We read the study conducted by Joseph and colleagues with great interest, which investigated the loco-regional control, disease-specific survival (DSS), overall survival (OS), and treatment-related complications in 163 oral cancer (OC) patients treated with radiotherapy (RT) or chemo-RT (CRT) for close resection margins (CRMs).The study results offer valuable insights into the role of RT/CRT in OC patients with CRMs, but two concerns must be addressed to interpret the outcomes rigorously.

BACKGROUND: Oral Submucous Fibrosis, OSF is an inflammatory mucosal disorder prevalent in areca nut chewing belts of the world. Although various treatments are available for its management, none provide complete resolution.Curcumin, an indigenous product, improves burning sensation, mouth opening along with other clinical signs of OSF and is potentially viable therapeutic option for its management.
OBJECTIVE: To assess the available evidence for employing curcumin in improving symptoms in patients with OSF.
METHODS: Systematic search was carried out in e-databases from January 2010 until July 2023 to identify relevant clinical trials comparing curcumin to active and/or nonactive controls (placebo) for the management of OSF.
RESULTS: A total of 20 studies were used for qualitative analysis out of which 11 studies were considered for quantitative synthesis.Curcumin was found to be highly effective in alleviating pain/burning sensation, improving mouth opening (MO), cheek flexibility, tongue protrusion and induces positive histological changes in patients with OSF.The standardized mean difference in mouth opening between both the Curcumin and Multivitamin group showed a statistically significant difference favouring the Curcumin group (SMD, 0.37, 95% CI = 0.18-0.56, p - 0.0001, I2- 0%).
CONCLUSIONS: Statistically curcumin was noted to be as effective as Aloe vera, lycopene and steroids in relieving symptoms of OSF in stages 1 and 2 and improving MO. It is seen to improve histopathological picture of lesions thereby suggesting its active role in preventing malignant transformation. Its found to be more effective than multivitamins in improving mouth opening of patients in OSF.

BACKGROUND: Isaacs\' syndrome, also known as neuromyotonia or peripheral nerve hyperexcitability, is a rare disorder that affects the peripheral nervous system. Clinical findings include cramps, fasciculations, and myokymia; however, there are few reports of dental treatment for trismus.
METHODS: A patient with trismus due to Isaacs\' syndrome experienced swelling and pain in the gingiva surrounding his right lower first molar. He was diagnosed with chronic apical periodontitis by a dentist near his home. However, the patient was informed that dental treatment and medication could not be administered because of the presence of Isaacs\' syndrome, and he visited the Geriatric Dentistry and Perioperative Oral Care Center at Kyushu University Hospital 2 weeks later. The patient\'s painless mouth-opening distance (between incisors) was 20 mm at that time, and medication, including amoxicillin capsules and acetaminophen, was administered because the dental extraction forceps or endodontic instruments were difficult to insert into the oral cavity for treatment. Two months after his initial visit, the patient visited us complaining of pain in the same area. However, he had recently undergone plasmapheresis treatment in neurology to alleviate limited mouth opening and systemic myalgia, resulting in a pain-free mouth-opening distance of approximately 35 mm. During this temporary period in which he had no restriction in mouth opening, we performed tooth extraction and bridge restoration on the mandibular right first molar and created an oral appliance for sleep bruxism.
CONCLUSIONS: Plasmapheresis therapy transiently reduced trismus, rendering dental interventions feasible, albeit temporarily. This case report underscores the importance of close collaboration between neurologists and dentists who encounter similar cases while furnishing valuable insights to inform dental treatment planning.

A 73-year-old man presented with subacute trismus and pancerebellar dysfunction. Brain imaging and routine blood test results were unremarkable. Chest computed tomography revealed an indistinctly enhancing 4.7 × 2.5 × 1.8-cm3 pulmonary mass in the right upper lung, with enlarged right paratracheal and hilar lymph nodes. Biopsy of the right supraclavicular lymph node confirmed metastatic carcinoma, with differential diagnoses of small cell carcinoma and poorly differentiated carcinoma, indicating lung cancer as the primary source. Paraneoplastic immunohistochemistry screening revealed anti-Hu antibodies in the serum at a titer of 1:7680 (normal range <1:240) and in the cerebrospinal fluid (CSF) at a titer of 1:256 (normal range <1:2). The line blot method yielded positive results for anti-Zic4 antibodies in serum, with a titer of >1:10 (normal range <1:10), whereas CSF anti-Zic4 was negative (normal range <1:2). The patient developed non-responsive hospital-acquired pneumonia and respiratory failure, and discharged himself against medical advice. This rare case indicates that trismus can be an initial manifestation of anti-Hu paraneoplastic neurological syndrome, and emphasizes the importance of clinical awareness.

