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National Journal of Maxillofacial Surgery
 
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   Table of Contents - Current issue
Coverpage
August 2022
Volume 13 | Issue 4 (Supplement)
Page Nos. 1-238

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REVIEW ARTICLES  

Is the facial nerve at risk following surgical correction of mandibular condylar fracture: A systematic review and meta-analysis Highly accessed article p. 1
Sapna Tandon, Vishal Verma, Mohd Rashid, Saurabh Srivastava, Akhilesh Kumar Singh, Naresh Kumar Sharma
DOI:10.4103/njms.njms_481_21  
To review the literature on the effect of different surgical approaches on facial nerve injuries.The present systematic review addresses the following focus question: Is the facial nerve at risk following surgical correction of mandibular condylar fracture? Electronic and manual literature searches were conducted on databases:PubMed, ScienceDirect and Google scholar,Cochrane and clinicaltrials.gov for studies published until July 2020 to collect information about the effect of different surgical approaches on facial nerve injuries.Systematic literature review was performed following the prisma guidelines to identify studies. Quantitative retrospective and prospective studies,controlled trials,controlled clinical trials were included;case reports and review articles were excluded from this systematic review. 1500 articles published till July 2020 was identified. 116 articles met inclusion criteria. After applying exclusion criteria seven articles were shortlisted.The level of heterogeneity was observed to be less than 50%, between all parameters for all studies making publication bias to be minimum.On comparing various studies statistically using Z-test for all parameters,it was observed that level of significance was significant for various findings like Displacement/Dislocation of fracture and transient facial nerve weakness was found to be statistically significant between all studies (p-value <0.05). Odd ratio, relative ratio and 95% CI was derived for all parameters recorded for various studies. Due to less number of subjective studies, and variability in study designs and lack of reporting on confounding factors,definitive conclusions on effect of various surgical approaches on facial nerve injury cannot be drawn Future well-designed long-term randomized controlled trials are necessary to reveal the necessary correlation between both the parameters.
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Biophysical therapy using the pulsating electromagnetic field as adjunctive therapy for implant osseointegration – A review Highly accessed article p. 11
Munna Khan, Mohammad Faisal, Lubna Ahmad
DOI:10.4103/njms.njms_400_21  
Development of procedures which accelerate osseointegration of dental implants, reduce the period of healing, and lead to an early rehabilitation of the patient are required for successful oral rehabilitation. Pulsed electromagnetic field (PEMF) is a noninvasive, therapeutic form of low field magnetic stimulation that has been used for healing bone non unions and various fractures. It acts on osteoblasts and bone, affecting their metabolism, therefore, increasing the tissue integration of the implanted devices and their clinical success. A broad range of settings that includes magnetic field intensity, frequency and duration of application, etc. used for PEMFs stimulation is a hurdle to properly define treatment protocols and extensive research is needed to overcome this issue. The present review includes studies that investigated the effects of PEMFs on the response of bone cells to different classes of biomaterials and the reports that focused on in vivo and in vitro investigations of biomaterials implanted in bone. This study is expected to serve as a guide for researchers and clinicians to bring into their clinical use these strategies to improve implant osseointegration in deficient and osteoporotic bone.
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Three-dimensional printing in the field of oral and maxillofacial surgery Highly accessed article p. 19
DS Yashavanth Kumar, Sunil Dutt Christopher, Harsha Mallegowda, Viral Dave, Sunil Kumar Gulia, Rishabh Bhanot
DOI:10.4103/njms.NJMS_43_20  
Advanced imaging techniques and modalities coupled with computer-assisted surgical planning and simulation has been in use in the field of medicine. However, it is worth noting that it is now being frequently used for the evaluation and exploration of the craniofacial structures. It had gained ingress in the planning as well as forecasting of the surgical outcomes of oral and maxillofacial surgical interventions. Numerous surgical guides and devices which are tailor-made can be fabricated using three-dimensional (3D) printing technology. The article is intended to put forth an overview of 3D printing technology and its applications in the field of oral and maxillofacial surgery.
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Socket shield technique: An unconventional method for immediate implant placement - A review Highly accessed article p. 24
Ankit Sharma, Komal Maheshwari, Bhawana Tiwari, Dwarakananda Naik
DOI:10.4103/njms.NJMS_53_20  
The aim of this review is to present the currently available studies on the treatment outcome of socket shield technique (SST) with an attempt to compare it with the conventional technique for immediate implant placement. An electronic search was performed using PubMed, Google Scholar, and Cochrane databases. All relevant human studies reporting the treatment outcome of SST in conjunct with immediate implant placement were included. In vitro studies, case reports, reviews, systematic reviews and articles not related to SST were excluded. The initial electronic database search identified 606 articles. After removing the duplicates, reading the titles and abstracts, 19 articles were eligible for full-text reading. Two case series were excluded as the specific treatment outcomes of the clinical cases were not mentioned. Further, one article was included after hand searching of the reference lists. Eighteen articles were included for the final review. These 18 articles consisted of 15 full texts and 3 abstracts. Out of them, 3 were randomized controlled trials, 7 were retrospective studies, 4 were prospective studies, 1 was a prospective case series, 1 was a prospective nonrandomized controlled study and 2 were comparative studies. This review concludes that though the implant survival rate may be comparable in SST and the conventional technique, the SST seems to perform better in terms of bone preservation, esthetic outcome, and patient satisfaction. Furthermore, further randomized clinical trials are required to generate strong evidence for recommending SST over the conventional technique for long-lasting successful treatment outcomes with immediate implants.
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ORIGINAL ARTICLES Top

Could maternal stress be a causal factor for nonsyndromic cleft lip and/or palate: A retrospective study p. 36
Kiran Sunil Mahapure, Rajesh S Powar
DOI:10.4103/njms.njms_326_21  
Background: The etiology of the nonsyndromic cleft lip and palate is multifactorial and not clearly defined. Objective: To determine whether maternal stress could be a causal factor for the occurrence of nonsyndromic cleft lip and palate. Materials and Methods: We conducted a retrospective observational study in which data from 50 mothers of children born with nonsyndromic cleft lip and palate and 50 mothers of noncleft children were analyzed. The outcomes defined were to study the association between the increased stress scores and the occurrence of nonsyndromic cleft lip and/or palate. Statistical analysis was performed using the Chi-square test. Results: The association between the high maternal stress scores and the occurrence of nonsyndromic cleft lip and/or palate was not found to be significant (P = 0.3220). A significant association was noted between increased maternal age and increased stress levels in the cleft group (P = 0.0001). Conclusion: No significant association was found between the increased stress scores and the occurrence of nonsyndromic cleft lip and/or palate. However, mothers of cleft children whose age was 35 years and above at the time of conception were noted to have higher stress levels.
