BackgroundHemorrhoids are a common condition that presents with bleeding per rectum, pain at rest and defecation, mucosal discharge, and prolapse. Surgical hemorrhoidectomy is the treatment method of choice for Grade 3 and Grade 4 hemorrhoids. Hemorrhoidectomy is associated with postoperative pain and no single surgical technique has been proved to significantly reduce the pain. We analyzed in our study the effect of lateral internal sphincterotomy with hemorrhoidectomy on postoperative pain, anorectal function, and retention of urine after the Milligan and Morgan technique. MethodsThis randomized, prospective, and comparative study included 200 Grade 3 and Grade 4 hemorrhoids patients who were scheduled for surgical management. The patients were classified randomly into two groups with an equal number of participants: Group A underwent Milligan & Morgan open hemorrhoidectomy and Group B underwent lateral internal sphincterotomy (LIS) in addition to Milligan and Morgan open hemorrhoidectomy. Postoperative pain was recorded using the Visual Analog Scale (VAS) score for up to 48 hours. Postoperative bleeding, urinary retention, and bowel and gas incontinence were noted. Long-term follow-up at six and 24 months for anal stenosis, anal fissure, incontinence, and recurrence was also noted. ResultsPatients who underwent LIS showed a significant reduction in postoperative pain at 12 hours (p=0.0008*), 24 hours (p=0.000*), and 48 hours (p=0.003*); the time taken to request rescue analgesia was similar between the two groups (p=0.07). Side effects, such as postoperative bleeding and urinary retention, were significantly lower after LIS (p=0.001* and p=0.01*, respectively), and gas incontinence was significantly higher after LIS (p=0.002*). The long-term outcomes of anal fissure were significantly higher without LIS at six months (p=0.02*) and 24 months (p=0.04*) and those of anal stenosis were significantly higher without LIS at six months (p=0.04*). ConclusionsFrom our study, we conclude that postoperative pain, bleeding, and urinary retention were significantly lower after LIS, and gas incontinence was transient. The long-term outcomes, which included anal stenosis and anal fissure, were significantly lower after LIS. However, bowel and gas incontinence and recurrence were not altered. Therefore, we conclude that the addition of LIS to hemorrhoidectomy improves patient outcomes in terms of postoperative pain and anorectal function.

Human teeth show a large number of morphological variations and cuspal variations are one among them. A parastyle is a paramolar cusp that appears on the buccal surface of the maxillary molars. The exact cause of occurrence of parastyle is not clear but primarily it is found to be polygenetic in origin with some environmental influence. It is found to be rare in occurrence with prevalence of 0-0.1% in first molars, 0.4-2.8% in the upper second molar, and 0-4.7% in the maxillary third molars. Various dental problems like caries, sensitivity, interference with cementation of brackets, bands gingivitis, have been found to be associated with these extra cusps. These morphological findings are important for anthropologist and forensic experts. Few case reports are there in literature. The present article mentions the four cases of this rare morphologic variation.

The aim of our study was to investigate the prevalence and patterns of M3 agenesis in the population of hilly state of H.P. (India) . An observational radiographic study was conducted in the age range of 13 -56 years from Feb 2019 -May 2020 in tertiary care center. Total 540 panoramic radiographs were included in the study based on inclusion and exclusion criteria. The panoramic radiographs were evaluated for the agenesis of third molars and data was recorded on the predesigned performa. Statistical analysis was done using Chisquare test (p<0.05) Out of 540 patients, 151 (27.9%) patients showed M3 agenesis.M3 agenesis was reported 53.6% in males and 46.4% females. There was statistically significant difference in frequency of type of quadrant involvement in males (χ 2 =8.59,P=0.03) and in females (χ 2 =10.64, P=0.01) both. All four M3 agenesis was more in males (33.3%) than females (7.1%) , single M3 agenesis was seen more in females (41.4%) than males (30.8%) . The prevalence of third molar agenesis was found to be 27.9%. Males affected more than females. Maxilla shows more M3 agenesis in compared to mandible. Right side of jaw exhibited more M3 agenesis than left side. The pattern of M3 agenesis was single third molar missing> two third molars missing> all four third molars missing> three third molars missing (1>2>4>3) .

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Ewing's sarcoma is a small round-cell malignant tumor of bones, primarily affecting children and young adults. It might be neuroectodermally derived with various degrees of differentiation of the primitive neural tissues. It has retained the most unfavourable prognosis of all primary musculoskeletal tumors, with long-term survival being less than 10%. The development of multi-disciplinary therapy with chemotherapy, irradiation and surgery, the survival rates are increased to greater than 50%. The pathognomonic translocations involving the EWS gene on chromosome 22 and an ETS-type gene, which is the Fli1 gene on chromosome 11, are implicated in more than 95% of Ewing's sarcomas. This paper reports a rare case of ES of mandible in 8years old male patient. The patient was managed with multiagent chemotherapy, followed by surgical resection.