Morphological docking of secretory vesicles

Calcium-dependent secretion of neurotransmitters and hormones is essential for brain function and neuroendocrine-signaling. Prior to exocytosis, neurotransmitter-containing vesicles dock to the target membrane. In electron micrographs of neurons and neuroendocrine cells, like chromaffin cells many synaptic vesicles (SVs) and large dense-core vesicles (LDCVs) are docked. For many years the molecular identity of the morphologically docked state was unknown. Recently, we resolved the minimal docking machinery in adrenal medullary chromaffin cells using embryonic mouse model systems together with electron-microscopic analyses and also found that docking is controlled by the sub-membrane filamentous (F-)actin. Currently it is unclear if the same docking machinery operates in synapses. Here, I will review our docking assay that led to the identification of the LDCV docking machinery in chromaffin cells and also discuss whether identical docking proteins are required for SV docking in synapses

The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients

Straight line closure for correction of congenital isolated bilateral macrostomia

Congenital bilateral macrostomia is a very rare deformity of the mouth, and it is still rarer to see cases of isolated bilateral macrostomia. Although the creation of a symmetric neocommissure is imperative, this presents a technical challenge. A review of the literature for surgical solutions revealed various techniques, but no cases in which a bilateral straight line repair was described and adopted. This report presents the case of a 3-month-old boy with isolated bilateral macrostomia for whom straight line closure was performed on both sides. At 1 year follow-up, the oral commissures are symmetric with aesthetically pleasing scars and no lateral migration

Dental sinus with parotid duct fistula: An unusual presentation

Injury to the parotid duct is commonly missed which may lead to a fistula subsequently. An external duct fistula is distressing to the patient because of continuous dribble of saliva during mastication. Management of established duct fistula is controversial with a variety of methods both conservative and operative being reported in the literature, each having varying degrees of success. Reconstruction of the duct is not a good option because of its modest results. Internal diversion of the opening is an innovative, simple method to correct this problem. We report the successful use of this technique in a case of distal parotid duct fistula associated with apical root abscess of maxillary molars with cutaneous sinus-an unusual presentation, with a brief review of the literature on the management of parotid fistula

Dental sinus with parotid duct fistula: An unusual presentation

Injury to the parotid duct is commonly missed which may lead to a fistula subsequently. An external duct fistula is distressing to the patient because of continuous dribble of saliva during mastication. Management of established duct fistula is controversial with a variety of methods both conservative and operative being reported in the literature, each having varying degrees of success. Reconstruction of the duct is not a good option because of its modest results. Internal diversion of the opening is an innovative, simple method to correct this problem. We report the successful use of this technique in a case of distal parotid duct fistula associated with apical root abscess of maxillary molars with cutaneous sinus-an unusual presentation, with a brief review of the literature on the management of parotid fistula

Descriptive and Surgical Analysis of 196 Cases of Traumatic Maxillofacial Fractures: An experience of 6 years

Aims To analyze the etiology, anatomical pattern, and management of upper, midface, and lower face fractures pertaining to our demography and compare our results with other regions and worldwide. Materials and methods A 6-year retrospective record analysis from 2013 to 2018 of eligible patients' data was recorded with a prepared proforma. Demographic parameters including age, sex, etiology, anatomical site, closed or open, displaced or un displaced fracture, type of treatment, associated with head injury, and implants used were evaluated. Inclusion criteria were all patients with facial bone fractures irrespective of age and gender. Exclusion criteria were patients with pure soft tissue injury of the face and with facial burns. Results Most were involved with multiple facial bone fractures. Out of 196, 72 patients (pts) had involvement of mandible fractures, 79 had involvement of the maxilla, 65 zygoma, 68 nasal bone, 42 orbital wall, 21 frontal bone with processes, and 7 NOE involvement. The most frequent etiologic factor was detected to be road traffic accidents (RTA; 162 ,83%), due to falling (24, 12%), and assault (10, 5%). In total, 173 were male (88%) and the rest 23 were female (12%). The mean age was found to be 29 years. Twelve patients (6.1%) were less than 14 years of age. Most RTAs had occurred in young adults from 16 to 30 years of age group. We analyzed individual bone fracture involvement and compared it with other geographical locations. Conclusions Most facial fractures are combined involving multiple bones in young adults with RTA as the most common etiology. There was a balance seen in managing the facial fractures between conservative and operative methods. These data provide us the information in evaluation of the preventive measures to be taken and give the direction of focusing the clinical and research priority in the future

Intraoperative modifications done to continue performing traumatic maxillofacial surgery during COVID-19 times

Background: Operating on maxillofacial trauma cases in the severe acute respiratory syndrome coronavirus-2 disease 2019 (COVID-19) era comes with its own disadvantages to operating teams with the current standard operating protocol. Methods: We present the various modification in techniques we have devised in a step-wise manner to overcome these difficulties while operating in COVID-19 times. Twenty-eight cases of maxillofacial fracture were operated in a span of 1 COVID year, i.e., from March 2020 to February 2021. Intraoperative modifications were applied for the techniques of drilling, implants used associated with aerosol generation (AG). Results: Of the 28 cases that had undergone maxillofacial injury, 20 were mandible fractures, 6 are midface, 2 are upperface/midface and 1 upper face fracture, of the mandible fractures, 12 were single sites and 8 were fractures involving two sites. Conclusions: Using microplating with self-drilling screws appear to be the first choice for fixing mandible fractures in COVID times, reducing AG by decreasing the duration of drilling and containing the aerosol spread by an adequate protective barrier around the drill apparatus should be considered. Intraoperative stability of fracture fixation sites post-fixation with mini and microplate as individual and in combination was found to be helpful