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Radio frequency analysis of partially grafted immediate dental implant with and without use of static magnetic field: An in vivo study p. 41
Akanksha Yadav, Lakshya Kumar, Uma Shankar Pal, Mayank Singh, Madan Lal Brham Bhatt, Ranjitkumar Patil, Aditi Verma
DOI:10.4103/njms.NJMS_37_19  
Background: Replacement of missing teeth with dental implants represents one of the most successful treatment modalities in modern dentistry. Patients desire for a shorter treatment time has made clinicians to attempt loading implants early or immediately after placement. The primary stability is determined by density and mechanical properties of the bone, the implant design, edentulous site complications, and the surgical technique.Various researchers have tried to achieve faster osseointegration static magnetic field is one of them. So the aim of this study was to investigate whether Static magnetic field created by using safer magnets was useful to promote osseointegration. Materials and Methods: Subjects were selected according to the predetermined inclusion and exclusion criteria in two groups (20 in each group). Conventional implant placement protocol was used and implant placement was performed and grafting was done. Magnetic healing cap was used in group I and conventional healing cap in group II. Implant stability assessment using radio frequency analyser was assessed at 2, 3 and 4 months on interval. Result: Mann-Whitney U test revealed that there was significant difference was observed between the groups I and II at 2, 3 and 4 months of interval (P < 0.001). Static magnetic field improve osseointegration in group I as compared to group II. Conclusion: The present double-blinded RCT showed significantly improved implant stability and osseointegration in implants which were stimulated by static magnetic field by using magnetic healing cap as compared to implants with conventional healing cap.
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Evaluation of effects of platelet-rich fibrin on treatment outcomes after impacted mandibular third molar surgery: A randomized controlled clinical study p. 46
TM Shruthi, Akshay D Shetty, KS Akash, Fazeel Ahmed, Navya Shetty, Ravalika Singarapu
DOI:10.4103/njms.NJMS_16_20  
Background and Objective: Impaction of the third molar teeth is a common disorder which often necessitates their removal. After third molar surgery, the common postoperative sequelae are pain, trismus, and buccal swelling. Our study sought to evaluate the effect of platelet-rich fibrin (PRF) on postoperative pain, swelling, trismus after surgical extraction of impacted mandibular 3rd molars. Materials and Methods: Over a period of 22 months (December 1, 2016–September 30, 2018), 44 patients in the age group of 18–40 years, who required surgical extraction of impacted third molar and met the inclusion criteria were recruited. After surgical extraction of the third molar, only primary closure was performed in the control group (22 Group), whereas PRF was placed in the socket followed by primary closure in the study group (22 patients). The outcome variables were pain, swelling, and maximum mouth opening were measured with a follow-up period of 1 week. Results: The application of PRF in the study group lessens the severity of immediate postoperative sequelae such as pain, swelling, and trismus compared to the control group. Conclusion: The treatment outcomes and postoperative sequel were better in the PRF group as compared to other control group on days 1, 3, and 7 postoperatively.
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Efficacy of low-level laser therapy in the management of postoperative surgical sequelae after surgical removal of impacted mandibular third molars p. 52
Sagar D Thorat, Kumar Nilesh
DOI:10.4103/njms.NJMS_52_20  
Introduction: The study is aimed to evaluate the effectiveness of low-level laser therapy (LLLT) in the control of pain, swelling, and trismus after the surgical removal of impacted mandibular third molars. Materials and Methods: A prospective study was conducted on thirty patients requiring surgical removal of the impacted mandibular third molar. Mesioangular impacted third molar with class I level B position (according to the Pell and Gregory classification) were included in the study. The study group (n = 15) received LLLT using diode laser of wavelength 980 nm and the control group (n = 15) received routine postoperative care without LLLT. The parameters evaluated were intensity of pain, maximum mouth opening, postoperative swelling, healing at the surgical site, and presence of dry socket. Results: The mean score of pain, swelling, and trismus in the study group were statistically lower as compared to the control groups. Healing assessment using Laury and Turnbull healing index inferred that the healing at the seventh postoperative day was superior in the study group as compared to the control group. Conclusions: LLLT with a diode laser of wavelength 980 nm can effectively reduce pain, swelling, and trismus in the postoperative phase after surgical extraction of the mandibular impacted third molar and promote healing at the operative site.
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Osteotomy in lateral sinus augmentation: A comparative study of rotary technique and Lateral Approach Sinus Kit® p. 57
Rachana Singh, Jitender Kumar Aurora, RS Bedi, Himanshu Chauhan, Adrineel Banerjee, Charukirti Srivastava
DOI:10.4103/njms.NJMS_155_20  
Background: Various sinus lift techniques have been tried to minimize the rate of perforations, especially in Type I and Type II sinus membrane thickness. Aims and Objectives: The aim and objectives of this study was to present our own experience compare and the efficacy of conventional direct sinus lift technique and direct sinus lift using LAS Kit. Material and Methods: Our study included 14 patients in which seven patients in conventional technique and seven patients in Lateral Approach Sinus (LAS) Kit®. Result: The results showed that the sinus membrane perforation rate, using LAS Kit® with specially designed drills, is less than that of the conventional technique, especially in Type I and II sinus membrane with the added benefit of reduced operative time. The mean operative time in conventional technique was 28.29 ± 2.21min and in LAS Kit®, it was 19.43 ± 2.88min which was statistically significantly less than the conventional technique group (P < 0.001). In both the groups, 100% implant integrity was achieved (measured using reverse torque technique) after 6 months of follow-up. It was observed that there was no statistically significant difference between the groups in pain, swelling, flap dehiscence, and infection at different time intervals. Conclusion: We conclude that the use of LAS Kit® for sinus lift procedure in atrophied maxilla with Type I and II sinus membrane is a much safer approach over the conventional technique. Further, the results obtained also showed that blood coagulum gave better gain in bone height over a period of 6 months.
