P S Gopinath Thilak, Abel Biji Abraham, Padmaraj Hegde, Riya Shah
{"title":"Post-operative Sequelae Following Surgical Removal of Mandibular Third Molars with and Without the Use of a Tube Drain - A Comparative Study.","authors":"P S Gopinath Thilak, Abel Biji Abraham, Padmaraj Hegde, Riya Shah","doi":"10.4103/ams.ams_60_25","DOIUrl":"10.4103/ams.ams_60_25","url":null,"abstract":"<p><strong>Introduction: </strong>The most commonly performed oral surgical procedure involves the surgical extraction of an impacted mandibular third molar. Subsequently, documented evidence indicates the presence of associated sequelae, including diminished mouth opening, swelling and postoperative discomfort. This study aimed to objectively assess the levels of pain, swelling and trismus following surgical removal of impacted mandibular third molars, comparing cases with and without the use of an intraoral tube drain.</p><p><strong>Materials and methods: </strong>Fifty patients with bilateral impacted mandibular third molars in both sides of the jaw were enrolled in this study. A modified infant feeding tube was inserted, measuring 2-3 cm in length, with custom slots into the experimental side. Patients were scheduled for follow-up 2 days, 4 days and 8 days after surgery to assess pain, facial swelling and trismus. The drain was removed during the first follow-up visit, and sutures were removed 8 days after surgery.</p><p><strong>Results: </strong>Our study findings clearly highlight the advantages of utilising a tube drain following the extraction of an impacted mandibular third molar, particularly in reducing post-operative facial swelling and trismus. Data reveal a notable decrease in postoperative pain when a tube drain is employed compared to the group that did not use tube drains post-extraction.</p><p><strong>Discussion: </strong>Use of drainage tubes has been shown to enhance postoperative pain relief, reduce facial swelling and alleviate trismus immediately after surgery. Moreover, surgical drains have demonstrated excellent patient compliance and safety, underscoring their importance in standard treatment protocol for patients undergoing surgical extraction of impacted mandibular third molars.</p>","PeriodicalId":7972,"journal":{"name":"Annals of Maxillofacial Surgery","volume":"16 1","pages":"8-14"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13456636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H T Arvind Rao, Vini Dharmendra Machchhar, Ashwin Harekal, Jagadish Chandra, V K Vineeth
{"title":"A Case of Actinomycotic Osteomyelitis in Maxilla Presenting as Oroantral Fistula - A Rare Case Report.","authors":"H T Arvind Rao, Vini Dharmendra Machchhar, Ashwin Harekal, Jagadish Chandra, V K Vineeth","doi":"10.4103/ams.ams_146_25","DOIUrl":"10.4103/ams.ams_146_25","url":null,"abstract":"<p><strong>Rationale: </strong>Actinomycotic osteomyelitis of the maxilla is a rare, chronic infection caused by <i>Actinomyces</i> species. Owing to the rich vascularity of the maxilla, involvement is uncommon, often leading to delayed diagnosis and increased morbidity if untreated.</p><p><strong>Patient concerns: </strong>A patient presented with a 6-month history of dull, persistent maxillary pain following the extraction of right upper first premolar.</p><p><strong>Diagnosis: </strong>Clinical examination revealed an oroantral fistula with an exposed, mobile sequestrum. Sequestrectomy with histopathological evaluation confirmed actinomycotic osteomyelitis.</p><p><strong>Treatment: </strong>Sequestrectomy with thorough debridement and intranasal antrostomy was performed for adequate sinus drainage. Prolonged high-dose intravenous antibiotics were administered, followed by oral therapy targeting <i>Actinomyces</i>.</p><p><strong>Outcomes: </strong>At 1-year follow-up, the patient was asymptomatic with no evidence of recurrence.</p><p><strong>Take-away lessons: </strong>It is rare and often difficult to diagnose due to non-specific symptoms and negative cultures. Early suspicion, histopathological confirmation and individualised regimens considering patient compliance and access to care, plus long-term follow-up, ensure favourable outcomes.</p>","PeriodicalId":7972,"journal":{"name":"Annals of Maxillofacial Surgery","volume":"16 1","pages":"120-123"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13456645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Resection and Reconstruction of Cribriform Adenocarcinoma of the Posterior One-third of the Tongue - A Case Report.","authors":"S M Balaji, Preetha Balaji","doi":"10.4103/ams.ams_229_25","DOIUrl":"10.4103/ams.ams_229_25","url":null,"abstract":"<p><strong>Rationale: </strong>Cribriform adenocarcinoma of the tongue and minor salivary glands (CATMSG) is a very rare salivary gland tumour mimicking adenoid cystic carcinoma (AdCC) or polymorphous low-grade adenocarcinoma, impacting treatment, prognosis and management.</p><p><strong>Patient concerns: </strong>A 71-year-old female presented with a painful, bleeding left tongue mass. An external biopsy reported AdCC.