Mouth Research Articles

Standardization of Oral Photography in Dogs and Cats.

Oral photography is one of the essential methods of maintaining dental records. The primary purpose of photography is to record an image. Images of the oral cavity should have sufficient detail for discerning the features of the hard and soft tissues; in addition, they should accurately reproduce the real colors as they appear in the mouth. Photographs are of value during the repeated monitoring of patients and while making comparisons among historical cohort studies. This article describes the equipment and techniques for obtaining high-quality images of the oral cavities of dogs and cats in a standardized way.

Differences in characteristics of Central Giant Cell Granuloma with Ameloblastoma, Odontogenic Myxoma and Aneurysmal Bone Cyst through radiographic approach

Objectives: This study aims to determine the differences in the characteristics of Central Giant Cell Granuloma with Ameloblastoma, Odontogenic Myxoma, and Aneurysmal Bone Cyst through a radiographic approach so as to expand understanding of the characteristics of Central Giant Cell Granuloma with benign lesions of the oral cavity that have similar characteristics. Review: The data used in this study are research journals published on PubMed and Google Scholar search engines. Selecting keywords namely Radiology, Central Gaint Cell Granuloma, Differential Diagnosis by formulating research questions to provide an operational framework using the PICO framework (P: Patient, Population, or Problem; I: Intervention or Exposure; C: Comparison; Outcome). Data collection procedures were carried out through journal identification, then data reduction was carried out, namely selecting journals that were in accordance with the research concept, so that inclusion and exclusion criteria were determined and tested for eligibility and completeness of journals. Conclusion: In this literature review, it was found that Central Giant Cell Granuloma can be diagnosed in comparison with Ameloblastoma, Odontogenic Myxoma, and Aneurysmal Bone Cyst. A total of 41.6% compared with Ameloblastoma, so Ameloblastoma has a higher percentage. 19.4% compared with Odontogenic Myxoma and 38.8% compared with Aneurysmal Bone Cyst.

Oral cancer screening using cytopathology: An advanced proposal with the Bethesda classification.

Oral cancer screening requires analysis capable of detecting changes preceding the clinical manifestation. Oral cytopathology studies as an oral cancer screening have shown promising results. This study aims to evaluate the use of cytopathology in a quali-quantitative analysis using Papanicoloau staining. Four experimental groups were evaluated: control (CG), exposed to carcinogens (EG), potentially malignant disorder with and without epithelial dysplasia (D-OPMDG and ND-OPMDG) and oral squamous cell carcinoma (OSCCG). Oral smears were collected using a Cytobrush® and conventional exfoliative cytology. Oral Papanicolaou smears from 143 individuals were analysed in 8100 images. Qualitatively, non-lesional groups exhibited minimal suspected cases (20% in CG and 5% in EG), in the OPMD groups the ability to identify altered cells was low (40% in D-OPMDG and 0% in ND-OPMDG). Conversely, a notable100% accuracy was achieved in the OSCCG. Quantitatively, a higher percentage of anucleated and a lower percentage of intermediate cells were observed in the OPMDG; a higher proportion of parabasal/suspicious cells was observed in OSCCG. The optimal threshold for improved accuracy in detecting suspected malignancies occurs when the count of parabasal/suspicious cells exceeds 8/100 cells examined. Cytomorphometric analysis revealed a higher nucleus/cytoplasm ratio (N/C) in OSCCG, with a best cutoff point indicating enhanced accuracy in discerning suspected malignancies when exceeding 17% of cells exhibiting this elevated ratio. It is possible to suggest updates in cytomorphometric and quantitative analysis in the modified Bethesda system for the oral cavity including objective criteria in the risk classification, therefore improving oral cancer screening.

Detection of Epstein‒Barr virus DNA methylation as tumor markers of nasopharyngeal carcinoma patients in saliva, oropharyngeal swab, oral swab, and mouthwash.

