Mucosal Elevation Research Articles

A new endoscopic technique to close big nasal septal perforations: Prospective evaluation of the double meat hook technique in 19 consecutive cases.

Despite the variety of surgical techniques available to close big symptomatic septum perforations, closure rates of 30 to 70% indicate the difficulty of obtaining a good end result. The double meat hook technique is a new endoscopically assisted technique that delivers excellent visualization and control of mucosal flap elevation, extension and suturing. Mucosa from the nasal floor, lateral nasal wall and inferior turbinate bone are valuable donor site extensions. There is no need for additional incisions into the nasal septal mucosa in order to perform a tension-free closure. Preservation of the structural integrity and blood supply of the mucosal flaps, possibly contributes to a high closure rate and delivers a physiological result. This article is protected by copyright. All rights reserved.

Sinus mucosa elevation with xenograft or xenograft and autograft. PET and CT study in the rabbit

Sinus mucosa elevation with xenograft or xenograft and autograft. PET and CT study in the rabbit

Influence of a collagen membrane positioned subjacent the sinus mucosa following the elevation of the maxillary sinus. A histomorphometric study in rabbits.

To evaluate the healing after elevation of the sinus mucosa when a collagen membrane was placed between the sinus mucosa and a xenograft used as filler. Eighteen rabbits were used. Sinus mucosa elevation was performed bilaterally, and a collagen membrane was applied subjacent to the sinus mucosa only at a randomly selected test site. At both sites, a collagenated corticocancellous porcine bone was placed within the elevated space and the access window was covered with a collagen membrane. The animals were sacrificed after 2, 4, and 8weeks of healing, six animals for group. Ground sections were prepared. At the histomorphometric evaluation, the elevated area after 2 and 8weeks was 11.8 and 8.8mm2 at the test, and 10.0 and 5.3mm2 at the control sites, respectively. The available area was obtained subtracting the remaining area occupied by the membrane from the elevated area and, after 8weeks, was 6.7±0.9mm2 . After 8weeks of healing, the mineralized new bone within the elevated space was 18.2±5.5% at the test and 26.7±7.7% at the control sites. Within the available space at the test site, the percentage was 27.3±7.0% after 8weeks of healing. At 2 and 8weeks of healing, within the elevated space, the xenograft proportion was 30.9±4.4% and 6.9±2.8% at the test, and 35.2±7.3% and 9.6±4.9% at the control sites, respectively. The placement of a collagen membrane subjacent the sinus mucosa did not reveal any major morphometric difference. The collagen membrane was not completely resorbed after 8weeks.

Efficacy and safety of a combination of hyaluronic acid, chondroitin sulfate, and poloxamer 407 as a submucosal injection solution for endoscopic resection: pilot study on a swine model.

Background and aims Endoscopic resection techniques require use of submucosal injection. The aim of this study was to assess a new solution that combines hyaluronic acid, chondroitin sulfate, and poloxamer 407 for submucosal injection. Methods A total of 48 gastric submucosal cushions were created in fresh porcine stomachs using gelafundin (n = 16) or the new solution diluted at 50 % (n = 16), or 80 % (n = 16). The duration of mucosal elevation was measured. In an in vivo model, 10 gastric submucosal cushions were created by injecting 2 mL of the new solution at 80 % and the animal was euthanized 30 minutes after the last injection. Results Submucosal cushions with the new solution at 80 % and 50 % concentration lasted longer than with gelafundin (23.13 ± 15.57, 13.1 ± 6.6, 3.94 ± 1.53 minutes, respectively; P = 0.000). In the in vivo study, no damage or necrosis was observed in the mucosa or muscularis propria. Conclusion The combination of hyaluronic acid, chondroitin sulfate, and poloxamer 407 produces a long-lasting submucosal cushion and does not seem to induce acute damage in the tissue making it suitable for submucosal injection.