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A biochemical research focused on the association of the levels of oxidative stress and nitric oxide with premalignant disorders and oral squamous cell carcinoma p. 65
Rohan Sachdev, Kriti Garg, Vishal Mehrotra, Samiksha Shwetam, Shubhra Saxena, Akash Srivastava
DOI:10.4103/njms.NJMS_160_20  
Context: The reactive oxygen species such as superoxide radicals (O2 •), hydroxyl radicals (OH•), and hydrogen peroxide play a vital role in the pathogenesis of human cancer development and have become one of the areas of key interest in the field of biochemical analysis. Aims: The present study was designed to determine the significance of oxidative stress and levels of nitric oxide (NO) in patients with premalignant disorders and oral squamous cell carcinoma (OSCC), by evaluating the levels of lipid peroxidation products, antioxidants, and NO products. Settings and Design: The present study was conducted on 280 patients for 2 years. These patients were divided into 4 groups, Group I (n = 70, control), Group II (n = 70, oral submucous fibrosis), Group III (n = 70, OSCC), and Group IV (n = 70, OL). Subjects and Methods: The levels of lipid peroxidation products, antioxidants, and NO products were determined by colorimetric methods. Statistical Analysis Used: Paired t-test was used to compare the mean. Results: Lipid peroxidation products such as lipid hydroperoxide and malondialdehyde and NO products such as nitrite (NO2–), nitrate (NO3–), and total nitrite (TNO2–) were significantly elevated, whereas enzymatic and nonenzymatic antioxidants were significantly lowered in OSCC, oral submucous fibrosis, and oral leukoplakia when compared to normal healthy participants. The P values were calculated and came as statistically significant (<0.05). Conclusions: Antioxidant enzyme impairment and NO status may be considered as one of the factors responsible for oral cancer pathogenesis and may serve as a promising biomarker and therapeutic target for minimizing malignant transformation in oral premalignant disorders.
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“Risk assessment for periodontal disease associated tooth loss among rural and urban population of 35-44, 45-54, 55-64 and 65-74 years age groups of Barabanki district, Uttar Pradesh, India: An epidemiological study p. 70
Awadhesh Kumar Singh
DOI:10.4103/njms.NJMS_62_19  
Aim: The aim of the study was to assess the risk for periodontal disease-associated tooth loss among rural and urban population of Barabanki district, Uttar Pradesh, India. Materials and Methods: A cross-sectional study was done on 1200 urban and rural adults (632 males and 568 females) aged 35–74 years. Data were collected, followed by clinical examination for missing teeth. One-way analysis of variance with Bonferroni post hoc test, Chi-square test, and Student's t-test were used for statistical analysis. Statistical significance was set at P ≤ 0.05. Results: The mean number of periodontal disease-associated tooth loss in the study population was 4.2 ± 7.4. A significant association was found between the place of residence and tooth loss (3.5 ± 6.8 urban; 4.7 ± 7.8 rural), with rural adults showing greater tooth loss compared to urban adults (P < 0.01). Tooth loss increased significantly with age, ranging from mean number of 1.2 teeth in 35–44 years old to 11.5 teeth among 65–74 years old (P < 0.001). Gender showed a significant difference (P < 0.01) in tooth loss between males (4.7 ± 7.7) and females (3.6 ± 6.9). A significant association for tooth loss was also found with respect to the level of education and socioeconomic status (P < 0.001). A decrease in the mean number of missing teeth with increasing education and better socioeconomic status was observed, which was statistically significant (P < 0.001). Conclusion: The insights gained illustrate that tooth loss was 57% in rural and urban Barabanki district population, and the significant risks identified were age, illiterate, marital status, and low socioeconomic status.
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Insights of dental postgraduate students and guides toward change in MDS examination pattern: A cross-sectional study p. 76
Shrivardhan Kalghatgi, Mahesh Ravindra Khairnar, Tanushri Mahendra Dalvi, Archana Dwivedi, Hrishikesh Saoji, Akhilesh Chandra
DOI:10.4103/njms.njms_330_21  
Introduction: According to the notification dated May 17, 2018, no. DE-14-MDS-2018/2131 published by the Dental Council of India, basic sciences theory examination (Paper-1) will be conducted before the commencement of II-year MDS academic year instead of III-year MDS end. Hence, this study was conducted to assess the opinions regarding this recent change in the curriculum among I MDS students, II MDS students, and their respective postgraduate (PG) guides. Methodology: The study was conducted on 120 participants from three dental colleges. All the participants were interviewed using a pretested, structured questionnaire. The initial part of questionnaire consisted of demographic information of the study participants followed by ten questions targeted to assess the perception toward change in MDS examination pattern. Statistical analysis was performed using SPSS software v20, and Chi-square test was used for comparison of responses among PG students and PG guides. Results: Questions pertaining to the need of allowed to keep term (ATKT), assumption to improved concentration on specialization subjects, and increase in understanding of the subject have received maximum positive response. Negative responses were more for the questions such as hampering of PG curriculum, effect on dissertation selection process, and rendering quality treatment to the patient. Responses to necessity of ATKT and the assumption to better concentrate on specialization subject later differed significantly among the participants. Conclusion: The present study results revealed an overall positive perception toward the change in MDS curriculum pattern among the study participants.
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A comparison of the outcomes following intra-articular steroid injection alone or arthrocentesis alone in the management of internal derangement of the temporomandibular joint p. 80
Surya Udai Singh, Rajendra B Prasad, Rohit Punga, Rahul Datta, Neeraj Singh
DOI:10.4103/njms.njms_291_21  
Context: One of the main causes of chronic facial pain is temporomandibular disorders (TMDs) which may turn out to be a major cause for disability. The two types of treatment strategies may be undertaken to counter temporomandibular joint (TMJ) disorders, namely conservative management and surgical intervention. Surgical management can be classified into invasive open methods and minimally invasive procedures such as arthrocentesis, intra-articular steroid injection, and arthroscopy. Aims: The aim of this study is to compare the efficacy of Kenacort (Triamcinolone) as an intra-articular corticosteroid injection and arthrocentesis for lysis and lavage, for the treatment of the temporomandibular joint disorders. Subjects and Methods: Twenty patients with internal derangement of temporomandibular joint (IDTMJ) not responding to conservative management and meeting the inclusion criteria randomly underwent either intra-articular steroid injection or arthrocentesis and the results of the two procedures were evaluated and compared. Statistical Analysis Used: Unpaired t-test, repeated-measures ANOVA. A value of P < 0.05 is considered to be statistically significant. Results and Conclusion: Both procedures turned out to be successful in reducing pain and improving mouth opening, both in a short-term and a long-term use. Upon comparison in our series of patients, arthrocentesis was noted to be a better treatment modality in the long term for the management of IDTMJ.