A patient presenting with a history of restricted mouth opening and deflection of the mandible after a prolonged dental procedure raises a suspicion of temporomandibular joint disorder (TMD) due to its estimated high prevalence of 29%. Muscle relaxants and routine active physiotherapy established normal range of movement and pain reduction was achieved through TENS therapy and analgesics. However, the non-subsidence of deflection prompted an initial suspicion of TMD which was overturned by MRI. The MRI evaluation revealed left side medial pterygoid abscess. It is imperative to understand that despite strong history and relevant clinical features, for the definitive diagnosis radiographic evaluation is highly contributory. Misdiagnosing TMD due to its similar presentation can have significant implications for the patient\'s well-being and quality of life. The clinical features of medial pterygoid abscess including restricted mouth opening and pain can be similar to that of TMD. These abscesses are most commonly caused by odontogenic infections but can also occur as a result of septic inferior alveolar nerve block techniques. Limited literature reports of pterygoid space abscess have been described, but intramuscular and medial pterygoid abscess is an absolute rarity. Causal relationship to septic inferior alveolar nerve block further makes this case report an interesting read.

Introduction Lower third molar impaction surgery is one of the most common minor oral surgical procedures done. Trismus has been one of the most common and disturbing postoperative sequelae for patients. The study aimed to evaluate the electrical activity of the masseter and temporalis muscles after mandibular third molar surgery. Materials and methods The research was conducted at Saveetha Dental College and hospitals in the Department of Oral and Maxillofacial Surgery. The study consisted of 20 individuals. The EMG (electromyography) activities of both masseter muscles in each patient were measured before the tooth extraction surgery, postoperatively after 72 hours, and after seven days. The inter-incisal distance was also measured at similar follow-up intervals. Data were analyzed using IBM Corp. Released 2015. IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp., with p-values less than 0.05 considered statistically significant. The Mann-Whitney U test was used for the comparison of electrical activity between masseter and temporalis on both the operated and non-operated sides during preoperative, postoperative, 72-hour, and postoperative seven-day periods. Results It has been found that the electrical activity of the temporalis is higher than that of the masseter muscle measured at all the intervals of the follow-up period, with statistically significant values (p=0.001). It was noted that all the patients have reduced mouth opening when compared with preoperative (mean mouth opening = 45.6 mm), postoperative 72 hours (mean mouth opening = 31.2 mm), and postoperative seven days (mean mouth opening =35.6 mm). When a comparison was done between temporalis and masseter, the masseter took longer to return to pre-operative electrical activity, which might also imply that for prolonged trismus seen in patients after lower third molar surgery, it is the masseter that is affected and needs recovery for trismus to be resolved.  Conclusion  Based on the results obtained, it can be concluded that there was a reduction in the electrical activity of both the masseter and temporalis post-third molar impaction surgery. It was also found that there was a reduction in mouth opening in patients who underwent lower third molar extraction surgery. Masseter muscle took longer to return to its preoperative electrical activity than temporalis muscle, implying that targeted therapies to accelerate the healing of masseter muscle may prevent prolonged trismus in patients who undergo lower third molar impaction surgery.

In this case report we present successful airway management in a patient with predicted difficult airway using the Difficult Airway Society guidelines. Our patient presented with recurrence of severely reduced mouth opening due to post-traumatic bilateral temporomandibular ankylosis, and was scheduled for surgical resection of the mandibular articular processes. Awake fiberoptic intubation was planned. After light sedation and thorough topicalization of the nasal cavity the flexible optic bronchoscope was successfully navigated into the trachea with \'spray-as-you-go\' technique and the endotracheal tube was railroaded over it. After a two-point check of the endotracheal tube placement the patient was put under anesthesia. The surgery was uneventful. Finally, a plan with surgeons for safe extubation was made and the patient was extubated uneventfully on the next day using the airway exchange catheter in the intensive care unit.