Endoscopic findings of the gastric mucosa during long-term use of proton pump inhibitor – a multicenter study

Background and aim: It is clinically important to diagnose drug-induced gastric lesions correctly. Recently, the use of proton pump inhibitors (PPI) has increased worldwide. The histological features induced by PPI have been reported; however, few reports have described endoscopic findings induced by PPI. Therefore, we aimed to clarify the characteristic endoscopic features in PPI users and associated pathogenic factors.Methods: We prospectively registered 1007 consecutive participants (70 PPI users and 937 nonusers) who underwent endoscopic examination for cancer screening in three hospitals/clinics. Clinical data and endoscopic findings were recorded in the registration forms. We compared the endoscopic features between the two groups and evaluated contributing factors via univariate and multivariate analyses.Results: Multiple white elevated lesions (MWEL) and cobblestone-like mucosa (CLM) were more commonly observed in PPI users compared with nonusers (p < .01). Foveolar hyperplastic polyps were also frequently observed in PPI users but were not statistically significantly different (p = .06). MWEL and CLM were more frequently observed in older patients than in younger patients. MWEL was more frequently observed in female patients than in male patients; however, CLM was predominantly observed in male patients.Conclusion: MWEL and CLM are characteristic endoscopic features in PPI users. A gender-associated difference was noted in terms of the frequency of these lesions.

Ultrastructural analysis of the tongue of White‐Eared‐Opossum (Didelphis albiventris)

The White‐Eared‐Opossum (Didelphis albiventris) is a marsupial that occupies a large variety of habitats, spreading through several Brazilian biomes and some urban areas, with an important role in seed dissemination. As a mammalian, its tongue evolved to specialized functions and, in the neonate, in addition to milk suckling, it also serves to keep them attached to the female nipple, as a support for protection within the marsupium, reflecting the success of organogenesis. Furthermore, the lingual papillae provides an indicative of the animal habits, mechanical uses, diet and taxonomic relationships.The organs were collected from individuals found dead by the roads in the state of Rio Grande do Sul, southern of Brazil. This material was previously fixed in modified Karnovsky aqueous solution and, once identified the tissue quality, it was submitted to processing for scanning (SEM) and transmission (TEM) electron microscopy.Through TEM the epithelial layers that forms the lingual mucosa were easily distinguished and identified, both in adults and fetuses. The stratum corneum at both stages demonstrate the epithelial renewal process through the release of the most superficial cells; the granular layer is more tenuous in fetuses than in adults, where many tonofilaments and several keratohyaline granules were observed; the spinous layer was similar in both ages and marked by the large number of desmossomes between the cells.Two adult tongues were used in the SEM study. One was used for the mucosa analysis, and revealed filiform papillae with different morphologies according to the region. The apex is filled with “major” papillae, like acute columns. The space among them is filled with tuft of “minor” thin and flat filiform papillae. This “minor” filiform papillae covers the entire top of the body surface but is much denser than in the apex, giving a velvet appearance to the organ. The fungiform papillae are scattered in the apex and body, and partially covered by an elevation of mucosa, looking like circumvallate papillae, since it present a moat‐like trough. Circumvallate papillae are 3 in number and form a triangle on the lingual root, with the apex oriented caudally. Foliate papillae are small and thin elevations in the caudolateral border of the tongue, ranging from 12 to 16.The other SEM study used corrosion with Sodium Hydroxide to remove the epithelial layer, reaching the connective tissue that supports the lingual mucosa. It was observed that the filiform papillae subepithelial tissue is similar to what is seen with the conventional technique. The other types of papillae present an irregular surface with some dorsal depressions. The subepithelial tissue of the two circumvallate papillae, located more rostrally, are oval like the epithelium, while the third is rounded.The characteristics observed in the tongue of D. albiventris are similar to those observed in other marsupial species.Support or Funding InformationThis research is supported by the São Paulo Research Foundation (FAPESP. Proc.: 2015/05065‐9).

Thermo-sensitive isopentane aerification for mucosal lift during endoscopic resection in animal models (with video)

Mucosal lift is critical for successful endoscopic treatment. Normal saline (NS) solution is widely used as the submucosal filler, but its short persistency restricts clinical endoscopic submucosal dissection (ESD). In this study, thermo-sensitive isopentane was introduced for submucosal injection. With a boiling point at 27.8°C, liquid isopentane can be easily applied, and gasification inflation can provide great support for submucosal lifting at body temperature. The feasibility and efficiency of isopentane were evaluated in this study. Porcine stomachs were used for invitro evaluation. A 37°C water bath was used to mimic body temperature. Compared with NS, isopentane was studied for its lifting performance, including injection dosage, persistence of lifting strength, and efficacy for assisting submucosal dissection. The changes in submucosal tissue were also compared. For invivo evaluation, rats were used to further compare the differences between isopentane and NS, including lifting efficacy, pathologic effect, and safety. Compared with NS, the maximum lifting height was achieved with less isopentane (2% NS volume). Longer persistency and faster operation for submucosal dissection were also recorded for isopentane during the invitro study. Aerification resulted in vacuolization of submucosal connective tissue, which facilitates EMR and postoperative recovery. The same results were confirmed in the rat model. With the same dosage, isopentane produced better mucosal elevation and larger range than NS. According to the histologic examination, no tissue injury was observed with isopentane application. As a submucosal injection agent, the feasibility, efficacy, and safety of isopentane has been demonstrated. Thermo-sensitive aerification may be a promising approach to facilitate ESD.