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Efficacy of tranexamic acid in prevention of alveolar osteitis following surgical removal of impacted mandibular third molar p. 85
Ajinath Nanasaheb Jadhav, G Shushma, Vijay Dnyandev Deshmukh
DOI:10.4103/njms.njms_298_21  
Context: Many preventive measures are described to avoid alveolar osteitis (AO) during third molar surgery (TMS), but very few are found to be effective. Tranexamic acid (TA), an antifibrinolytic agent, impedes the proteolytic degradation of fibrin and prevents blood clot disintegration. Aims: The study was conducted to determine the efficacy of intra-alveolar application of TA soaked in Gelfoam in prevention of AO. Settings and Design: This was a randomized control trial. Materials and Methods: A total of 200 patients (100 in control group and 100 in study group) reporting for TMS were allocated randomly. Following surgery, TA soaked in gel foam was placed in socket and sutured in the study group, while in the control group, closure was done by suturing. Patients followed subsequently to observe the incidence of AO, pain severity, and duration of healing after AO. Statistical Analysis: Z-test, Mann–Whitney test, and t-test were applied, respectively, to compare the incidence of AO, severity of pain, and duration of healing between the two groups. Results: The incidence of AO in the control group was 18% and 6% in the study group. Patients in the control group experienced severe pain as compared to patients in the study group. The duration of healing varied from 12 to 16 days in the control group, but in the study group, it was <10 days. Conclusion: TA significantly reduces the incidence of AO in addition to the reduced severity of pain and enhanced healing. We recommend the routine use of TA, owing to its astonishing rewards.
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Minimally traumatic extraction techniques in nonrestorable endodontically treated teeth: A comparative study p. 91
Sneha D Sharma, Ashish Gupta, Pankaj Bansal, Mohan Alexander, Vidya B , Himani Gupta
DOI:10.4103/njms.njms_309_21  
Aim: The goal of this study was to assess the effectiveness of piezotome as compared to periotome extractions of nonrestorable endodontic treatment of teeth in terms of operational time, pain control, and postoperative bone loss considering the prosthetic rehabilitation in future. Materials and Methods: A double-blind, randomized controlled trial was conducted with 100 patients who wanted single-rooted teeth to be extracted (which failed endodontically). The participants have been randomized into two equal groups named as - (i) a periotome group (ii) and a piezotome group. Duration of the surgery, postoperative pain within 7 days, complications (if any) associated with the extraction process were performed as a part of clinical assessment. Bone loss has been analyzed 6 months after the surgery radiographically. The data have been recorded and analyzed using the version 22.0 of the SPSS software package. Results: All parameters in the periotome category (P < 0.05) were statistically significant except for bone loss and gingival laceration in comparison to piezotome group. In the piezotome group, a longer time was observed for surgery and delayed pain control was achieved. In our study, we found statistically significant more marginal bone loss in piezotome group in comparison with periotome group. Conclusion: The findings of this study indicate that for intraoperative and postoperative comfort periotome could be used as a safer and cheaper option for atraumatic extractions but piezosurgery may prove as a better choice soon for surgeries in the maxillofacial region to maintain soft-tissue integrity.
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Facial soft-tissue changes after anterior maxillary osteotomy: A prospective study p. 97
Gorrela Harsha, Rasagna Thota, Aditya Mohan Alwala
DOI:10.4103/njms.njms_311_21  
Aims: The aim of this study was to analyze and assess the soft-tissue response in patients treated by anterior maxillary osteotomy (AMO) in the postoperative period at 3, 6, and 9 months and to qualitatively assess the outcome of the surgery by the patients. Patients and Methods: The study included twenty adult healthy patients between 18 and 25 years with skeletal Class II malocclusion and requiring AMO setback for the correction of facial deformity. Preoperative and postoperative lateral cephalograms were taken and soft-tissue changes that occurred following AMO were compared at 3, 6, and 9 months postoperatively. The stability and acceptance of the soft-tissue changes were analyzed, and the patient's acceptance for the soft-tissue changes was measured on the surgical rating scale (SRS). Results: All the soft-tissue parameters showed noticeable changes following AMO. Statistically significant difference was observed with nasolabial angle, upper lip, and lower lip inclination. All the patients were moderately satisfied with the outcome of the surgery. Conclusion: This study aims in quantifying the soft-tissue changes following the AMO and the quality of the changes were recorded based on the SRS by the patients. Although there are changes associated with all the parameters assessed, significant differences was observed in nasolabial angle, upper lip, and lower lip inclination. The surgeon must be aware of the soft-tissue adaptation following the surgery for better outcomes.
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An objective assessment of microneedling therapy in atrophic facial acne scars p. 103
Komal Babu Waghmare, Joyce Sequeira, B H Sripathi Rao
DOI:10.4103/njms.NJMS_7_18  
Context: Microneedling therapy is one of the recent advances in treating acne facial scars. Aim: To evaluate the efficacy of microneedling therapy in the treatment of atrophic acne facial scars. Settings and Design: A total number of 10 patients between the age group of 20 and 40 years (8 women and 2 men) who complained of acne scars from November 2012 to August 2014 were selected for the study. Subjects and Methods: Microneedling therapy was performed following the application of the Eutectic Mixture of Local Anesthetics in an interval of 2 months. All patients underwent three sessions. A follow-up of 2 months after the last sitting was carried out. Statistical Analysis: Cochran's Q-paired test, Kendall's W-test, and Pearson's correlation were used for statistical analysis. Results: Patients in our study had three forms of acne scars: box-scar, icepick form, and rolling scars. Patients were told to rate the outcome of the treatment at the end of the follow-up. Three observers randomly selected were shown the pre- and postoperative photographs of the patients to rate the treatment outcome. Statistically there was no interobserver bias. Ninety percent reduction in number of scars and depth of scars was noted at the end of three sittings. The improvement in pigmentation was insignificant. Seventy percent improvement in the skin texture was noted. Nine patients suffered from transient postinflammatory erythema and six patients had postoperative swelling. Conclusion: Microneedling therapy is a safe and effective method of treating acne scars.