Saliva biopsy of nasopharyngeal carcinoma (NPC) has been developed in our latest study, indicating the application of oral sampling in NPC detection. Further exploration of the potential for self-sampling from the oral cavity is necessary. A total of 907 various samples from oral cavity, including saliva (n=262), oropharyngeal swabs (n=250), oral swabs (n=210), and mouthwash (n=185), were collected. Epstein‒Barr virus (EBV) DNA methylation at the 12,420bp CpG site in EBV genome from the repeat-copy W promoter (Wp) region and at the 11,029bp CpG site in the single-copy C promoter (Cp) region were simultaneously detected in these samples. A significant increase in EBV methylation, no matter at Wp or Cp region, was found in all types of samples from NPC patients. However, EBV DNA methylation in saliva and oropharyngeal swab showed a better diagnostic performance in detecting NPC. The combination of these two sample types and two markers could help to improve the detection of NPC. Our study further explored the optimal self-sampling methods and detection target in the detection of NPC and may facilitate the application of EBV DNA methylation detection in a home-based large-scale screening of NPC.

Effects of fluid shear stress on oral biofilm formation and composition and the transcriptional response of Streptococcus gordonii.

Biofilms are subjected to many environmental pressures that can influence community structure and physiology. In the oral cavity, and many other environments, biofilms are exposed to forces generated by fluid flow; however, our understanding of how oral biofilms respond to these forces remains limited. In this study, we developed a linear rocker model of fluid flow to study the impact of shear forces on Streptococcus gordonii and dental plaque-derived multispecies biofilms. We observed that as shear forces increased, S. gordonii biofilm biomass decreased. Reduced biomass was largely independent of overall bacterial growth. Transcriptome analysis of S. gordonii biofilms exposed to moderate levels of shear stress uncovered numerous genes with differential expression under shear. We also evaluated an ex vivo plaque biofilm exposed to fluid shear forces. Like S. gordonii, the plaque biofilm displayed decreased biomass as shear forces increased. Examination of plaque community composition revealed decreased diversity and compositional changes in the plaque biofilm exposed to shear. These studies help to elucidate the impact of fluid shear on oral bacteria and may be extended to other bacterial biofilm systems.

Visualization of the infratemporal fossa: enhancing anatomical learning through three-dimensional modeling.

The infratemporal fossa and pterygopalatine fossa are critical pathways for blood vessels and nerves leading to the orbit, nasal cavity, and oral cavity. Anatomical observation of these areas is challenging for learners due to their complex connections with surrounding structures and their deep location within the body. Since it is not easy to understand this area in three dimensions with only textbook images, there is a need to produce three-dimensional (3D) content. Most existing 3D data have reconstructed the digital imaging and communication in medicine files from computed tomography images with high accuracy; however, the surrounding structures often obstruct the view. For this reason, this project utilized Cinema4D (R18; Maxon) software to refine the modeled bones and to create 3D models of muscles, blood vessels, and nerves that accurately represent their anatomical shapes and pathways. To facilitate easier access for learners via PC, the content was converted into PDF format. This enables the educational materials to be more easily viewed and the main structures more clearly observed using a computer-based viewer.

Acute salivary antimicrobial peptide secretion response to different exercise intensities and durations.

