Surgical Research and Reviews

Aim: Ameloblastoma is known to be a benign, slow-growing but locally aggressive and infiltrative odontogenic epithelial neoplasm with a rare capacity to metastasize. Peripheral ameloblastoma is a rare extraosseous variant with histological characteristics similar to those of the common intraosseous ameloblastoma. Methods: The present study describes a case of a 66-year-old woman with a maxillary peripheral desmoplastic ameloblastoma. Clinical features, histopathology, surgical treatment and follow-up are discussed. Conclusion: A clinical case of maxillary desmoplastic ameloblastoma is reported. Two months after surgery, a temporary prosthesis was applied. After the planned follow up, final rehabilitation will include bone grafting to reconstruct the resected maxillary area followed by implants positioning. Further reports of new cases are however necessary for a better knowledge of the origin, the biological behavior, and the clinical treatment of this particular odontogenic tumor variant.

Vermiform appendix anomalies including duplicated appendix are very rare with 0.004% incidence and are usually incidental findings diagnosed intraoperatively. The diagnosis can also be missed even intraoperatively during appendectomy procedure and the patient might present with another attack of acute appendicitis. We report a case of a 34-year-old male patient who presented with a typical picture of acute appendicitis based on clinical assessment, laboratory investigation and radiological studies with his past surgical history significant for appendectomy done few months prior. He underwent laparoscopic appendectomy two times within a 6-month period for two attacks of acute appendicitis both confirmed on histopathological examination.

Gastrectasia, Ectasia, or Acute gastric dilatation is a surgical emergency. Historically it was associated with binge eating, branded as gluttony, wolf eating and today goes by a refined name BED or binge eating disorder. Myriad in spectrum presentation the triggers continue to be the same a history of psychiatric disorders like anorexia nervosa, bulimia, and psychogenic polyphagia (1), (2) or following surgical procedure like fundoplication, pyloric stenosis. A masquerader in abdomen emergencies with abdominal pain and vomiting in the initial stages to shock & multiorgan collapse in later presentation. If not picked early the consequences disastrous. The mortality and morbidity from gastric dilatation is reported at 80% to 100% (1), (2), (21).

The incidence of cholecystitis with cholelithiasis is increasing day by day either acute or chronic cases. Gall stones are the most common cause of acute cholecystitis in 90-95% of the cases. The management of acute cholecystitis is still laparoscopic cholecystectomy in urban area of India but in rural area open cholecystectomy is still preferred method of surgery for acute as well as chronic gall stone. Our study was conducted on 100 patients divided into two groups of 50 of each to compare the results of open cholecystectomy between acute and chronic cases. The overall post-operative morbidity was more in acute cases. But there was significant difference in the total hospital stay and total cost of the therapy in both the groups. drain output was also high in first three days in acute case so, acute case cholecystectomy was found to be more expensive overall and higher length stay and more co morbidities than chronic cases.

Purpose: The resection of a normal-looking appendix during laparoscopic appendicectomy (LA) remains a dilemma. The optimal approach requires reliable macroscopic judgment by the surgeons. The aim of this study is to assess the surgeon’s ability to laparoscopically diagnose acute appendicitis (AA) in its initial uncomplicated grades. Method: Subgroup analysis from the POSAW study, 2016. Patients diagnosed with initial grades of AA (0 – 1) who underwent LA were included (n=718). The median age was 29.4 years, and 52% were female. The accuracy of the macroscopic intraoperative diagnosis was assessed with the histopathological examination of the resected specimens, and the agreement between the surgeon’s and the pathologist’s judgment was established. Results: Of the 79 appendices classified intraoperatively as normal-looking, 18 (22.8%) had some inflammation degree. Of the 639 appendices classified intraoperatively as inflamed, 101 (15.8%) were normal. The intraoperative surgeon’s judgment had an accuracy of 83.4% and a moderate to low agreement (Kappa 0.42). The sensitivity and specificity values were 96.8% and 37.7%, and the positive and negative predictive values were 84.2% and 77.2%, respectively. Conclusion: The surgeon’s intraoperative diagnosis of uncomplicated AA’s initial grades is not sufficiently accurate to establish good reliability for appendicectomy. The surgeon overestimates the presence of appendicular inflammation.