Comparison of the clinical value of XELOX and FOLFOX6 in the treatment of elderly patients with colorectal cancer

Objective To compare the clinical value of XELOX and FOLFOX6 in the treatment of elderly patients with colorectal cancer. Methods Clinical data of 68 elderly patients(aged>60 years) with colorectal cancer were retrospectively analyzed.The patients were divided into XELOX group(n=32) and FOLFOX6 group(n=36) according to the chemotherapy regimen.The response evaluation criteria in solid tumors, progression free survival, 2-year mortality, chemotherapy related adverse reactions and health related quality of life in the two groups were compared. Results Compared with the FOLFOX6 group, the neurotoxicity incidence in the XELOX group was significantly lower (3.13% vs.22.22%, χ2=5.380, P=0.020). The neutrophils reduced incidence was significantly lower(9.38% vs.30.56%, χ2=4.649, P=0.039). The hand foot syndrome complications significantly increased(34.38% vs.8.33%, χ2=7.027, P=0.008). There was no significant difference in the incidence of nausea, vomiting, diarrhea, oral mucosal ulcer, thrombocytopenia and elevation of transaminase in the two groups(χ2=0.001, 0.000, 0.008, 2.102, 1.071, 1.851, all P>0.05). The quality of health related quality of life was significantly higher in the XELOX group than in the FOLFOX6 group at 6 months after the operation[(67.94±12.49)points vs.(57.39±13.59)points, t=3.198, P=0.015]. There were no significant differences in the curative effect grade at 6 months after the operation, 2-year mortality rate and progression free survival time between the two groups(χ2=0.949, 0.008, t=0.573, all P>0.05). Conclusion Although XELOX increases the incidence of hand foot syndrome in elderly patients with colorectal cancer, but it significantly reduces the incidence of neurotoxicity and neutrophil, and improves the quality of life of patients after surgery. Key words: Colorectal neoplasms; Antineoplastic combined chemotherapy protocols; Comparative effect research; Aged

胃がん検診における胃X線検査後にS状結腸穿孔を来した1例

A 56-year-old woman presented with abdominal pain after undergoing a barium study for gastric cancer screening 2 days prior. On day 3 after the examination, she visited an emergency room and a glycerin enema was performed as the abdominal radiography revealed stagnation of barium in the pelvic region. On day 7 after the examination, she was referred to our department because of lower abdominal pain and a sensation of retained feces. Abdominal radiography revealed a small amount of barium pooled in the pelvic region and splenic flexure without free air. Colonoscopy revealed a deep ulcer with barium stagnation. The barium was removed with forceps. After 1 month, the ulcer lesion was covered elevated mucosa with dilated and tortuous surface vessels. Histopathology revealed inflammatory granulation. Five months after the initial colonoscopy, the elevated lesion was improved slightly and was incidentally biopsied. Histopathological findings remained unchanged. Eleven months after the initial colonoscopy, the elevated lesion was replaced by an ulcer scar.

Influences of Schneiderian membrane conditions on the early outcomes of osteotome sinus floor elevation technique: a prospective cohort study in the healing period.