Antimicrobial peptides, key players of innate mucosal immunity in the oral cavity, exert antibacterial and bacteriolytic effects. This study aimed to clarify the effects of acute exercise at different intensities and durations on salivary antimicrobial peptide levels. In a randomized crossover trial, 14 young healthy untrained men performed intensity trials (cycling at 35%, 55%, and 75% of maximal oxygen uptake [VO2max] for 30 min) and duration trials (cycling at 55% VO2max for 30, 60, and 90 min). Saliva samples were collected at baseline and 0 and 60 min after exercise. In intensity trials, the change in salivary Lactoferrin levels from baseline to 0 min after 30-min exercise was greater at 75% VO2max exercise intensity compared to that at 35% VO2max. Furthermore, the change in salivary human beta defensin-2 (HBD-2) levels was greater at 75% VO2max compared to that at 35% and 55% VO2max. Salivary Lysozyme levels increased after exercise, independent of exercise intensity. However, salivary LL-37 levels did not change after exercise at any intensity. Additionally, in duration trials, the change in salivary levels of LL-37 and HBD-2 from baseline to 0 min after exercise at 55% VO2max was greater after 60 min and 90 min of exercise compared to that after 30 min of exercise. However, salivary Lactoferrin and Lysozyme levels increased after exercise, independent of exercise duration. Our findings suggest that secretory responses to acute exercise with exercise intensity and duration differ among salivary antimicrobial peptides.

Kawasaki Disease

Kawasaki disease (KD) is a type of acute inflammation of blood vessels, accompanied by a fever, for which the cause is yet unknown. It primarily affects children who are under the age of five. Kawasaki disease (KD) frequently results in the development of coronary artery lesions (CALs), which include dilated arteries, coronary artery aneurysms (CAAs), and potentially life-threatening myocardial infarction. under the age of five. Kawasaki disease (KD) frequently results in the development of coronary artery lesions (CALs). This case report aims to further explore the diagnosis and the management of KD. In this case report we discuss a 3-year-old male patient who was diagnosed with KD with the main complaints of fever, red eyes, rash, redness of lips with cracked and oral cavity. Patient’s lab work showed hypoalbuminemia, increased D-Dimer, and increased Troponin I. Electrocardiography and echocardiography was performed to observe cardiac complication. Soon aspirin and IVIG and showed an improvement. The child was treated for 6 days and then controlled at the outpatient clinic. Keywords: Kawasaki Disease, Pediatric, IVIG, Aspirin

A Multimodal Protocol Combining 99mTc-Tilmanocept with Indocyanine Green Fluorescence Lympho-Angiography for Sentinel Lymph Node Biopsy in Early-Stage Oral Cancer: A Case Series.

Sentinel lymph node biopsy (SLNB) is currently considered as a viable alternative to elective neck dissection (END) for the management of cN0 oral cavity squamous cell carcinoma (OCSCC). However, some difficulties were detected in sentinel lymph node (SLN) identification in floor of mouth (FOM) and ventral tongue tumors because of the so-called "shine-through radioactivity" of the injection site, which may mask nodal hotspots in proximity. We assessed the feasibility and the potential strengths of combining 99mTc-Tilmanocept with indocyanine green (ICG) fluorescence lympho-angiography in a dedicated multimodal protocol for SLNB in T1/T2N0 oral cancer to evaluate the synergistic role of each of these two tracers in providing the appropriate sensitivity and ease of learning, even in such a critical anatomical subsite. A detailed, stepwise description of our multimodal protocol is provided, together with the presentation of its application in two cases of early-stage ventral tongue tumors. Radioactive guidance with 99mTc-Tilmanocept was used preoperatively to perform planar lymphoscintigraphy and single-photon emission computed tomography/computed tomography and to define the nodal hotspot(s) and the surgical "roadmap". In addition, it was used intraoperatively to pinpoint the SLN location within each nodal hotspot with high specificity but limited spatial resolution. Optical guidance with ICG injection at the tumor bed and near-infrared fluorescence imaging was then added, providing intuitive intraoperative guidance within each nodal hotspot with high spatial resolution. Our small experience with this protocol is illustrated and future perspectives are highlighted.

Analysis of 132 submandibular salivary glands using the Randox Evidence Investigator and Randox DOA ULTRA WB array.

