Lateral Pedicle Graft Procedure for the Treatment of Isolated Tooth Recession- A Case Report

Gingival recession is defined as the apical migration of the gingival margin from its physiologic level which further causes pathologic exposure of root surfaces. Mucogingival esthetic surgery includes the treatment of mucogingival esthetic alterations. The Mucogingival problems may be caused by gingival recession which is often associated with non-carious cervical lesion or by root caries or by altered passive eruption. Root coverage is achieved by many procedures like free gingival autografts, pedicle graft and connective tissue grafts. Recession can be treated by surgical or non-surgical means. surgical procedure includes various methods of increasing the width of keratinized tissue such as frenectomy in case of high frenal attachment & root coverage procedures and nonsurgical approach include-restorations, crowns, veneers and gingival masks. Lateral displaced pedicle flap was first described by Grupe and Warren in 1956 which was indicated in area to cover isolated apical migration of gingiva, & denuded root surfaces that have adequate amount of donor tissue adjacent to the recipient site. In few clinical studies it is seen that the success rate with Lateral pedicle graft is 70%, it is preferred over free gingival autografts in narrow and shallow gingival defects. This case report present the predictability of root coverage by using Lateral pedicle grafts in single tooth narrow and shallow gingival recession. Keywords: Lateral pedicle graft, Gingival recession, Attachment loss, Graft.

Combined Subcostal and Posterior Transversus Abdominis Plane Block for Postoperative Pain Relief after Abdominoplasty: A Randomized Clinical Trial

Background: Abdominoplasty is a common esthetic surgery for adequate pain management during the postoperative period. Transversus abdominis plane block (TAPB) is a therapeutic complement for analgesia for postoperative pain following abdominal surgery.Aim: To compare the outcomes of TAPB and systemic opioids in patients undergoing abdominoplasty.Methods: Fifty-eight patients undergoing abdominoplasty were randomly assigned to two groups: Combined subcostal and posterior TAPB group (BG, n=29) and Control group (CG, n=29). The standard postoperative analgesic regimen for both groups consisted of IV Paracetamol 1 g every 6 h. The visual analog scale (VAS) scores for pain were recorded postoperatively, and once the patient had a VAS ≥4, IV pethidine was administered. The primary outcome was pethidine consumption in the first 72 h postoperatively; the secondary outcomes included VAS scores at rest and during movement in the first 72 h postoperatively, time to first ambulation, and time to first incentive spirometer at 900 mL/min.Results: Pethidine consumption in the first 72 h was 208.62±85.64 in the CG group and 20.69±25.06 in BG (p<0.05). VAS was lower in BG during the first 72 h both at rest and during movement (p<0.05). Time to first ambulation was 12.41±5.04 h in the CG group and 4.62±1.08 h in BG (p<0.05), time to first incentive spirometer at 900 mL/min was 11.45±5.05 h in CG and 4.27±1.09 h in BG (p<0.05).Conclusion: Combined subcostal and posterior TAPB offers a longer postoperative analgesic effect and reduced postoperative opioid requirements with fewer postoperative complications.Trial RegistrationClinical Trial: TCTR20200602001 “Retrospectively registered”Date of registration on May 30, 2020.

Complications in Facial Esthetic Surgery

Esthetic surgery continues to become increasingly popular both in the United States and globally. Facial esthetic procedures in particular account for a large proportion of procedures performed. This increase in popularity will inevitably result in the number of potential complications associated with these procedures. In this review, the authors describe common complications encountered with frequently performed cosmetic facial procedures and their associated management. This article is meant as a general overview and introduction to potential complications surgeons may encounter, interested readers are encouraged to further review comprehensive subspecialty literature for more detailed discussion.

Nasal polyposis: A semiquantitative morphometric histopathological study

Background/Aim. Nasal polyps are inflammatory hyper-trophic proliferations of the sinonasal mucosa composed of both epithelial and stromal elements. The aim of this study was to determine histopathological hallmarks of nasal polyposis via semiquantitative morphometric study. Methods. The study comprised 77 patients with chronic rhinosinusitis and nasal polyposis (CRSwNP) that underwent functional endoscopic sinonasal surgery performed by the same surgeon. The control group consisted of 9 different nasal mucosal samples that were taken from patients without CRSwNP that underwent functional and esthetic surgery. Morphometric analysis included gradation of tissue edema within polyps, thickening of epithelial basal membrane, degree of inflammation, presence/absence of metaplasia with-in epithelium, degree of fibrosis within polyps, and percentage of inflammatory cells within inflammatory infiltrate (lymphocytes, macrophages, plasma cells, neutrophils and eosinophils). Results. As expected, samples from the study group showed significantly higher degree of inflammation than samples from the control group (?2 = 35.89, with p < 0.01). Degree of fibrosis in nasal polyposis was in positive correlation with duration of symptoms (r = 0.25, p < 0.05) and with percentage of macrophages in inflammatory infiltrate (r = 0.26, p < 0.05). Patients with nasal polyposis had significantly lower number of lymphocytes (r = -7.66, p < 0.01), but significantly higher number of eosinophils (r = 3.84, p < 0.01), macrophages (r = 3.34, p < 0.01) and plasma cells (r = 3.14, p < 0.01) than controls (p < 0.01). Conclusion. Tissue samples from patients with nasal polyposis show significant changes that reflect in various degrees of inflammation, fibrosis and basement membrane thickening which may contribute to more difficult surgical management and perioperative complications such as bleeding.