Aim: The aim of this article is to report on the safety and long-term efficacy of Cerament® BoneVoid Filler bone substitute for repairing craniofacial bone defects. Post-traumatic cranioplasty is a complex and challenging procedure for all maxillo-craniofacial surgeons and neurosurgeons, especially when repairing large areas. The standard criterion for repairing small cranial defects is the use autogenous bone from the iliac crest or split calvarial grafts. Autogenous grafts may result in donor-site morbidity, increased surgical time, reabsorption, blood loss, and longer recovery time . Alloplastic materials used for bone repair, such as methyl methacrylate, hydroxyapatite, titanium, or porous polyethylene, are expected to have optimal properties, including easy adaptation, biocompatibility, ingrowth of new tissue, stability of shape, and low rate of reabsorption. A cranial implant should be easily shaped and positioned, allowing easy tissue growth. In very wide cranium defects the new technology is a custom made cranial implant constructed three-dimensionally with different types of materials. However, this procedure is very expensive with various infection rates depending on the kind of material used and on the chemicophysical composition of the implant. Methods: The authors report the case of a 50-year-old man with a severe deformity of the forehead-supra orbital area as a result of a previous complex fronto-facial trauma treated in an emergency Unit. Secondary correction and reconstruction of the residual deformities were performed by using Cerament® Bone Void Filler, an alloplastic biphasic material, composed of 40% hydroxyapatite, 60% calcium sulfate and the radio-contrast agent iohexol. The unique ratio of hydroxyapatite and calcium sulfate is designed to enable Cerament to resorb at the same rate that bone forms. Calcium sulfate acts as a resorbable carrier for hydroxyapatite which is highly osteoconductive, promoting bone ingrowth.It seems to be a promising bone graft substitute in the management of bony irregularities in the fronto-orbital…

Aim: Autologous fat transfer (AFT) for the correction of maxillofacial defects was first reported at the end of the 19th century. AFT was introduced as a way of improving facial esthetics and in the last few years has expanded into applications in craniomaxillofacial reconstructive surgery and regenerative therapy. This protocol is part of translational medicine. The aim of translational medicine, or translational science, is to combine disciplines, resources, expertise, and techniques based on three main pillars: bench, bedside, and community. The primary goals to coalesce assets of various natures to significantly improve the global healthcare system. AFT is thus part of translational medicine in tissue healing, regeneration and augmentation. Methods: Several techniques have been suggested for harvesting and grafting the fat. The Authors follow Coleman’s technique with centrifugation and infiltration using different types and sizes of cannulas. Conclusion: This review provides a fairly comprehensive summary of the many exciting possibilities that exist in the field of facial fat grafting. Five clinical cases are presented and discussed. Translational medicine is the basis of this new reconstructive and regenerative field of science and research.

Appendicitis is a very common cause of acute abdomen. Most of the patient admit in surgical emergency. Diagnosis usually made clinically, sonography sometimes may be helpful. Regarding management there is still controversy exists. Developed country usually performed laparoscopy appendectomy while in developing country surgical management is still in debate. Different surgeons have different opinion either emergency open or laparoscopy appendectomy or interval appendectomy. Even in open appendectomy there is still debate between classical procedure vs small incision. This study favors single stitch surgery rather than classical and laparoscopy appendectomy. this case study supports even better cosmetic and outcome than laparoscopy appendectomy.

Desmoplastic small round cell tumor (DSRCT) is a tumor derived from the Greek desmos referring to knot and plasis to formation an uncommon soft tissue malignant tumor, mesenchymal in origin and aggressive with a prelidiction for males and advanced at presentation. It was first described as a distinct clinical entity by Gerald WL and Rosai J (7). There are fewer than 200 reported to date. Depending on the primary site of location the Clinical manifestations vary. As most arise from the abdomen and pelvis they remain asymptomatic till they attain a huge size. Other reported sites are the skull, thorax, and paratesticular region (10,13). We report the case of a 19 yr old male who had non specific abdominal discomfort with asthenia for a period of six months and was referred to us for evaluation of left supraclavicular nodes. The prognosis of Desmoplastic small round cell tumor (DSRCT) is poor with few surviving less than two years.

Aim: Frontal linear scleroderma, also known as ‘‘en coup de sabre,’’ is a congenital deformity characterized by atrophy and furrowing of the skin of the front parietal area above the level of the eyebrows. In most cases it occurs as a single paramedian line that may be associated with hypoplasia of underlying structures and facial hemiatrophy. In case of a wide lesion many reconstructive strategies have been proposed. The modern approach is aimed at augmentation of the tissue deficiency by using lipostructure and tissue regeneration. Autologous fat transfer (AFT) seems to be an effective strategy to restore the normal volume and contour of the face while providing a source of adipose-derived stem cells (ADSCs) with a multilineage differentiation potential. Methods: In this report, we present a rare case of linear scleroderma en coupe de sabre which was successfully managed with three stages of autologous fat grafting. Conclusion: The proposed uses for ADSCs in tissue repair and regeneration are quite impressive. Recent works on ADSCs would suggest that adult cells may prove to be an equally powerful regenerative tool in treating congenital and acquired maxillofacial disorders. More importantly, physicians, researchers and international associations need to cooperate in informing clinicians about what practices are based on evidence and to encourage support of additional research. There is increasing interest in a possible therapeutic effect of ADSCs from processed lipoaspirate for a wide spectrum of clinical applications in the facial and craniofacial area. AFT can be used in any facial area where soft tissue is lacking or where there is scarring, producing natural and long-lasting results. Mesenchymal stem cells represent a great tool in regenerative medicine. However, more definitive studies are needed to answer specific questions regarding the best technique to be used and the role of ADSCs. Autologous fat grafting provides a safe…