</p><p><strong>Diagnosis: </strong>A rebiopsy at our centre diagnosed the lesion as a classic CATMSG: cribriform architecture, pale overlapping nuclei and S-100/SMA positivity on immunohistochemistry.</p><p><strong>Treatment and outcomes: </strong>Based on the revised diagnosis, the patient underwent composite resection, neck dissection and free flap reconstruction. Final pathology confirmed CATMSG (pT3 pN0) with perineural invasion. She recovered well and was referred for adjuvant radiotherapy.</p><p><strong>Take-away lessons: </strong>This case highlights that an accurate distinction of CATMSG from AdCC is essential, as it mandates specific surgical and adjuvant strategies. Expert histopathological review is critical for optimal, tailored patient care.</p>","PeriodicalId":7972,"journal":{"name":"Annals of Maxillofacial Surgery","volume":"16 1","pages":"128-132"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13456644/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Federica Sobrero, Pablo Enrique Mejia Paz, Álvaro Sada-Malumbres, Néstor Montesdeoca-García, Eduardo Olavarria Montes, José Luis Cebrián Carretero
{"title":"Trans-antral Temporal Flap to Reconstruct Palatal Defects in Dentate Patients - A Technical Note.","authors":"Federica Sobrero, Pablo Enrique Mejia Paz, Álvaro Sada-Malumbres, Néstor Montesdeoca-García, Eduardo Olavarria Montes, José Luis Cebrián Carretero","doi":"10.4103/ams.ams_45_25","DOIUrl":"10.4103/ams.ams_45_25","url":null,"abstract":"<p><p>The temporalis myofascial flap (TMF) is a reliable option for midfacial defect reconstruction, benefiting from robust vascularisation and anatomical proximity. However, its use in palatal defect coverage has been limited by the presence of dentition. This article describes a novel TMF transposition technique through a trans-antral pathway, with immediate correction of temporal contour deformity with a titanium mesh. A case of type 2A maxillectomy in a fully dentate patient with a malignant neoplasm shows the technique's feasibility. Key steps include raising the TMF via a hemicoronal approach, rotating it beneath the zygomatic arch, and then through an anterolateral maxillary bone window to reach the palatal vault. The bone window is then reshaped and fixated with plates and screws, and a titanium mesh is contoured to restore the temporal contour. The procedure was completed without complications. The TMF successfully covered the palatal defect, providing a stable foundation for mucosal regeneration. The titanium mesh corrected the temporal depression, restoring soft-tissue contour. Post-operative recovery was uneventful, and no functional or cosmetic deficits were observed. The trans-antral TMF technique is a reliable, single-stage method for palatal defect reconstruction, even in fully dentate patients. This approach is a viable option when microvascular reconstruction is contraindicated or unavailable, offering vascular reliability, minimal donor-site morbidity and reduced operative complexity.</p>","PeriodicalId":7972,"journal":{"name":"Annals of Maxillofacial Surgery","volume":"16 1","pages":"109-112"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13456631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Angiotensin-converting Enzyme 2 Expression in Oral Squamous Cell Carcinoma: Correlation with p53 and Vascular Endothelial Growth Factor Using Reverse Transcriptase Polymerase Chain Reaction - An Evaluative Study.","authors":"Shivani Sivasakthivel, Pratibha Ramani","doi":"10.4103/ams.ams_26_25","DOIUrl":"10.4103/ams.ams_26_25","url":null,"abstract":"<p><strong>Introduction: </strong>Angiotensin-converting Enzyme 2 (ACE2), though expressed in various tumour cells, is increasingly recognized for its potential tumour-suppressive role, primarily through inhibiting angiogenesis and related pathways involved in tumour progression and invasion. However, there is uncertainty about its expression, association with angiogenesis and tumour growth. Vascular endothelial growth factor (VEGF) and tumour protein 53 (p53) are known biomarkers for the angiogenesis pathway and tumour progression; hence, we intended to investigate how ACE2 expression correlates with VEGF and p53 expression in oral squamous cell carcinoma (OSCC) tissue. This study aimed to analyse the gene expression levels of ACE2, p53, and VEGF in OSCC patients and assess their correlations with OSCC progression.</p><p><strong>Materials and methods: </strong>A total of 20 tissue samples each from OSCC patients and healthy individuals were analysed. Ribonucleic acid (RNA) isolation was performed, followed by cDNA synthesis using ACE2, p53, and VEGF primers. Reverse transcription polymerase chain reaction (RT-PCR) was performed, and results were analysed.</p><p><strong>Results: </strong>The mean mRNA expression levels of the ACE2, p53, and VEGF genes in OSCC patients were 1.8, 1.4, and 2.7, respectively. Notably, the Pearson coefficient demonstrated that ACE2 levels were positively correlated with VEGF levels and negatively correlated with p53 levels.