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CASE REPORTS Top

Epiphora and nasal blockage – An unusual presentation of Pindborg tumor: A case report and literature review p. 108
Urvi Shah, Hiren Patel, Haren Pandya, Hitesh Dewan
DOI:10.4103/njms.NJMS_104_20  
Odontogenic tumors are silent ailments which can affect any individual. One such lesion is a calcifying epithelial odontogenic tumor (CEOT). It is a rare lesion with a locally aggressive nature. A 33-year-old male presented with nasal blockage and continuous flow of tears from the left eye for the past 7–8 months. Clinical examination revealed slightly protruded left eyeball and altered level of eyeballs with continuous watery discharge. Hess chart confirmed normal eye movements. Intraoral findings were not significant. The final diagnosis of CEOT was established based on the histopathological aspects. CEOT is mostly found in the third to fifth decade of life without gender predilection. Presenting symptoms and signs comprise painless expansile mass, although there are reports associated with pain, nasal obstruction, epistaxis, and proptosis. In this article, we would like to present a case of CEOT with epiphora and nasal blockage as the main and only presentation, an uncommon finding. Furthermore, discussing and posing a question of an adequate period of follow-up required to negate the presence of recurrence. One must stay vigilant enough not only to attest a singular symptom to the commonest ailment related to it but also to explore the possibility of the less known. Furthermore, we need to further research in depth to establish a certain duration after which the likeliness of recurrence is to the minimum.
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Single-stage reconstruction of traumatic lower lip defects with chin island myocutaneous and labial mucosal flap p. 113
Rahul Sahai, Sudhir Singh
DOI:10.4103/njms.NJMS_162_20  
In the present study of eight cases of traumatic lower lip defects, the reconstruction was achieved in a single stage by V-Y advancement island chin myocutaneous flap and labial mucosal advancement flap. There are many methods described for the reconstruction of small-to-large size of lower lip defects from straight-line closure of small defects to local flaps and free flaps for large defects. V-Y advanced chin flap has been reported previously also for the repair of lower lip defect with varying results. The vermilion reconstruction in others reported cases was done with the free mucosal grafts, V-Y labial mucosa advancement, or pedicled tongue flaps. Tongue flap is a two-stage procedure with esthetically unnatural look and an irregular surface of the vermilion. The free mucosa graft showed necrosis partial or complete resulting in irregular surface of vermilion and notching in the lip. V-Y labial mucosa advancement was done more for a small defect of the lip only. In the present series, we have repaired the vermilion of the lip by labial mucosal advancement flap, muscle by advancement of orbicularis oris from chin flap, and skin by V-Y advancement of island myocutaneous chin flap. Our results showed normal oral size with no evidence of microstoma or commissural distortion; oral competence was good with normal sphincteric function. The vermilion reconstructed had normal color and sensation. Lip seal was very good without notching defect in the vermilion. Drooling of saliva or speech defect was not noticed. The facial expressions and the look of the face were near normal. Hence, esthetically and functionally, the results were good without any irregularity or notching of the lip along with no incidence of drooling of saliva. We think that this technique may be considered as a procedure of choice for managing the moderate-to-large post traumatic defects of the lower lip. It is good esthetically and functionally besides being single stage for reconstructing moderate-to-large defects of the lower lip and is satisfying to the patient.
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Chondroid choristoma of the tongue: A rare case report p. 121
Sumaiya Nezam, Roquaiya Nishat, Shabab Ahmed Khan, Jeevendra Nath Shukla
DOI:10.4103/njms.NJMS_93_19  
Choristomas are tumor-like masses consisting of normal cells in an abnormal location. Choristomas of the oral cavity are rare lesions. We report a case of Cartilaginous choristoma on the ventral aspect of the tongue in a 25-year-old female. Clinical features, differential diagnosis, and tumoral origin theories are also discussed along with a meta-analysis of the reported cases in the PubMed database.
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Juvenile psammomatoid ossifying fibroma with aneurysmal bone cyst in the mandible: A report of a rare case p. 127
Amarnath Konda, D P Uma Magesh, Saichand Guntupalli, Shravan Teja Kodi
DOI:10.4103/njms.NJMS_181_20  
Aneurysmal bone cysts (ABCs) are rare benign lesions seen as locally destructive, rapidly expansile, and mostly affecting the long bones and vertebrae. The association of ABCs with juvenile psammomatoid ossifying fibroma (PsJOF) is predominantly seen in the extra gnathic region, and it is extremely rare with only a few cases reported so far in the mandible. Here, we report one such case of a hybrid lesion in a 30-year-old male, who presented with a solitary swelling of the right mandible showing partial obliteration of lingual vestibular sulcus, which was histologically confirmed as PsJOF as a preexisting lesion, transforming into an ABC. Such hybrid lesions are usually misdiagnosed and have been sparsely reported in the literature.
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Novel regimen of combined intralesional triamcinolone and salmon calcitonin nasal spray to treat a large central giant cell granuloma p. 131
Jitender Kumar Aurora, Himanshu Chauhan, Kapil Loomba, Ipshita Potlia
DOI:10.4103/njms.NJMS_185_20  
About 10% benign tumors of the jaw are known to be central giant cell granulomas (CGCGs) affecting mandible more than maxilla. They are more commonly seen among young females, mean age range being 10–25 years. The aggressive variants of CGCG require surgical intervention, leaving colossal disfiguring defects. This being the reason for many nonsurgical alternative therapies as calcitonin injections and nasal spray, intralesional steroid injections and subcutaneous interferon injections advocated for its management. Although the exact success rate of using these nonsurgical therapies are not fully known, they provide the advantage of being conservative in nature, as majority of the patients are young adults. This lack of accurate regimen is due to paucity of randomized control trials and systematic reviews addressing the topic. This manuscript attempts to present a novel regimen protocol which was followed for a case of CGCG, right mandible on a 22-year-old female patient, for a period of 1.5 years and trailed by a follow-up of 2 years.
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Guided autotransplantation of tooth: An innovative approach p. 136
Sanjeev Srivastava, Khushboo Gupta, Sandeep Dubey, Arohan Singh
DOI:10.4103/njms.NJMS_169_20  
This case report describes a novel approach of guided autotransplantation of tooth so that we can assess its feasibility, accuracy, and stability. In the present case, autotransplantation of a third molar at the recipient site of mandibular first molar was done. Three-dimensional (3D) replica of donor tooth along with surgical guiding template was virtually designed and fabricated using 3D printing. The 3D replica and surgical template helped in the surgical modification of recipient site and placement of donor tooth in the exact position. Root canal treatment of the donor tooth was carried out after 2 weeks. At 6 months' follow-up, the transplanted tooth was functional with no evidence of mobility or periodontal inflammation. Radiographic evaluation showed the absence of widening of periodontal space and external root resorption. Hence, the transplantation of the third molar is an outstanding procedure for replacing a lost permanent molar tooth which in turn restores esthetics and function.