Occasionally, obtaining an adequate or acceptable postmortem blood specimen for drug analysis is not possible due to factors such as decomposition, exsanguination, or embalming. Submandibular salivary gland tissue, one of three major types of salivary gland tissue in the oral cavity of humans, has been reported to be a viable alternative postmortem specimen for toxicological testing. In this study, we evaluated the performance of the Randox Evidence Investigator instrument and Randox DOA (Drugs of Abuse) Ultra Whole Blood Array for the semi-quantitative determination of 21 immunoassays in an alternative matrix, submandibular salivary gland tissue. We analyzed 132 submandibular salivary gland tissue specimens and compared the generated results to concomitantly collected postmortem whole blood specimen results. Oxycodone 2, meprobamate, barbiturate, benzodiazepine assay 1, zolpidem, and buprenorphine all showed perfect agreement (Cohen's kappa score = 1.00) between the submandibular salivary gland tissue results and the postmortem whole blood results; dextromethorphan, fentanyl, benzoylecgonine, methamphetamine, tricyclic antidepressants, oxycodone 1, and opiate showed an almost perfect agreement (Cohen's kappa score = 0.81-0.99); methadone, generic opioids, and amphetamine exhibited substantial agreement (Cohen's kappa score = 0.61-0.80). Tramadol demonstrated fair agreement (Cohen's kappa score = 0.41-0.60). The lowest measure of agreement was observed with cannabinoids, meeting criteria for slight agreement (Cohen's kappa score = 0.01-0.20). An application of the techniques described in this study could be implemented in postmortem toxicology laboratories as well as medical examiners offices to provide preliminary drugs of abuse test results that can be used to direct additional testing. This study highlights the successful integration of a novel specimen matrix and an "off-label" use of an established analytical technique.

Occult Metastasis: Incidence, Pattern, and Impact on Survival in Patients with Oral Cancer, pN0 vs pN1 in a Cohort of cN0. A Prospective Cohort Study

AbstractSquamous cell carcinoma of the oral cavity is the most common malignancy of head and neck cancer in India. With nodal dissemination, there is a significant decrease in survival. This study is aimed at studying the impact of occult metastasis on an estimated overall survival in clinically N0 patients post neck dissection. In a prospective study with 110 patients with squamous cell carcinoma of the oral cavity, clinically N0 with all T stages were included in the study. operated on for both primary and neck followed up for a median of 5 years after completion of definitive treatment. The impact of surgery on patients with occult metastasis was questionable in our study with a difference in estimated overall survival of around 11 months, which was not significant statistically. Subset analysis had shown the correlation of overall survival with a grade of tumor, T stage and depth of invasion which was statistically insignificant. Correlation of occult metastasis with the depth of invasion, T stage was statistically significant. we conclude that even after addressing the neck in clinically N0 patients with oral cancer, there is a difference in the overall survival of the patients with occult metastasis which might not be statistically significant with a p-value of 0.68. We conclude that with neck dissection in patients with occult metastasis, improved survival might not be comparable to pathological N0.Level of Evidence: LEVEL -2.

Prevalence of rapid calculus formers and its associated factors amongst patients visiting a dental hospital: a preliminary investigation

BackgroundThis study focuses on the determination and classification of patients as rapid or slowcalculusformersbasedontherateofcalculusformationafteroralprophylaxis. It also aims to determine the factors that positively impact the formation and deposition of calculus in patients and identify the factors that accelerate or decelerate the deposition of calculus.MethodsThe study was conducted in the Department of Periodontology, Dr Harvansh Singh Judge Institute of Dental Sciences and Hospital, Panjab University Chandigarh, India. We examined 51 patients after a month of the oral prophylaxis, recorded the amount of calculus present in the oral cavity, and then recorded a detailed history which was briefly divided into Age, Sex, Residence, Oral habits, and maintenance of oral hygiene.ResultsAn evident and meaningful link was found between age and the rate at which dental calculus forms. The average age of individuals differed significantly between the rapid and slow calculus formers, which could be ascribed to the decline in manual dexterity as age increases, resulting in less effective oral hygiene habits, including toothbrushing. None of the other factors dietary and oral hygiene related could be identified distinctly, probably owing to the small sample of the study. The oral health status exhibited a significant difference between slow and rapid calculus formers.ConclusionsWithin the limitations of the study, the data analyzed, identified age as a significant determinant that impact the rate of formation of calculus in patients and reported a significant difference in the oral health status of rapid and slow calculus formers.

