Tuberculous meningitis can lead to precocious puberty. Central nervous system (CNS) hamartomas are common etiological factors but association of tuberculomas with precocious puberty is very unusual. Here, we are reporting a 6-year-old male child who developed precocious puberty secondary to tuberculoma.

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Context: Frontal esthetics should equal the profile in importance when planning orthodontic treatment. Soft tissue profile changes associated with orthodontic treatment have been the subject of many studies, but changes in the vertical dimension of the lips after orthodontic treatment by different appliances has received little attention. Aims: The purpose of this study was to compare the changes of vertical dimension of vermilions after standard and preadjusted orthodontic treatment. Setting and Design: Retrospective study. Materials and Methods: In this retrospective study, 60 patients (30 patients treated with standard edgewise appliances and 30 patients treated with preadjusted appliances) were randomly selected from the practice of two experienced orthodontist. Ratios between vermilion height and inter-commisural width were recorded on pre- and posttreatment photographs using Adobe Photoshop software. Data were analyzed with SPSS version 16 software and ANOVA analysis to compare vertical lip changes between two orthodontic systems. Results: The mean of vermilion height to inter-commisural width ratios after orthodontic treatment in preadjusted group (P = 0.019) and standard group (P ? 0.001) was significantly less than that before treatment. The reduction of this ratio after preadjusted orthodontic treatment was less than that in standard edgewise orthodontic treatment but this difference was not statistically significant (P = 0.127). Conclusion: In this study, the vertical height of lips decreased significantly after orthodontic treatment in both groups and there was no significant difference in standard and preadjusted appliance. Therefore these changes must be discussed with patients before orthodontic treatments.

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Atherosclerosis is a chronic inflammatory condition and infectious diseases are believed to contribute to its pathophysiology. Periodontitis is a chronic infectious disease of the supporting tissues of the teeth, and the epidemiological association with atherosclerosis is now beyond doubt. However causal mechanisms are still lacking; research suggests that bacteria from the periodontal lesions may enter atherosclerotic plaques. Alternatively, elevated CRP and a prothrombotic state in periodontitis contribute to exacerbation of atherosclerosis. Finally, the link may also be explained by polymorphisms in the ANRIL gene, which has been associated with both atherosclerosis and periodontitis. Previous studies used surrogate biomarkers to investigate the association between atherosclerosis and periodontitis, and to evaluate the effects of periodontal intervention. Unfortunately, more definitive cardiovascular parameters are still lacking, because of methodological difficulties in study design and ethical considerations.

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Context: Lingula is a sharp tongue-shaped bony projection located on the medial aspect of mandibular ramus and knowledge regarding its shape, size, and location is clinically significant in oral and maxillofacial surgeries. Aim: The present study aims to study shape, height, and precise location of lingula in dry adult human mandibles. Materials and Methods: The material for this study comprised of sixty (120 sides) dry adult human mandibles of North Indian origin to determine the morphological features and location of lingula. Student's t-test was used for statistical analysis. Results: Triangular (61.6%) shape of lingula was most commonly found followed by truncated (46.6%), nodular (31.6%), and assimilated (11.6%) types. Each type of lingula was more often unilateral than bilateral. The mean height of the lingula was 5.5 ? 2.02 mm. The mean distance of lingula from the anterior and posterior borders of mandibular ramus was 20.0 ? 2.4 mm and 15.0 ? 2.7 mm, respectively. The lingula was located at 15.4 ? 2.7 mm from the mandibular notch and 30.4 ? 3.5 mm from the distal side of alveolar socket of mandibular second molar tooth. The mean lingula ratio was 0.567 ? 0.005. Conclusion: The information regarding shape, height, and precise location of lingula in relation to various mandibular ramal landmarks could be of immense help in performing surgical procedures such as bilateral sagittal split ramus osteotomy (BSSRO), intraoral ventral ramus osteotomy (IVRO), and inferior alveolar nerve block.