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Enhancing retention and esthetics of fabricated silicone finger prosthesis using stump reduction technique and customized acrylic nail: A unique approach p. 140
Sapna Bhaskaran, Georgie P Zachariah
DOI:10.4103/njms.NJMS_251_20  
Prosthesis of any type is a necessity for a patient with defect to continue their daily life, on a socially acceptable level. The most commonly encountered forms of defects or loss include complete or partial finger amputations. One of the major concerns in the replacement of a partially amputated finger is inadequate retention of the prosthesis. This paper presents prosthetic rehabilitation of partially amputated index finger with a silicone prosthesis using reduced stump model technique and customized acrylic nail which enhances retention and esthetics of finger prosthesis.
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Ameloblastic fibrosarcoma transformation from ameloblastic fibroma p. 145
Divya Sanjeevi Ramakrishnan, Sudarssan Subramaniam Gouthaman, MR Muthusekhar
DOI:10.4103/njms.NJMS_100_20  
Ameloblastic fibrosarcoma (AFS) is an extremely rare malignant odontogenic tumor. It is composed of benign odontogenic epithelium, resembling that of ameloblastoma, and a mesenchymal part exhibiting features of fibrosarcoma. The development of this lesion in the jaws is either de novo or from preexisting ameloblastic fibroma which has been well documented. The most commonly affected site within the jaw is the posterior mandible. These tumors show local aggressiveness and a high tendency to recur. We present a case of a 33-year-old female patient with swelling of the right posterior mandible for 2 months and progressive paresthesia of the same region for the past 6 months. Patient's history revealed undergoing surgical enucleation for ameloblastic fibroma before a year in the same region as current swelling. Examination of the swelling revealed an ulceroprolifeartive Growth of 6 × 4.5 cm extending from premolar to molar region. Primary investigation involved biopsy of the swelling, which was reported as sarcoma for which resection of the right hemimandible and selective neck dissection was performed. Following surgery, the final histopathology report of the resected specimen was reported to be AFS. One year after the surgical procedure, the patient is clinically and radiologically disease-free. Considering the aggressive nature of these tumors, it is vital to give an accurate diagnosis through biopsy, which is considered as gold standard diagnostic evidence, so that the surgeon plans the appropriate therapeutic decision. Knowledge of this rare entity and its histologic features as opposed to the more common benign counterparts such as ameloblastoma or ameloblastic fibroma is crucial as the latter involves a conservative treatment approach while the former can only be treated through aggressive resections.
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Opportunistic use of naturally expanded neck skin for a buccal mucosa defect p. 150
Dushyant Jaiswal, Firoz Borle, Tasneem Belgaumwala
DOI:10.4103/njms.NJMS_164_20  
A 77-year-old female presented with an ulceroproliferative lesion of the left buccal mucosa extending to the commissure, diagnosed with squamous cell carcinoma on biopsy. She also had a large thyroid swelling, with expanded skin, diagnosed with a multinodular goiter. The patient underwent buccal mucosa wide local excision with left-sided selective neck dissection and total thyroidectomy. The naturally expanded skin over the anterior neck overlying the goiter was used for the reconstruction of the buccal mucosa defect based on the perforator unexpectedly arising directly from the external carotid artery instead of superior thyroid artery. The venous drainage was to an internal jugular vein tributary, multiple dilated veins on the flap were draining into this vein. We describe the innovative use of locally expanded skin for buccal mucosa reconstruction and thereby avoiding the morbidity of a free flap transfer and associated donor site morbidity.
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Mucormycosis coinfection post-COVID-19 recovery: Early suspicion and prompt action p. 153
Vishal Kulkarni, C Senthil Kumar, CS Misra
DOI:10.4103/njms.NJMS_289_20  
Severe acute respiratory syndrome coronavirus 2 infection has resulted in a pandemic, the disease manifests itself as various conditions ranging from respiratory disorders to exacerbated inflammatory responses. The management in some cases involves immediate care in an intensive setup with the administration of various antibiotics and steroids which has resulted in the imposition of risk factors and growth of fulminant fungal infection. The present article addresses two such cases which presented with osteomyelitis secondary to mucormycosis in patients who had more than one episode of COVID-19 infection. The upsurge of existing manifestation and development of opportunistic infections has to be considered in patients who are suffering or recovering from COVID-19. The COVID-19 scenario brings up a possibility of many bacterial and fungal infections in its aftermath. This article brings out two such opportunistic aggressive fungal infections and comprehensive management of the same.
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Solitary fibrous tumor of the masticator space – Report of a rare case p. 159
V Shruthi Patil, Konduru Vidya, S Arun Paul, Amit Jiwan Tirkey
DOI:10.4103/njms.NJMS_117_20  
The solitary fibrous tumor (SFT) is a potentially malignant spindle cell neoplasm of the mesenchymal origin that was originally described as a thoracic lesion originating from the pleural tissue. Recently, numerous extrapleural sites of origin have been described, also affecting the head and neck region. SFTs are benign in most cases, but 10%–15% of extrapleural SFTs show malignant behavior in the form of recurrent or metastatic disease. We present the case of a 25-year-old female who presented with an asymptomatic left-sided facial swelling of over three years. She had a diffuse swelling in the left preauricular region, extending to the temporal region deep to the zygomatic arch. On magnetic resonance imaging, the vascular lobulated mass occupied the masticator space, infratemporal fossa, and parapharyngeal space, eroding the mandible. An ultrasound-guided fine-needle aspiration cytology was suggestive of SFT, positive for signal transducer and activator of transcription 6 and negative for TLE1. After preoperative embolization, the tumor was excised through a midline lip split approach with posterior segmental mandibulectomy and reconstruction with a titanium plate. Histopathological report was consistent with SFT. Due to high-risk features, she was advised adjuvant radiation therapy. SFTs of the head and neck are exceedingly rare and those with aggressive behavior even more so. To our knowledge, this is the only case of SFT arising in the masticator space. Diagnosis is often difficult and not definitive without immunohistochemistry. In most cases, complete surgical excision is the only treatment necessary. Regardless, all patients require close clinical follow-up for several years.
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Antero-medially displaced condylar head leading to pseudoankylosis: A case report p. 162
Jagadish Chandra, Jijy James, Gopinath Thilak, Veena Jagadish
DOI:10.4103/njms.NJMS_131_20  
Ankylosis is one of the most disruptive maladies affecting the masticatory system with trauma being the most common cause. Pseudoankylosis though uncommon can cause functional and psychological discomforts for the patient. Described here is operative management of a case of posttraumatic pseudoankylosis in a 27-year-old female, having fractured condylar head dislocated anteriorly and medially, with eventual fusion to sigmoid region. Retromandibular approach for condylar fracture has been advocated by many authors to be advantageous over other approaches given that they cause good cosmetic results, lower risk of facial nerve injury, reduced operation time. The question still remains whether open reduction internal fixation or removal of the condylar head should be favored for restricted mouth opening after closed reduction.