Serum Cortisol and Blood Glucose Concentrations in Anesthetized Dogs Administered Levobupivacaine and Low-Dose Dexmedetomidine for Regional Anesthesia of the Oral Cavity.

The effects on the stress response, postanesthetic sedation, and altered behavior were evaluated following regional anesthesia and dental treatment in 40 dogs. Serum cortisol and blood glucose concentrations were measured following the administration of levobupivacaine (LBUP) 0.5% and dexmedetomidine (DEX) (0.5 µg/kg) or a placebo. The dogs were randomly assigned to 4 groups of 10 dogs each. All dogs received a regional nerve block using LBUP 0.5%. Group 1 (LBUP + DEX IV) also received DEX intravenously (IV); group 2 (LBUP + PLC IV) also received a placebo IV; group 3 (LBUP + DEX IO) also received DEX in one infraorbital (IO) block; and group 4 (LBUP + DEX IA) also received DEX in one inferior alveolar (IA) block. Serum cortisol and blood glucose concentrations were determined before the administration of oral blocks and at the end of the procedure. Sedation and behavior scores were assessed before premedication and hourly for 6 h after the end of anesthesia. Cortisol concentration did not change in any group at either evaluation time. The glucose concentration was higher (P < .05) only in the LBUP + DEX IA group at the end of the procedure. The sedation score was higher until the end of the observation period only in the LBUP + DEX IV and LBUP + PLC IV groups. No change in behavior score was observed in any of the groups. The reduction of perioperative stress response in all groups was due to the use of LBUP and not DEX.

Secondary cleft palate correction with 3D-printed thermoplastic polyurethane film – a case report

Cleft palate is an oronasal communication that can affect the area comprehending the lips and the soft palate. Its clinical signs vary depending on the degree of the defect and the age of the animal, ranging from nasal secretion, coughing, sneezing, halitosis, respiratory difficulty, aspiration pneumonia, and loss of body condition. Its diagnosis is based on inspection of the oral cavity and imaging tests. Palatal defects must be surgically corrected as quickly as possible, using mucosal flaps, grafts, or implants. A desire to evolve alternative treatments for cleft palates drives the search for ways to manufacture customized pieces. 3D printing and biomaterials have enhanced in detail and applicability; combined with design tools and imaging exams, they allow for the making of precise implants and anatomical models for the planning and execution of surgical procedures. This report describes the case of a female, mixed-breed feline treated at a veterinary clinic; it was diagnosed with secondary cleft palate, had a history of falling, and underwent previous palatoplasties with recurrence. A surgical reintervention was performed to implant a 3D-printed TPU film to close its secondary cleft palate.

Salivary CD44 and Total Protein Levels to Detect Risk for Oral and Oropharyngeal Cancer Recurrence