</p><p><strong>Discussion: </strong>Our findings indicate that, compared with healthy tissues, OSCC tissues present increased mRNA expression of ACE2, p53, and VEGF. The findings of the present study suggest that ACE2 levels are associated with increased expression of VEGF in OSCC patients. Further studies are necessary to explore and elucidate the role of ACE2 in the VEGF angiogenesis pathway in OSCC progression.</p>","PeriodicalId":7972,"journal":{"name":"Annals of Maxillofacial Surgery","volume":"15 2","pages":"164-169"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12919878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147269472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Federico Marinelli, León Graneros, Esteban Bolea, Benjamín Tomas Pina, Fernando Dip, Alberto Rancati, Marcelo Bou, Diego L Sinagra
{"title":"Application of the Radial Forearm Free Flap in Intraoral Reconstruction - A Retrospective Study.","authors":"Federico Marinelli, León Graneros, Esteban Bolea, Benjamín Tomas Pina, Fernando Dip, Alberto Rancati, Marcelo Bou, Diego L Sinagra","doi":"10.4103/ams.ams_66_25","DOIUrl":"10.4103/ams.ams_66_25","url":null,"abstract":"<p><strong>Introduction: </strong>The radial forearm free flap (RFFF) is an established technique for the reconstruction of intraoral defects following oncological resection. The objective of this study was to evaluate the functional, aesthetic and complication-related outcomes of the RFFF in immediate microvascular reconstruction of intraoral defects.</p><p><strong>Materials and methods: </strong>A retrospective, observational and descriptive study was conducted based on the clinical records of 15 patients who underwent resection and immediate reconstruction with a RFFF at Hospital de Clínicas \"José de San Martín\" between May 2019 and June 2024. Post-operative oral function was assessed using the functional oral intake scale for swallowing, the speech intelligibility rating for speech and the modified Vancouver Scar Scale for aesthetic outcomes. Complications were classified according to the Clavien-Dindo system adapted for reconstructive microsurgery. Descriptive and inferential statistical analyses were performed, with significance set at <i>P</i> < 0.05.</p><p><strong>Results: </strong>The mean age was 62.8 years; 60% were female. The most frequent diagnosis was oral cavity squamous cell carcinoma (80%). Flap survival was 100%. Swallowing function was adequate in 86.7% of cases, speech in 73.3% and aesthetic outcome in 80%. The overall complication rate was 20.0%, with only one case requiring microsurgical reintervention. No statistically significant association was found between the occurrence of complications and functional or aesthetic outcomes.</p><p><strong>Discussion: </strong>The RFFF proved to be a safe and effective technique for immediate reconstruction of intraoral defects, offering high survival rates and satisfactory functional and aesthetic outcomes.</p>","PeriodicalId":7972,"journal":{"name":"Annals of Maxillofacial Surgery","volume":"15 2","pages":"203-206"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12919860/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147269496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Lab-on-Chip Platforms: A Paradigm Shift in Maxillofacial Surgical Science.","authors":"S M Balaji","doi":"10.4103/ams.ams_219_25","DOIUrl":"10.4103/ams.ams_219_25","url":null,"abstract":"","PeriodicalId":7972,"journal":{"name":"Annals of Maxillofacial Surgery","volume":"15 2","pages":"135-136"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12919882/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147269550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pablo Andrés Crespo-Reinoso, Erika Paola Padilla-Viñanzaca
{"title":"Spontaneous Fracture of the Atlas in a Patient with Pycnodysostosis and Mandibular Osteomyelitis - A Case Report.","authors":"Pablo Andrés Crespo-Reinoso, Erika Paola Padilla-Viñanzaca","doi":"10.4103/ams.ams_21_25","DOIUrl":"10.4103/ams.ams_21_25","url":null,"abstract":"<p><strong>Rationale: </strong>Mandibular osteomyelitis is a common complication in pycnodysostosis; however, spontaneous atlas fracture has not been previously reported.</p><p><strong>Patient concerns: </strong>Persistent mandibular pain, swelling, and purulent discharge following tooth extraction, along with recent cervical discomfort.</p><p><strong>Diagnosis: </strong>Left mandibular osteomyelitis and type 3 atlas (C1) fracture in a patient with a prior diagnosis of pycnodysostosis.</p><p><strong>Treatment: </strong>Cervical immobilisation with a Philadelphia collar for 8 weeks, sequestrectomy under local anaesthesia, irrigation, debridement and targeted antibiotics.</p><p><strong>Outcomes: </strong>Favorable progress with no signs of infection or cervical symptoms after 6 months, along with partial bone healing in the mandible and stabilization of the C1 fracture.</p><p><strong>Take-away lessons: </strong>In patients with pycnodysostosis, maxillofacial procedures must include prior cervical evaluation. Vertebral fractures may occur without evident trauma and present with minimal symptoms, posing a high clinical risk if undetected.</p>","PeriodicalId":7972,"journal":{"name":"Annals of Maxillofacial Surgery","volume":"15 2","pages":"241-244"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12919862/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147269492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sharvari Daithankar, Amit Mahajan, Rakesh Shah, Aditya Shah, S Kaustuv Kanta, Aditya Shendurse