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Conventional fibrotomy and reconstruction with lateral thigh dermal fat pad in grade III oral submucous fibrosis patients: A case report and review of literature p. 166
Rubin S John, Jaykishan A Solanki, V E Shanthosh Kanna, Hari Ram
DOI:10.4103/njms.NJMS_167_20  
Oral submucous fibrosis is a chronic debilitating premalignant condition with progressive stiffening of oral mucosa ultimately ending in trismus most commonly from substance abuse. The most common etiological factor is the consumption of areca nut. Patients usually report to us when the mouth opening is almost nil. Various grafts have been used in the reconstruction of buccal defects after fiberotomy, the most popular being the buccal fat pad. We present the case of a 34-year-old man presenting with the complaint of reduced mouth opening and burning sensation in the mouth for 8 months. The patient is a poor candidate for buccal fat grafting as the patient body type being ectomorphic. The patient had a stigma of scar in the abdomen; hence, the possibility of an abdominal fat graft was out of the equation. Therefore, dermal fat is was harvested from the lateral thigh and reconstructed into the defect. The patient had a favorable outcome with good healing. Further studies are required to assess the quality, microscopic features of the adipose tissue, and the fate of dermal fat from the anterolateral thigh region.
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Costochondral grafts for reconstruction of acquired mandibular defects involving the temporomandibular joint: Report of two cases p. 170
Indu Bhusan Kar, Dibya Falgoon Sarkar, Dipti Samal, Niranjan Mishra
DOI:10.4103/njms.NJMS_233_20  
Autogenous reconstruction of temporomandibular joint (TMJ) with costochondral graft (CCG) has been a popular method of growth center transfer in children. However, unpredictable growth pattern of CCG has been reported in children that often leads to dentofacial deformities in future. This institutional study describes the results of mandibular reconstruction with CCG in two growing children, one with plexiform ameloblastoma of mandible and the other with unilateral TMJ ankylosis. Long-term follow-ups showed a significant growth of the grafts in both the patients. However, there was a lack of uniformity in the amount and rate of growth. The authors support the theory that CCG possesses innate growth potential and is a desirable option for reconstruction of acquired mandibular defects involving the TMJ in pediatric population. However, regular postoperative monitoring is necessary for such patients as the graft shows an unpredictable growth pattern.
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Nasal sebaceous carcinoma: A rare case p. 176
Saeid Tavanafar, Hamed Gheibollahi, Seyede Sona Mousavi, Amirreza Dehghanian
DOI:10.4103/njms.NJMS_245_20  
Nasal sebaceous carcinoma is an extremely rare cutaneous malignancy. We present the case of an 86-year-old female who had a skin nodule with surface telangiectasia on the right ala of the nose. The lesion had been removed and has been reconstructed with an advancement rotational flap with a minimal residual defect. Upon histopathological examination, the lesion was diagnosed with sebaceous carcinoma. The patient was followed up because of the high rate of recurrence as well as metastatic potential. No recurrence occurred during 4 years of follow-up, and the patient was unwilling to reconstruct the remaining alar defect. We present a rare skin cancer case that could be encountered during the head and neck examination by oral and maxillofacial surgeons. By reporting this case, we aimed to raise the awareness and familiarize clinicians with these less common lesions.
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Ramsay hunt syndrome: A diagnostic dilemma p. 179
Narotam Kumar Ghezta, Yogesh Bhardwaj, Rangila Ram, Rowena Navjyot Basi
DOI:10.4103/njms.NJMS_259_20  
Ramsay Hunt Syndrome is not just a syndrome but rather an engrossing infectious disease that is difficult to rationalize owing to unpredictable onset. Reactivation of the varicella-zoster virus remains the etiological factor. The clinical depiction remains the cornerstone of diagnosis. Characteristic feature of the disease includes acute lower motor neuron facial palsy, otalgia, and mucosal and cutaneous rashes. A 37-year-old male reported to our department with pain and difficulty in closing the eye. At follow-up, the lesions got healed, but facial nerve deficit persisted. It is vital to establish an early diagnosis which aids in distinguishing the syndrome from other severe neurological illnesses, and early initiation of treatment is of prime importance to improve the impaired nerve function; hence, precise knowledge of the disease is crucial. Audiometric analysis must be performed since it can lead to permanent hearing loss.
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Juvenile aggressive ossifying fibroma p. 183
H Jagadish Chandra, Vinay Krishna, Mohammed Tahir, S Harishankar
DOI:10.4103/njms.NJMS_70_18  
Ossifying fibroma, also the cement ossifying fibroma radiographically, represents a well-demarcated mixed radiolucency/radio-opacity with smooth and often sclerotic borders. These lesions are usually solitary and most commonly seen in the mandible; cases in the maxilla have also reported. Histologically, they contain a relatively avascular cellular fibrous stroma with reticular bone trabeculae and cementum-like spherules. We present a case report of an 11-year-old boy with a 2-month history of an asymptomatic swelling seen on the left side of the angle of the mandible. An initial diagnosis of ossifying fibroma was made by an incisional biopsy, and considering the age as a factor surgical resection of the tumor was done under general anesthesia following closure by a two-layer suturing under proper antibiotic and analgesic coverage. The patient has been on regular follow-ups with no adverse effects and satisfactory healing.
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A promising era of immediate esthetic rehabilitation p. 187
Neeti Solanki, Ramya S, Lakshya Kumar, Mayank Singh
DOI:10.4103/njms.NJMS_109_20  
The extraction of a tooth in the anterior region can result in resorption of alveolar bone around the socket, especially the buccal bone leading to horizontal as well as vertical bone loss. This makes rehabilitation in the anterior region an esthetically complex situation. To preserve the buccal bone, the root is bisected and buccal two-thirds is preserved in the socket. This is called socket shield technique. Immediate implant placement and immediate provisionalization yield an esthetically pleasing and more acceptable outcome.