To radiographically investigate early outcomes of osteotome sinus floor elevation in the healing phase utilizing cone beam computed tomography and evaluate influences of Schneiderian membrane conditions. One hundred patients were consecutively recruited for osteotome sinus floor elevation (OSFE) surgery using deproteinized bone mineral. CBCT was taken prior to (T0), immediately post-operatively (T1), and after the healing period (T2). Linear and volumetric measurements of the elevated region from T0 to T1 were performed for evaluation on computed tomography (CT). Osteotome sinus floor elevation were performed in 100 patients. One implant of each patient was selected. Mean residual bone height (RH) was 7.21±1.12mm. Mean sinus floor elevation height (SE) was 4.81±0.75mm. The mean endo-sinus bone gain after the healing period was 3.25±0.83mm. Pre-opterative CBCT scans revealed that 72 patients had a normal sinus membrane in osteotome region, 13 patients presented with flat thickened mucosa and 15 patients with antral pseudocysts. There is no significant difference in sinus mucosa elevation height, bone graft volume and new bone formation in group of Thickening membrane and Antral pseudocysts compared with normal. The radiographical results show that OSFE is a safe and predictable surgical procedure in residual bone height of 7.21±1.12mm. Mild flat thickening (>2 and <5mm) and antral pseudocysts in a small size without clinical symptoms may not be contraindications to OSFE surgery.

Endometriosis of the Bladder

Endometriosis is characterized by the presence of functional endometrial tissue outside the uterus. Endometriosis is common entity, but the involvement of the urinary tract is rare (1). Although endometriosis frequently occurs in women of reproductive age, bladder endometriosis is an uncommon condition (approximately 1% of all endometriosis cases). On the other hand, the bladder is the most affected organ in the urinary tract (2). Two forms of bladder endometriosis have been defined: One occurs in women without a history of uterine surgery (primary), and the other one develops after pelvic operation (iatrogenic or secondary) (3). The average age of cases is approximately 35 years. Frequency, hematuria, dysuria and urgency are the most common symptoms, however, approximately 50% of patients are asymptomatic. Severity of symptoms is related to the size of endometriotic lesions and the location. Endometriosis of the muscularis propria may show similar symptoms to those of interstitial cystitis. There is a palpable suprapubic mass in almost 50% of cases, and it may undergo catamenial expansion. Therefore, it must be kept in mind in the differential diagnosis of hematuria especially in female patients in the reproductive age (4,5). Rarely, endometriosis has been described in postmenopausal female patients treated with estrogen, likewise in men treated with hormone therapy for prostate cancer (5). Cystoscopic examination of endometriosis reveals edematous, erythematous mucosal elevations overlying blue-black or red-blue cysts, a grossly hemorrhagic, ill-defined, polypoid lesion. The overlying urothelium sometimes may be eroded. If the lesions are located in the muscularis propria or serosa, the mucosa may be intact. The bladder wall around the lesion may be thickened because of hyperplasia and fibrosis (1). Microscopically, the lesion is consisted of endometrial glands and stroma which is identical endometriosis as seen elsewhere (Figure 1). The diagnosis depends on identification Tepecik Training and Research Hospital, Clinic of Pathology, Izmir Turkey Mesanenin Endometriozisi

Sinus mucosa elevation using Bio-Oss® or Gingistat® collagen sponge: an experimental study in rabbits.

To describe the sequential healing in augmented sinus cavities with deproteinized bovine bone mineral (DBBM) granules or collagen sponges. Twenty albino New Zealand rabbits were included in the study. An incision was performed along the midline of the nasal dorsum, and the nasal bone was exposed. Circular bony windows with a diameter of 5mm were prepared bilaterally. After elevation of the mucosa, the two sites were randomly filled with either DBBM or a collagen sponge. Five animals each were randomly sacrificed after 7, 14, 21 and 40days, respectively. At both sides, new bone was found forming from the resident pristine bone. During the first stage of healing, DBBM granules were surrounded by a denser connective tissue that was attached to the biomaterial surface and that was progressively mineralized. At the collagen sponge side, the biomaterial was almost completely resorbed and the space was reduced by to two-thirds already after 21days. At both sides, after 40days, mineralized bone and marrow spaces were occupying large areas of the elevated space. New bone was found forming from the pristine bony walls of the sinus and extending toward the most peripheral regions in both sites. While DBBM particles yielded osteoconductivity and were able to preserve over time the space within the elevated mucosa, the collagen sponge failed the goal of maintaining the space.

The EndoRotor(®): endoscopic mucosal resection system for non-thermal and rapid removal of esophageal, gastric, and colonic lesions: initial experience in live animals.

