGabapentin should not be prescribed during pregnancy, as no therapeutic dose of gabapentin is safe during this period as far as the foetal well-being is concerned.

Abnormalities, Drug-Induced ; Amines ; adverse effects ; Animals ; Anticonvulsants ; adverse effects ; Body Weight ; Congenital Abnormalities ; prevention & control ; Cyclohexanecarboxylic Acids ; adverse effects ; Dose-Response Relationship, Drug ; Female ; Mice ; Mice, Inbred ICR ; Models, Chemical ; Pregnancy ; Pregnancy, Animal ; drug effects ; Teratogens ; gamma-Aminobutyric Acid ; adverse effects

Facial asymmetry is not an uncommon occurrence in day to day dental practice. It can be caused by various etiologic factors ranging from facial trauma to serious hereditary conditions. Here, we report a rare case of non-syndromic facial asymmetry in a young female, who was born with this condition but was not aware of the progression of asymmetry. No relevant family history was recognized. She was also deficient in both deciduous and permanent teeth in the corresponding region of maxilla. Hence, the cause of this asymmetry was believed to be a segmental odontomaxillary hypoplasia of left maxilla accompanied by agenesis of left maxillary premolars and molars and disuse atrophy of corresponding facial musculature. This report briefly discussed the comparative features of segmental odontomaxillary hypoplasia, hemimaxillofacial dysplasia, and segmental odontomaxillary dysplasia and justified the differences between segmental odontomaxillary hypoplasia and the other two conditions.
Bicuspid ; Facial Asymmetry ; Female ; Humans ; Maxilla ; Molar ; Muscular Disorders, Atrophic ; Tooth

Reports of combined candidal and herpetic esophagitis in immunocompetent states are rare and sporadic. A 44-year-old previously healthy lady presented with a one week history of progressive dysphagia, odynophagia and fever. Esophagogastroduodenoscopy (EGD) showed extensive desquamation of the entire esophagus except for distal 4 cm. Histopathological examination revealed ulcerated and inflamed squamous epithelium with the margin of ulcer showing a few overhanging squamous cells with dense eosinophilic cytoplasm, multinucleated and faceted nuclei with glassy chromatin, and an occasional Cowdry type A intranuclear inclusion bodies. Few candidal spores were seen in the underlying stroma. Intravenous acyclovir, fluconazole and pantoprazole were initiated. Oral analgesics were given for pain relief. She was treated for a total of 14 days. She showed significant improvement and was tolerating oral intake after discharge. The patient was asymptomatic with no evidence of recurrence at a 2-month follow-up.
Adult ; Antifungal Agents ; therapeutic use ; Antiviral Agents ; therapeutic use ; Candidiasis ; diagnosis ; drug therapy ; microbiology ; Esophagitis ; diagnosis ; drug therapy ; microbiology ; virology ; Esophagus ; microbiology ; pathology ; virology ; Female ; Herpes Simplex ; diagnosis ; drug therapy ; virology ; Humans ; Inclusion Bodies, Viral ; Spores, Fungal ; Treatment Outcome

Natural medicinal systems such as Ayurveda and folk medicine has remedies for wound management. However, the exact cellular and extracellular mechanisms involved in the healing process and its influence on keratinocytes is less discussed. Therefore, the present study was designed to evaluate the effect of certain natural wound healing medicines on the biology of the keratinocytes/HaCaT cells. Test materials such as honey (H), ghee (G), aqueous extracts of roots of Glycyrrhiza glabra (GG) and leaves of Nerium indicum (NI) were considered. The HaCaT cells were treated with the test materials singly and in combinations (H+G, all combined [Tot]) for a specific period (24, 48, and 72 hours). The cells were then subjected to cytotoxicity/proliferation and migration/scratch assays. All the test materials, except NI, were non-cytotoxic and showed increased cell proliferation at variable concentrations. Significant observations were made in the groups treated with honey (100 µg/ml at 48 hours, P<0.05; 1,000 µg/ml at 72 hours, P<0.05), GG (all concentrations at 48 hours, P<0.05; 750 µg/ml at 72 hours, P<0.05), H+G (250 µg/ml at 24 hours, P<0.001; 500 µg/ml at 48 and 72 hours, P<0.05), and Tot (50 µg/ml at 24, 48 and 72 hours, P<0.01). In the in-vitro wound healing assay, all the treated groups showed significant migration and narrowing of the scratch area by 24 and 48 hours (P<0.001) compared to control. The results obtained from the present study signifies the positive influence of these natural wound healing compounds on keratinocytes/HaCaT cells.
Biology ; Cell Proliferation ; Ghee ; Glycyrrhiza ; Honey ; Keratinocytes ; Medicine, Traditional ; Nerium ; Wound Healing ; Wounds and Injuries