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The presence of a solitary, firm, progressive or rapidly growing mass in the orofacial region has a long list of differential diagnoses, ranging from benign lesions to more fatal malignant ones. Nodular fasciitis (NF) is a benign, reactive proliferation of fibroblasts and myofibroblasts, which typically arises in the subcutaneous fascia, most probably in response to a local injury. Although commonly seen in the upper extremities (50%), orofacial NF is less common, with an incidence of less than 20%, primarily affecting adults in the fourth and fifth decades of their life. In this report, we describe a unique case of oronasal nodular fasciitis, aggravated by trauma, in a six-year-old female child. To the best of our knowledge, this is the first case report in the literature of nodular fasciitis arising in this anatomic location.

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Objectives: In the present study, we reviewed our experience with full-length low- and medium-pressure peritoneal shunts and recorded any additional complications/benefits caused by using these shunts. Materials and Methods: This study was conducted from May 2005 to December 2006 in the Department of Surgery, Government Medical College Hospital, Jammu. Over the study period, all the children who underwent ventriculoperitoneal shunt for hydrocephalus were included. Ventriculoperitoneal shunt was placed in all the cases by using the Chhabra 'Slit n spring' hydrocephalus shunt system. In all the cases, the shunt was placed on the right side with a common technique of insertion. In the present study, the full length of the distal catheter was placed in the peritoneal cavity in all the cases. Before placing the peritoneal catheter into the abdomen, the length of the inserted peritoneal tube was measured. All patients were followed up on a fortnightly basis for the first three months and thereafter on a three-monthly basis. Results: A total of 30 children underwent right ventriculoperitoneal shunt for congenital hydrocephalus during the study period. Mean age of the patients was 11.1 months (range: 1-36 months, SD: 11.0963, median: 7 months). There were 16 male and 14 female patients and 75% children were less than 17 months of age. In the present study, the full length of the distal catheter was placed into the peritoneal cavity and it was observed that the minimum length of the distal catheter placed inside was 44 cm and the maximum length was 52 cm. Twenty-five children (83.3%) had normal shunt functioning with no clinical or radiological evidence of shunt complications at a follow-up at one year. Five children (16.6%) had features of shunt malfunction and were evaluated further. Conclusion: In accordance with the literature, we find that the length of the peritoneal catheter of the shunt tube does not increase the distal complication rate; however, the use of adequate length of the peritoneal catheter does eliminate the need to lengthen the peritoneal catheter as the child grows.

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Unicystic ameloblastoma (UA) refers to those cystic lesions that show clinical and radiologic characteristics of an odontogenic cyst but in histologic examination show a typical ameloblastomatous epithelium lining part of the cyst cavity, with or without luminal and/or mural tumor proliferation. These tumors characteristically expand within the jaw and displace the bone, the teeth and their roots. Occasionally, infiltrating tumors may erode through the bone and extend into the soft tissue. The tumor is most commonly seen in the posterior mandible, but may also arise in the maxilla and the anterior aspect of the jaws. The unicystic type of ameloblastoma is one of the least encountered variant of the ameloblastoma. We report a case of UA of maxilla in a 32-year-old male patient.

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Herpes zoster (HZ) presents as cutaneous vesicular eruptions in the areas innervated by the affected sensory nerves and is usually associated with severe pain. Oral manifestations of HZ appear when the maxillary or mandibular divisions of the trigeminal nerve are involved. Infection commonly occurs unilaterally and affects mostly middle-aged or the elderly persons. Multiple complications have been reported following HZ of the trigeminal nerve. The most common among them is the neuralgia. There are only a few reports of bony and dental complications following HZ infection. The aim of this article is to present a case of a 44-year-old male patient affected by HZ infection involving trigeminal nerve which led to necrosis of bone and exfoliation of teeth.