Background and study aims: The EndoRotor® is a novel, non-thermal, automated mechanical endoscopic resection system designed to remove benign mucosal neoplastic tissue throughout the gastrointestinal tract. It uses suction pressure to pull in mucosa and rapidly and precisely cut it while automatically transporting the samples to a collection trap for later histologic evaluation. Patients and methods: To study the technical properties and therapeutic potential of this new tool, we performed multiple upper and lower gastrointestinal endoscopic mucosal resections in three healthy live pigs. Animals were anesthetized and kept artificially ventilated while two physicians performed multiple qualitative mucosal resections on various sites of the pigs’ esophagus, stomach, duodenum, and colon. Results: Rapid resection of flat and slightly elevated mucosa up to several centimeters in size/diameter was performed. No major bleeding occurred during and after resections. When used properly, no gastrointestinal wall perforations occurred during superficial resections. Perforations in the colon were only observed when the device was deliberately pushed against deeper sub-mucosal layers or when exceptional force was applied to penetrate the gastrointestinal wall. Histologic specimens showed complete mucosal removal at resection sites. The flexible catheter could be moved and directed towards most of the areas of interest in the gastrointestinal tract. Conclusion: The EndoRotor rapidly and easily resects flat and slightly elevated gastrointestinal mucosa with a short learning curve. Future studies in humans should be performed to prove its ability for large-area mucosal resections in benign conditions such as laterally spreading adenomas in the colon, or Barrett’s mucosa in the distal esophagus.

Five surgical maneuvers on nasal mucosa movement in cleft palate repair: A cadaver study

This biomechanical study aims to characterize the nasal mucosa during palatoplasty, thereby describing the soft tissue attachments at different zones and quantifying movement following their release. Palatal nasal mucosa was exposed and divided in the midline in 10 adult cadaver heads. Five consecutive maneuvers were performed: (1) elevation of nasal mucosa off the maxilla, (2) dissection of nasal mucosa from soft palate musculature, (3) separation of nasal mucosa from palatine aponeurosis, (4) release of mucosa at the pterygopalatine junction, and (5) mobilization of vomer flaps. The mucosal movements across the midline at the midpalate (MP) and posterior nasal spine (PNS) following each maneuver were measured. At the MP, maneuvers 1-4 cumulatively provided 3.8mm (36.9%), 4.9mm (47.6%), 6.1mm (59.2%), and 10.3mm, respectively. Vomer flap (10.5mm) elevation led to mobility equivalent to that of maneuvers 1-4 (p=0.72). At the PNS, cumulative measurements after maneuvers 1-4 were 1.3mm (10%), 2.4mm (18.6%), 5.7mm (44.2%), and 12.9mm. Here, vomer flaps (6.5mm) provided less movement (p<0.001). Maneuver 4 yielded the greatest amount of movement of the lateral nasal mucosa at both MP (4.2mm, 40.8%) and PNS (7.2mm, 55.8%). At the MP, complete release of the lateral nasal mucosa achieves as much movement as the vomer flap. At the hard-soft palate junction, the maneuvers progressively add to the movement of the lateral nasal mucosa. The most powerful step is release of attachments along the posterior aspect of the medial pterygoid.

Septoplasty in children.

Physicians have long had concerns about the potential harmful effects of pediatric septoplasties on the nasoseptal growth process because septal cartilage is important for the growth and development of the face. In this review article, pediatric septoplasty and its indications are discussed, together with a literature survey. In addition, overviews of development of the nasal skeleton from neonate to adult, nasal growth, and cartilaginous septum are presented. Important issues and comments on pediatric septoplasties are provided. During septoplasty procedures, elevation of the mucoperichondrium unilaterally or bilaterally does not negatively affect growth of the face. Stabilization of the septum may be easier when mucosal elevation is performed unilaterally. The nasal floor mucosa should not be elevated so to avoid damage to the incisive nerves. Corrections and limited excisions may be done from the cartilaginous septum. Separation of the septal cartilage from the perpendicular plate, especially at the dorsal part, should not be performed because this area is important for the length and height of the nasal septum and nasal dorsum. Incisions or excisions should not be performed through the growing and supporting zones, especially at the sphenoethmoid dorsal zone. If there are severe breathing problems related to the septal deviation, septoplasty should be performed. In the majority of cases, septal surgery may be conducted in 6-year-old children. However, if necessary, septal surgery may be performed in younger children and even at birth.

Safe and Efficient Colonic Endoscopic Submucosal Dissection Using an Injectable Hydrogel.