Oral and oropharyngeal cancer have low survival rates, and incidence continues to increase. To determine whether soluble CD44 and total protein (TP) are useful for monitoring head and neck cancer recurrence, either used in a point-of-care (POC) test or as individual laboratory-based biomarkers. This multi-institutional nonrandomized clinical trial testing a novel diagnostic/screening assay took place across the University of California, San Diego; Johns Hopkins University; the Greater Baltimore Medical Center; New York University; and the San Diego Veterans Affairs Hospital. Patients with newly biopsy-proven, untreated oral cavity and oropharyngeal cancer were enrolled. Patients were enrolled April 2017 to April 2019, and data were analyzed December 2022 to June 2023. POC salivary oral rinse test. Oral rinses were collected at pretreatment baseline and 3, 6, 12, and 18 months after completion of therapy; participants were then followed up for 3 years to define disease status. Associations of baseline characteristics with a positive test were evaluated by Fisher exact test. The association of a positive value on the CD44 or TP test with progression-free survival was evaluated in an adjusted multivariable proportional hazards model. Of 172 patients enrolled, the mean (SD) age was 62.5 (10.2) years, and 122 (70.9%) identified as male. Additionally, 92 patients (53.3%) had never smoked, 99 (57.6%) formerly or currently drank alcohol, and 113 (65.7%) presented with oropharyngeal cancers, which were positive for human papillomavirus in 95 (84.1%). Tumor site was associated with test results at baseline; patients with oral cavity cancer had a higher baseline positive POC test rate (47 of 51 [92.2%]) compared to patients with oropharyngeal cancer (85 of 110 [77.3%]). Using Cox regression models with CD44 or TP level as a time-varying covariate, a higher CD44 level showed a statistically significant association with a higher hazard of recurrence (hazard ratio, 1.06; 95% CI, 1.00-1.12), though the TP level was not statistically significant. In multivariate adjusted analysis, higher CD44 and TP levels were associated with increased hazard ratios of recurrence of 1.13 (95% CI, 1.04-1.22) and 3.51 (95% CI, 1.24-9.98), respectively. In this multi-institutional nonrandomized clinical trial of an assay, posttreatment longitudinal monitoring for elevated salivary CD44 and TP levels using an enzyme-linked immunosorbent assay-based laboratory test identified patients at increased risk of future cancer recurrence. The CD44 and TP rapid POC test holds some promise, but further development is needed for this indication. ClinicalTrials.gov Identifier: NCT03148665.

Oral Health and "Modern" Digestive Diseases: Pathophysiologic and Etiologic Factors.

In the contemporary era of medicine, exploring the complexity of the human body and its intricate interactions has become a central concern for health researchers. The main purpose of this article is to summarize the current understanding of relevant pathophysiological factors such as chronic inflammation, dysbiosis (microbial imbalance), and metabolic disorders, as well as etiological factors including dietary habits, lifestyle choices, obesity, metabolic syndrome, and genetic predispositions, as well as to emphasize potential avenues for upcoming studies and their medical significance. Additionally, this article aims to assess the potential impact of integrated treatment approaches on patient outcomes, emphasizing the need for interdisciplinary collaboration between gastroenterologists, dentists, and other healthcare professionals to develop comprehensive care plans that address both oral and digestive health issues simultaneously. Among the branches with a significant impact on general well-being are oral cavity health and digestive diseases, which have been the subject of intensive research in recent decades. In this context, analysis of the current state of knowledge on oral cavity disorders in relation to "modern" digestive diseases such as non-alcoholic fatty liver disease (NAFLD), small intestinal bacterial overgrowth (SIBO), inflammatory bowel disease (IBD), and irritable bowel syndrome (IBS) becomes essential for a deeper understanding of the interconnections between oral and digestive health. The temporal overlap or succession, whether preceding or following, of oral manifestations and digestive disorders should be taken seriously by both gastroenterologists and dentists to facilitate early diagnosis and explain to patients the correlation between these two body systems. In summary, this article underscores the importance of understanding the intricate relationship between oral and digestive health, advocating for interdisciplinary approaches to improve patient outcomes and guide future research.

Oral fibrolipoma in dogs: Retrospective case series study and comparative review.