Trismus is a common, extremely detrimental side effect following definitive radiotherapy for head and neck malignancies. Existing therapeutic modalities (active and passive range-of-motion exercises and systemic therapies) offer only modest, slow improvements in jaw opening; thus, there is a need for additional treatment options. Boswellia serrata (BS) (\"Indian frankincense\") is a tree native to West Asia and North Africa that produces resin-containing \"boswellic\" acids. These have been shown to have in vitro and in vivo anti-inflammatory effects and have previously been found to be an effective treatment for asthma, colitis, arthritis, and post-radiation edema. Herein we report the case of a 54-year-old male with severe post-radiation trismus who experienced a dramatic resolution with BS/Therabite® combination therapy. His trismus improved from 6 mm to 45 mm over 10 weeks (0.46 mm/day), far exceeding previous rates of improvement documented in the literature. There were no ill effects. Given the dearth of effective treatments for post-radiation trismus, BS is a promising agent deserving of further study.

UNASSIGNED: To evaluate the profile of patients operated for maxillofacial space infections and associated risk factors for the length of hospital stay.
UNASSIGNED: We conducted a retrospective study among patients operated for maxillofacial infections at our center from 2010 to 2020. Information collected from the records were age, sex, type and number of spaces involved, clinical signs and symptoms (pain, swelling, toothache, sore throat, otalgia, hoarseness, headache, cough, neck swelling, rancid breath, sialorrhea, gingival swelling, muffled voice, trismus, fever, dysphagia, odynophagia, malaise, lymphadenopathy, dyspnoea, pus discharge), treatment modality, total leukocyte count, evidence of bacterial growth, comorbidities, complications if any and length of hospital stay.
UNASSIGNED: A total of 128 medical records were examined, out of which 59 were female. The mean age was 38.59 ± 19.7 and the length of hospital stay was 7.56 ± 3.8 days. The most commonly involved space was submandibular space (46.1%) and the common symptoms reported were swelling (99.2%), pain (86.7%), and trismus (68%). Four patients had complications like necrotizing fasciitis (1.6%), pneumonia (0.8%), and death in one patient (0.8%). Logistic regression showed that patients more than 36 years of age, male sex, evidence of bacterial growth, and diabetics had higher odds of increased hospital stay (>6 days). Multiple logistic regression analysis showed that age (P = 0.015; OR: 2.98) and evidence of bacterial culture (P = 0.001; OR:6.64) were potential predictors associated with increased hospital stay.
UNASSIGNED: Our study showed that the age of the patient and evidence of bacterial culture were potential predictors of prolonged hospital stay among patients operated for maxillofacial space infections.

The aim of this split-mouth randomized clinical trial was to evaluate the clinical outcomes (operative time, edema, trismus, and pain), the immediate histological effects, the alveolar repair (2 and 4 months), and the quality of life after the extraction of impacted third molars using high-speed pneumatic and electrical rotation. Sixteen patients underwent extraction of the two mandibular third molars with a minimum interval of 15 days. On one side of the participant\'s mouth, high-speed pneumatic rotation was used (Control Group-CG) while for the other side, high-speed electrical rotation was used (Study Group-SG). Statistical analysis included ANOVA repeated measures and Pearson correlations. SG group showed: shorter operative time (p = 0.019), less pain (p = 0.034), swelling (p < 0.001) and trismus (p = 0.025) on the 1st postoperative day; less pain (p = 0.034) and trismus (p = 0.010) on the 3rd postoperative day; less trismus (p = 0.032) on the 7th postoperative day; and better quality of life (p = 0.007). No differences were observed for peripheral bone damage or bone density of alveolar repair at 2 and 4 months between groups. Electric high-speed rotation provided better postoperative clinical parameters of pain, edema and trismus when compared with pneumatic high-speed rotation for mandibular third molar surgery.Trial registration: Brazilian Registry of Clinical Trials registration number RBR-4xyqhqm ( https://ensaiosclinicos.gov.br/rg/RBR-4xyqhqm ).