Endoscopic submucosal dissection (ESD) has not yet been widely adopted in the treatment of early colonic cancers due to the greater technical difficulty involved, longer procedure time, and the increased risk of perforation. Adequate mucosal elevation by submucosal injection is crucial for en bloc resection and prevention of perforation during colonic ESD. This study is aimed to evaluate the efficacy of an injectable thermoreversible hydrogel as the colonic submucosal agent for the first time. Triblock copolymer poly(lactic acid-co-glycolic acid)-poly(ethylene glycol)-poly(lactic acid-co-glycolic acid) (PLGA-PEG-PLGA) was synthesized, and its concentrated aqueous solution was injected into the colonic submucosa of living minipig and spontaneously transformed into an in situ hydrogel with adequate mucosal elevation at body temperature. Such a mucosal lifting lasted for a longer time than that created by the control group, glycerol fructose. Colonic ESD was then performed with the administration of hydrogels at various polymer concentrations or glycerol fructose. All colonic lesions were successfully resected en bloc after one single injection of the hydrogel, and repeated injections were not needed. No evidence of major hemorrhage, perforation and tissue damage were observed. Considering the injection pressure, duration of mucosal elevation and efficacy of "autodissection", the hydrogel containing 15 wt % polymer was the optimized system for colonic ESD. Consequently, the thermoreversible hydrogel is an ideal submucosal fluid that provides a durable mucosal lifting and makes colonic ESD accessible to a large extent. In particular, the efficacy of "autodissection" after one single injection of the hydrogel simplifies significantly the procedures while minimizing the complications.

Quantitative and qualitative analysis of palatal rugae patterns in Gujarati population: A retrospective, cross-sectional study.

Introduction:Palatal rugae are irregular and nonidentical mucosal elevations seen on the anterior third of palate. They are arranged in transverse direction on either side of the median palatine raphe (MPR) and are protected from high temperature and trauma because of their rational position in the oral cavity. Their number and patterns are not uniform in all the individuals, and they appear to vary in different population subsets. The study of palatal rugae is termed as “Rugoscopy” or “Palatoscopy”, and it finds its application in various fields such as anthropology, orthodontics, forensic sciences; including forensic odonto-stomatology.Aim:The aim of this study was to evaluate the quantitative and qualitative parameters of palatal rugae using pre-orthodontic study models of Gujarati samples.Objectives:(1) To identify the predominant palatal arch forms in the study samples. (2) To evaluate and correlate the rugae count in both male and female samples with the different palatal arch forms. (3) To assess the symmetry and/or asymmetry in rugae count between the right and left side. (4) To analyze and correlate the qualitative characters such as size, shape, direction, and unification in male and female study samples.Materials and Methods:One hundred pre-orthodontic maxillary dental stone casts of patients with an age range of 17–25 years were selected. The outlines of the rugae were traced using microtip graphite pencil and examined using magnifying glass for different patterns. The quantity and quality of rugae patterns were recorded according to Thomas et al. classification and the data were statistically analyzed by the statistician using SPSS program.Results:Overall, 962 rugae were observed in the study sample. The mean rugae count was 9.86 in males and 9.38 in females. The left side rugae count was more than the right side in both the sexes and it was not statistically significant. Fifty-six percent of the samples showed asymmetry in rugae count between the right and left. Class B palatal arch form was the most common type in the study samples. The number of primary rugae count was more in both the sexes. The distribution of straight (40.2%) and curved (40.4%) types of rugae were almost equal in males but in females, the straight rugae pattern (42.2%) was more than the curved (36.9%), followed by wavy and circular. Of 962 rugae, 36.4% were of horizontal type followed by forward (33.4%) and backward (29.2%). About 1 % of rugae showed perpendicular pattern and only 9.25% showed unification pattern and the divergent type of unification was more common than the convergent type.Conclusion:There is no gender discrimination in relation to any of the metric or non-metric parameters of the palatal rugae in this study samples. No two samples showed similarity in the distribution of palatal rugae patterns. The straight and horizontal rugae distributions were predominant in our Gujarati Study samples.