Fibrolipoma is defined as a typical lipoma transected by variable amounts of paucicellular and collagenous fibrous components. Oral and lingual fibrolipomas are well-recognized histological entities in human medicine that are slightly more prevalent in females, occur most commonly after the fourth decade, and arise from the buccal mucosa. The documentation of this neoplasm in the oral cavity is lacking in veterinary medicine. Through a multi-institutional retrospective compilation of cases submitted to diagnostic pathology services, here we describe the clinical and pathologic features of oral fibrolipomas in dogs. A total of 112 cases of oral fibrolipomas in dogs were retrieved. The mean age was 10.1 years (range 2-16 years, ±2.63 years standard deviation), with an average tumor size of 1.7 cm (range 0.2-8 cm, ±1.1 cm standard deviation). The most common location was the tongue (57.1%, 64/112), followed by the buccal mucosa (15.2%, 16/112), sublingual area (8.0%, 9/112), gingiva and lip (4.5%, 5/112 each), and palate (1 case). The anatomical location of oral fibrolipomas only differed significantly among the dog breeds (P < .001) but not among sex, age, anamnesis, or reason for submission. The tumor was most commonly reported in males (69.7%, 78/112), and in 62.5% (70/112) of the cases, the tumor was an incidental finding. Fibrolipoma should be considered a differential diagnosis when considering benign lingual and other oral soft tissue masses in dogs.

Initial experience with ovine forestomach matrix graft for glossectomy defect reconstruction: A case series

Soft tissue reconstruction of oral cavity defects, such as glossectomy defects secondary to malignancy, pose a challenge for head and neck, oral, and maxillofacial surgeons. Reconstruction options for mucosal defects include primary closure, healing by secondary intention, full mucosal and split-thickness skin grafts, pedicled flaps, and microvascular free flaps. Biological grafts have become an integral part of the modern reconstructive ladder and are widely used for the regeneration of various soft tissue defects, including oral defects. This case series describes our initial experience using ovine forestomach matrix grafts in tongue and oral cavity reconstruction. Oral reconstruction using ovine forestomach matrix grafts was undertaken on three patients post wide excision and resulted in good functional and cosmetic outcomes. The rate of tissue formation provided by the graft and the grafts’ relative resistance to the hostile environment of the oral cavity support further clinical research to validate the use of these devices in oral reconstruction.

Comparison of Index-Finger Guided, Two-Finger Guided, and 90° Rotation Techniques for Insertion of Flexible LMA in Pediatric Patients

Background: Flexible LMA offers the advantage of providing a better surgical field without being compressed compared to other LMAs in surgeries around the oral cavity. The insertion of flexible LMA is comparatively difficult as the shaft is flexible. The aim of this study is to compare the index-finger guided technique, two-finger guided technique, and 90° rotation technique for the success and time of insertion of flexible LMA in pediatric patients. Methods: After obtaining consent from parents,84 patients aged between 3 to 12 years of either gender were randomized into 3 groups. After administration of general anesthesia, flexible LMA of appropriate size as per manufacturer recommendations was inserted. In the index finger guided method (Group A), the LMA was held like a pen and the mask was pushed backward pressing against the palate. In the two-finger guided method (Group B), the anesthetist stood by the side facing the patient. LMA was fixed in between the index and middle fingers, held facing the lower jaw, and pushed along the palatopharyngeal curve. In the 90° rotation method (Group C), the LMA was rotated 90° anticlockwise in the oral cavity and was advanced through the right side of the tongue till resistance was felt and then turned back. The time from insertion of LMA and the number of attempts taken for successful insertion were noted. The data were analyzed using ANOVA. Results: The mean time of insertion was the least in Group B and highest in Group C. The first attempt success rate was highest in Group B and least in Group C. However, the mean time of insertion and the first attempt success rates were not significantly different between Group A and Group B. Conclusion: The LMA insertion by the two-finger guided method is the easiest and most efficient method and a good alternative to the standard method (index finger guided) for insertion of flexible LMA.

From Snack Time to the Operating Room: A Case Report of Septic Arthritis in a Child After a Toothpick Injury.

Eikenella corrodens and Streptococcus sanguinis are indigenous to the oral cavity and infrequently associated with osteoarticular infections. We detail a case of septic arthritis in a 13-year-old boy who suffered a puncture wound with a toothpick after eating. This case highlights the ability of these microorganisms to instigate osteoarticular infections through penetrating trauma and not only through the hematogenous route.