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Background: Measurement of normal maximum mouth opening (MMO) in children is an important diagnostic criterion in the evaluation of the stomatognathic system. The aim of this study was to determine the MMO in children from the Indian population, of age six to twelve years, and to examine the possible influence of age, gender, height, and body weight on MMO. Assessment of MMO was accomplished with a modified Vernier Caliper, by measuring the distance between the incisal edges of the upper and lower incisors during maximal mouth opening up to the painless limit. Materials and Methods: The study consisted of 856 children from various schools in the city of Rohtak (Haryana), India, who were randomly divided into three groups based on their age: Group 1: Children of age six to eight years; Group II: Children of age eight to ten years; Group III: Children of age ten to twelve years. For each subject three readings were recorded in millimeters and the mean value was considered. The age, gender, height, and body weight of each child were also recorded at the same time. A P value of < 0.05 was considered to be significant. Results: The results of the present study revealed that MMO in Indian children were 46.04 mm, 48.53 mm and 52.38 mm for boys and 45.95 mm, 47.27 mm and 52.05 mm for girls, in the age groups of six to eight, eight to ten, and ten to twelve years, respectively. Conclusion: Significant associations were observed in between age, height, body weight, and MMO. However, no gender difference was observed.

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Odontogenic keratocyst (OKC) has been the subject of great interest since Philipsen introduced the term in 1956. Investigations continue into the lesion's pathologic classification, diagnosis and biologic behavior. OKCs are one of the most frequent features of nevoid basal cell carcinoma syndrome (Gorlin Goltz syndrome/Bifid rib syndrome). We report a rare case of multiple OKCs in a nonsyndromic patient in a 16-year-old male patient, with emphasis on its diagnosis, radiographic features and management.

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Background: Application of resorbable materials in craniofacial surgery offers many advantages compared with conventional materials such as titanium which is used in the reduction of incidence of complications like extrusion, intracranial migration or translocations of the implant, also there is no restriction on the skeletal growth as well as no distortion in plain radiographic and CAT scan studies. Materials and Methods: It was a prospective, sequential, comparative and open study carried out between October of 2002 and February of 2004 among patients of the Clinic of Craniofacial Surgery at ISSEMYM Medical Center in Metepec, Mexico. The patients were sequentially assigned either to group I in which LactoSorb^? (Biomet microfixation) resorbable screws and miniplates of 1.5 mm, 2.0 mm and 2.5 mm sizes (made up of 82% PLLA and 18% PGA) were used; and to group II in which titanium screws and miniplates of the same sizes were used. All patients were preoperatively documented with clinical examination, clinical photographs and CAT scan. Results: A total of 100 patients were included with 50 patients in each group. In group I, 40 patients (80%) with facial fractures were operated, of which 18 were simple maxillary fractures, 11 were fractures of orbitomalar complex, 7 panfacial fractures, 2 fractures of frontal sinus and 2 mandibular fractures; in 5 patients (10%) with malocclusion, some kind of orthognathic surgery was performed, 4 maxillary osteotomies and one maxillo-mandibular osteotomy were performed; and the remaining 5 patients (10%) were subjected to some advanced craniofacial surgery procedure, in one patient with Apert's syndrome a fronto-orbital advancement was performed, there were 3 patients with hypertelorism in whom orbital medialization was undertaken in two cases and facial bipartition in one; the remaining case was a Treacher Collins patient in which a orbital reconstruction using monocortical parietal bone was performed. In the age range of 6-55 years with an average of 30.5-year-old in these procedures, a total of 196 miniplates were placed. Conclusions: The results of our study confirm data reported by previous descriptive studies about the systems for resorbable fixation. We consider that the present method of resorbable fixation is a viable and safe option for the management of patients who require some type of fixation of the craniofacial skeleton.

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The risk of local and systemic complications are ever present during the administration of nerve blocks in the field of dentistry, but the knowledge and timely steps taken by the clinician can decrease the incidence of this event in his/her practice. Here the author presents a case of transient blurring of vision in one eye following the administration of posterior superior alveolar nerve block prior to a dental surgical procedure. To explain the possible mechanism of this rare complication and to make aware of such complications of local anesthetic in dental practice.