The reconstructive surgeries utilize pes anserinus (PA) tendons, because of their lesser post-operative clinical deficits and donor site morbidity. These surgeries require anatomical knowledge about the extent of PA formation. The goal of this study was to determine the length and width of the PA formation. The objectives were to measure the distance of its upper limit, lower limit, and vertical distance from the tibial tuberosity (TT). The present descriptive cross sectional study included 53 embalmed cadaveric lower extremities. The upper and lower limits of PA were exposed with the careful dissection. Measurements of the dimensions were performed with the help of a digital vernier caliper (Mitutoyo Co., Kanagawa, Japan). The PA length, width, distance of its upper limit, lower limit, and vertical distance of it from the TT were 47.4±13.3 mm, 37.3±7.2 mm, 47.6±12.5 mm, 54.6±10.4 mm, and 39.1±14.2 mm, respectively over the right extremity. The same measurements were 46.3±14.7 mm, 39.1±9.4 mm, 39.1±5.9 mm, 49.5±8.2 mm, and 36.4±12.1 mm, respectively for the left extremity. The extent of PA was observed to be extremely variable. The preoperative knowledge about the dimensions of PA will help the plastic and orthopedic surgeon put the accurate skin incision, decreasing the donor site morbidity and biomechanical instability of the PA grafts. We suggest that, preoperative ultrasound measurement of the PA may help the operating surgeon to prevent the complications like injury to the infrapatellar branch of saphenous nerve.

The reconstructive surgeries utilize pes anserinus (PA) tendons, because of their lesser post-operative clinical deficits and donor site morbidity. These surgeries require anatomical knowledge about the extent of PA formation. The goal of this study was to determine the length and width of the PA formation. The objectives were to measure the distance of its upper limit, lower limit, and vertical distance from the tibial tuberosity (TT). The present descriptive cross sectional study included 53 embalmed cadaveric lower extremities. The upper and lower limits of PA were exposed with the careful dissection. Measurements of the dimensions were performed with the help of a digital vernier caliper (Mitutoyo Co., Kanagawa, Japan). The PA length, width, distance of its upper limit, lower limit, and vertical distance of it from the TT were 47.4±13.3 mm, 37.3±7.2 mm, 47.6±12.5 mm, 54.6±10.4 mm, and 39.1±14.2 mm, respectively over the right extremity. The same measurements were 46.3±14.7 mm, 39.1±9.4 mm, 39.1±5.9 mm, 49.5±8.2 mm, and 36.4±12.1 mm, respectively for the left extremity. The extent of PA was observed to be extremely variable. The preoperative knowledge about the dimensions of PA will help the plastic and orthopedic surgeon put the accurate skin incision, decreasing the donor site morbidity and biomechanical instability of the PA grafts. We suggest that, preoperative ultrasound measurement of the PA may help the operating surgeon to prevent the complications like injury to the infrapatellar branch of saphenous nerve.

The objective of this study was to study the morphometry of the styloid process of temporal bone and prevalence of elongated styloid process. The morphology of elongated styloid process along with its embryological and clinical importance are discussed. The present study included 110 human dry skulls which were procured from the bone collections of the department of anatomy. The styloid process was observed macroscopically on both sides of all the skulls, the elongations if any were noted. All the styloids were measured for their length, thickness at different levels and interstyloid distance at various levels. Out of 110 specimens, only 5 skulls (4.5%) exhibited the elongated styloid process. Among them, 3 skulls (2.7%) had unilateral elongation and 2 skulls (1.8%) had bilateral elongation of the styloid process. The mean length of the styloid process was 17.8+/-9.3 mm and 18.2+/-5.6 mm for the right and left sides, respectively. The prevalence of elongated styloid process in the present study was 4.5%. The clinical anatomy of this congenital variant is important to the neurosurgeon and radiologist, while interpreting the computed tomogram and magnetic resonance image scans. The morphological knowledge of elongated styloid process is clinically important since the course of the vertebral artery may be distorted in such situations.
Humans ; Prevalence ; Skull ; Temporal Bone* ; Vertebral Artery

PURPOSE: The treatment and outcome of tibial stress fractures concomitant with knee osteoarthritis (OA) are complicated. The aim of this study was to evaluate the functional and radiological outcome of total knee arthroplasty with long tibial stem as a treatment for patients having knee OA and tibial stress fracture. METHODS: Patients who were diagnosed to have proximal tibia stress fracture along with knee OA at our institution between June 2013 and November 2018 were included in our study. All patients underwent total knee arthroplasty with long tibial stem. Preoperative and postoperative functional assessments were done according to range of movement of the knee joint, knee society score and knee injury and OA outcome score. Descriptive analysis was carried out by mean and standard deviation for quantitative variables, frequency and proportion for categorical variables. RESULTS: Twelve patients were included in the study. All patients were found to have stress fractures in the proximal half of tibia and extra-arthrosis. Four patients had non-union/delayed union, and 8 patients had acute fractures. The average preoperative range of movement was 88.1°, which improved to 116.3° at 3 months following surgery. It was found that the fracture has healed in all cases. Mean knee society score improved from 32.9 preoperatively to 89.3 at 1 year follow-up. Knee injury and OA outcome score improved from a mean score of 28.3 preoperatively to 81.1 at 1 year follow-up. CONCLUSION Stress fractures can occur in the proximal tibia in patients with knee OA. Total knee arthroplasty with tibial stem provides a suitable solution for both conditions. Additional plating or bone graft is unlikely to be required.
Humans ; Arthroplasty, Replacement, Knee/adverse effects* ; Osteoarthritis, Knee/surgery* ; Tibia/surgery* ; Fractures, Stress/surgery* ; Tibial Fractures ; Knee Joint ; Knee Injuries/surgery* ; Treatment Outcome