{"title":"Zip Stitch Adhesive Bandage for Maxillofacial Wounds - An Evaluative Study.","authors":"Sharvari Daithankar, Amit Mahajan, Rakesh Shah, Aditya Shah, S Kaustuv Kanta, Aditya Shendurse","doi":"10.4103/ams.ams_177_24","DOIUrl":"10.4103/ams.ams_177_24","url":null,"abstract":"<p><strong>Introduction: </strong>Zip stitch is a complete atraumatic wound closure device that has garnered widespread acceptance among healthcare professionals. Despite existing research on zip stitch adhesive bandages in other surgical fields, their application in maxillofacial surgery remains relatively unexplored. The study aims to establish a baseline for the use of zip stitch over maxillofacial region, evaluating its benefits, disadvantages and risks to inform its implementation.</p><p><strong>Materials and methods: </strong>A pilot study was carried out on 15 patients having facial wounds and those requiring incision placement over the maxillofacial region. A Mediss zip stitch was used for skin closure and evaluated further.</p><p><strong>Results: </strong>All patients exhibited satisfactory results as evidenced by the <i>P</i> values of ASEPSIS (0.00014), modified Hollander (0.00003), Vancouver scores (0.00001) indicating minimal scarring. Patient and observer scar assessment scale (POAS) scores (0.00056) demonstrates favourable outcomes from the patient's point of view. Potential disadvantages were identified and strategies for mitigation were developed.</p><p><strong>Discussion: </strong>While zip stitch adhesive bandages are gaining popularity in India, their use in the maxillofacial region remains relatively limited. This pilot research establishes a baseline for safety and efficacy of zip stitch in this specific area for further in-depth analysis.</p>","PeriodicalId":7972,"journal":{"name":"Annals of Maxillofacial Surgery","volume":"15 2","pages":"170-174"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12919870/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147269470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"ABO Blood Groups as Predictors of Oral Malignancy Risk - A Retrospective Study.","authors":"Abhilasha Yadav, Anuj Jain, Rajiv Borle, Bindu Singh","doi":"10.4103/ams.ams_33_25","DOIUrl":"10.4103/ams.ams_33_25","url":null,"abstract":"<p><strong>Introduction: </strong>Oral cancer is a major public health issue globally, especially in developing countries. While various risk factors for oral malignancies have been identified, the role of genetic and immunological predisposition remains unclear. This retrospective case-control study investigates the association between ABO blood groups and the risk of developing oral malignancies in the Indian population, aiming to provide insights into potential predictive markers for early detection and prevention.</p><p><strong>Materials and methods: </strong>A total of 307 patients with histologically confirmed oral malignancies, diagnosed between January 2011 and December 2014, were analysed. Demographic details, ABO blood group data and the anatomical site of malignancy were extracted from medical records. These patients were compared to 600 healthy controls. Statistical analysis used the Chi-square test for association, and odds ratios were calculated to estimate risk.</p><p><strong>Results: </strong>Among 307 patients diagnosed with oral malignancies, the majority were male (75%), with the peak incidence observed in the fifth decade of life. Buccal mucosa was the most commonly affected site (73%), followed by tongue and alveolar ridge. Analysis of ABO blood group distribution revealed that blood group A was the most prevalent among cases. Individuals with blood group A demonstrated a 1.46-fold higher risk of developing oral malignancies compared to other blood groups (<i>P</i> < 0.05).</p><p><strong>Discussion: </strong>The study showed a significant association between blood group A and the risk of developing oral malignancies in the Indian population. These findings may assist in identifying high-risk individuals and developing targeted screening programs for early detection and improved outcomes.</p>","PeriodicalId":7972,"journal":{"name":"Annals of Maxillofacial Surgery","volume":"15 2","pages":"213-217"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12919872/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147269526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}