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Objectives: To assess the impact of socioeconomic status (SES) on decayed, missing, filled teeth (DMFT) among state government employees in Shimla city, Himachal Pradesh. Design: Cross-sectional study. Materials and Methods: This study was conducted on 1008 dentate subject 705 (69.9%) males and 303 (30.1%) females out of 10908 government employees. Data regarding dentition status and treatment needs was recorded on a W.H.O. format 1997. Type III examination was conducted under good illumination by the investigator himself. Student's t-test or ANOVA was applied for statistical evaluation of means and the comparisons of proportions. P value ? 0.5 and ? 0.01 was considered statistically significant and highly significant respectively. Results: Total teeth examined were 29575 out of which 14.84% were decayed. Overall mean DMFT was 3.29 (1.86). Females were reported significantly higher ( P < 0.05) DMFT 3.49 (2.31) than males 3.12 (1.42). Subjects who belong to upper SES had lesser mean DMFT than lower SES 2.31 (2.4) vs 4 (3.89), which was statistically highly significant ( P < 0.01). Employees who brush their teeth once a day presented with higher DMFT 4.01 (2.01) than those who brush once daily 2.57 (1.96). The difference was highly significant ( P < 0.01). Conclusions: A preventive and curative oral health policy for the government employees in Shimla city needs to be planned and implemented to maintain their commitment in their official work. Also they must be educated the importance of oral health and methods how to maintain it.

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Context: It is well-known that subjects affected by Ehlers-Danlos Syndrome (EDS), hypermobility type/Joint Hypermobility Syndrome are characterized by severe joint hypermobility with recurrent joint dislocations and chronic pain and biomechanical dysfunction of the temporo-mandibular joint (TMJ). Aims: The study aims to measure TMJ mobility in EDS subjects to quantitatively characterize the TMJ dislocation during specific tasks as well as head adjustments, already documented by literature by observational techniques. Materials and Methods: Female EDS subjects and age matched controls were asked to perform simple opening-closing movements of the mandible. Kinematics data was recorded and analyzed through an optoelectronic motion capture system. Some parameters of the motion were studied: range of motion of the condyles, range of motion of the chin, aperture angle, movement speed, and frequency. Statistical Analysis Used: The statistical t-test was used to compare results from pathological group to the control group. Results: Significant differences, between EDS group and controls, were found for the backward rotation of the head, lateral range of motion of the chin, frequency, and velocity. Results were in accordance with the clinical observations. The results not only confirmed that EDS subjects back-rotate the head while performing the opening-closing task but also quantified the entity of this behavior. Conclusions: The method we proposed is noninvasive and is able to analyze mandible kinematics. It may be used by clinicians to assess the healthy status of TMJ, to quantify mobility, and hypermobility of the mandible and to help diagnosis of TMJ dysfunctions.

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Fusion is a developmental anomaly of dental hard tissues characterized by the union of two adjacent teeth. It may be complete with the formation of an abnormally large tooth or incomplete with the union of crowns or roots only. Exact etiological factors are still enigmatic. It is more common in deciduous than in the permanent dentition with higher frequency in anterior maxillary region. We present a case of fusion in permanent maxillary incisor region in a 35-year-old male who presented with the complaint of pain in same region. Early diagnosis is important to avoid various complications such as compromised aesthetics, space loss, midline shift, and carious exposure.

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Zygomatic air cell defect is extension of pneumatization of temporal bones anteriorly into the articular tubercle. These are variations of normal structures which can be detected on the simplest imaging modality, the panoramic radiograph. A literature search, electronic as well as manual, was done using the keywords zygomatic air cell defect, pneumatized articular eminence and pneumatized articular tubercle. The search yielded considerable literature on the topic, which was analyzed thoroughly for its contents and this paper reviews this normal variant from the time of its recognition to the present day updates. It can be concluded that the zygomatic air cell defect has a low prevalence in general population and can be mistaken for a pathologic process. Further, if not recognized in subjects undergoing surgical procedures may lead to inadvertent complications such as leakage of cerebrospinal fluid.

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