Quantitative and Transverse Changes in the Position of Palatal Rugae after Palatal Expansion

Background: Palatal rugae are irregular and non-identical mucosal elevations seen on anterior third of palate. They are arranged in transverse direction on either side of Median Palatine Raphe [MPR]. Though they are the most stable anatomical structures in the oral cavity, certain conditions like orthodontic treatment contribute to some amount of variations in their pattern qualitatively. During literature review, we found scarcity of articles related to quantitative changes in rugae patterns, before and after palatal expansion. The aim of this study was to compare the number of rugae and its positional changes using before and after Semi Rapid Maxillary Expansion (SRME) study models. Materials and Methods: Seventy nine pairs of pre and post expansion casts showing finer details of palatal rugae from 37 males and 42 females in the age group of 10 to 12 years were selected for this study. The number of rugae and the distance between the median points of the first and the last two rugae on either side of MPR were noted. The data collected were statistically analyzed using SPSS program Results: Descriptive statistics mean and standard deviation were performed for study group before and after treatment at T0 and T1. There was no statistically significant change in number of rugae in the right side but significant differences were noted in the distance between medial points of first two rugae and distance between last two rugae. There was statistically no significant change in any of the variables when the data from male and female samples were compared. Conclusion: During maxillary expansion, there is stability of palatal rugae with respect to its number but not with respect to its position. There is significantly more separation of the medial ends of the opposing rugae on either side of MPR in the anterior region than on the posterior.

Interlink of Two Syndromes - Demarquay-van der Woude and Popliteal Pterygium in One Family Group

Background and Objective: Demarquay-van der Woude (DVWS) and Popliteal Pterygium (PPS) syndromes are distinct autosomal dominant conditions generally presenting with a cleft lip and/or cleft palate. Both syndromes are genetically associated with mutations of the gene coding for Interferon Regulatory Factor 6 (IRF6) and grouped together as the IRF6-Related Disorder. In addition to a cleft, DVWS characteristically includes generally two labial pits on the lower lip. The pits may be symmetrical or asymmetrical, with saliva draining from them, or may also be abnormally flabby or conical-shaped mucosal elevations without distinct pitting. In PPS, the cleft patient commonly presents with an extensive single lower lip pit with salivary drainage, as well as popliteal webs/pterygia of the lower limb/limbs. Additional defects may include intraoral synechial web, syndactyly and genito-urinary malformations. Methods: One case (infant) with two family members presented with overlapping deformities associated with DVWS, as well as PPS. Sequencing of the IRF6- gene was performed on one of the members. Results: The surgical records of 4182 patients of a major cleft lip and palate clinic recorded 71 (1.70%) patients diagnosed with DVWS, 12 (0.29%) with PPS and one infant (0.02%) as an interlinked DVWS-PPS. In the family of the baby presented in this paper, all three affected individuals are females and each the third child in the family, who have lip pits typically associated with DVWS that are both bilateral and symmetrical. The grandmother and grandchild, but not the mother, has underdeveloped or minor unilateral popliteal webs. All three have syndactyly of their feet with hypoplastic toenails (involving one to three phalanges) and pyramidal-shaped (or redundant) skin above the hallux nail of the main phalanges. Conclusion: The infant and two family members are identified as interlinked DVWS-PPS.

Assessment and Evaluation of Anatomic Variations of Retromolar Pad: A Cross Sectional Study.

The retromolar pad also called piriformis papilla is a mucosal elevation located in the retromolar area covering the retromolar triangle. After molar loss, the bony alveolar process and surrounding soft periodontal tissue remodel, mainly resorb and blend with retromolar pad. It is a key intraoral landmark in prosthodontics. The aim of this in-vitro study was to analyze the various anatomical shapes and sizes of retromolar pad in 150 completely edentulous patients between 55 to 70 years of age group. The study was conducted on 150 completely edentulous patients. The shapes of retromolar pad on the left and right side were seen and divided into pear, triangular and round shape. The comparison of the mean longitudinal diameter and transverse diameter on the right and left sides was done. The data was evaluated statistically. The chi-square test was used for the comparison between the proportions with the help of standard deviation, t-test was used for comparison between the left and the right side and ANOVA test was used for comparison between the various shapes of the retromolar pads. The result showed that there was statistically significant difference among different shapes of retromolar pad and there was significant difference in mean transverse and longitudinal diameter on right and left side, the mean value of the longitudinal diameter on left and right side was 8.81 and 8.69 whereas the mean value of the transverse diameter on left and right side was 6.79 and 6.82 respectively and p-value obtained for both was 0.550 and 0.814 respectively. The study conclude that there are three different shapes of retromolar pad among which pear and triangular shaped retomolar pad provides more stability in lower denture because of increase surface area.