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Modified Cupar's method for immediate diastema closure p. 191
Ashutosh Avinash Deshpande, MR Muthusekhar, OR Hemavathy, Swetha Murali
DOI:10.4103/njms.NJMS_148_20  
Anterior maxillary osteotomy or ostectomy (AMO) is a safe, reliable, and easily adaptable procedure routinely performed in orthognathic surgery for the management of the dentoalveolar segment of the anterior maxilla. The anterior segmental maxillary osteotomy was first performed in 1921 by Cohn–Stock. Several modifications were done regarding approaches for AMO; however, Cupar's method is the most preferred approach by the surgeons and in practice since several decades. A novel midline split osteotomy is performed in combination with Cupar's method for superior and posterior repositioning of anterior maxillary segment in combination with immediate closure of diastema in this case report.
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Rehabilitation using implants in free fibula flap of a patient with ameloblastoma: Case report with 4-year follow-up p. 194
Gunjan Srivastava, Subrat Kumar Padhiary, Tusar Kanti Nayak, Niranjan Mishra
DOI:10.4103/njms.NJMS_239_20  
Ameloblastoma is a locally invasive odontogenic tumor of the jaw. It can advance to large size resulting in facial deformity, loose teeth, and in severe cases pathologic fracture of the jaws. As ameloblastoma shows local invasiveness and tendency for recurrence, radical surgery which includes marginal resection or segmental resection are preferred. This clinical report describes the prosthetic rehabilitation of a patient affected by extensive mandibular ameloblastoma. Enbloc resection of the tumor and reconstruction by fibula-free flap was done. After initial healing for about 18 months, five endosseous implants were placed and implant-supported fixed hybrid prosthesis using computer-aided design and computer-aided manufacturing milled titanium framework was fabricated. Surgical and prosthodontic challenges are discussed. Osseointegrated implants provide a new perspective of treatment to enhance the quality of life of patients resected for oral tumors.
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Unicystic ameloblastoma of mural variant crossing the midline p. 199
Leena James, Adil Shafath, Tejavathi Nagaraj, Arundhati Biswas
DOI:10.4103/njms.NJMS_21_19  
Unicystic ameloblastoma (UCA) refers to cystic lesions that show gross features of a jaw cyst but on histologic examination show a typical ameloblastomatous epithelium lining part of the cyst cavity, with or without luminal and/or mural tumor growth. Even though the lesion is not as aggressive as the solid ameloblastoma, an accurate histopathologic diagnosis is essential for the treatment and prognosis. This case report illustrates a case of UCA of mural variant in the anterior region of the mandible crossing the midline, which is usually an unusual site of occurrence.
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Three-dimensional printing in maxillofacial surgery: A quantum leap in future p. 203
Anuj Dadhich, Kumar Nilesh, Seemit Shah, Harish Saluja
DOI:10.4103/njms.NJMS_65_20  
Although application of three-dimensional (3D) printing in oral and maxillofacial surgery (OMFS) was first reported almost 30 years back, reduction in its manufacturing cost and availability of affordable 3D printing devices have popularized its use over the past few years. The 3D-printed objects include anatomical models, occlusal splints, drilling, or cutting guides and patient-specific implants (custom made plates and reconstruction devices). The anatomical model not only assists the surgeon in better understanding of the deformity or pathology but also aids in explaining the same to the patient and relatives. Mock surgery carried out on these models improve precision and thereby reduce the operating time. The guiding splints provide an exact design and fit for the graft, thus replicating form and function of the jawbone. The patient specific implants manufactured through computer-assisted designing help in superior replication of original anatomical form. This paper intends to highlight the current applications of 3D printing in field of maxillofacial surgery in the management of facial deformity, esthetic disturbances, and jaw pathologies. Cases of condylar hyperplasia, jaw tumor, facial asymmetry secondary to joint deformity, apertognathia, and chin augmentation managed with the application of 3D printing have been described in this paper. It also discusses the history, techniques, advantages, limitations, and future scope of 3D printing technology in OMFS.
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A combination of follicular and plexiform ameloblastoma: A rare case report p. 212
Paramjit Kajla, Jeevan Lata, Seema Aggarwal
DOI:10.4103/njms.NJMS_82_16  
Ameloblastoma is a benign but locally aggressive neoplasm of odontogenic epithelium origin. Follicular type is the most common variant of ameloblastoma followed by plexiform, acanthomatous, and granular subtypes. Synchronized existence of plexiform ameloblastoma with follicular ameloblastoma is a rare event. When the plexiform type coexists with other common variant, it is termed as hybrid ameloblastoma. Here, we present a case of hybrid ameloblastoma with follicular and plexiform variants occurring in a 43-year-old female patient having persistent swelling for 5–6 months in the left mandibular body region extending up to the left angle of the mandible. The tumor was treated by en bloc resection followed by reconstruction.
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An interdisciplinary approach for the management and rehabilitation of a fibro-osseous neoplasm using platelet-rich gel and an implant-supported hybrid prosthesis p. 216
Navpreet Singh Bedi, Sumir Gandhi, George Abraham, Vijay Alageshan
DOI:10.4103/njms.NJMS_13_19  
Fibro-osseous neoplasms such as central ossifying fibroma (COF) can lead to destructive expansile lesions involving the maxilla or the mandible. Management of such lesions usually involves surgical intervention in the form of enucleation or resection. Platelet-rich gel (PRG) has been known to expedite bone regeneration due to its osteoconductive property. PRG initiates a greater and faster initial cellular response in comparison to platelet-rich plasma and has better handling characteristics. The challenge in rehabilitation often occurs due to the size of the osseous defects postsurgery. Fixed prosthodontic rehabilitation with endosteal implants is a viable treatment approach in such cases, improving the oral health quality of life and masticatory efficiency, when compared to a removable partial denture. This case report describes the management of an extensive lesion of COF using PRG and rehabilitation with a screw-retained, implant-supported hybrid prosthesis.
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Prosthetic rehabilitation of resorbed mandible with two implant-supported overdentures using ball attachments p. 220
Krishna Kumar Varshney, Vishwas Bhatia
DOI:10.4103/njms.NJMS_34_19  
The aim of this study was to describe a technique of fabrication of two implant-supported mandibular overdentures. There are several treatment modalities for completely edentulous patients including conventional complete dentures (CDs), implant-supported overdentures (IODs), and implant-supported fixed prosthesis. Patients with a severely resorbed mandible often experience problems with their conventional CDs. Treatment concepts involving IODs have proven to be as satisfactory as implant-supported fixed prosthesis with added advantage of ease in hygiene maintenance and less cost. This clinical report summarizes a simplified and accurate method of fabricating two implant-supported mandibular overdentures. In this case, two implants were placed in the intercanine region of mandibular ridge and conventional CD was installed. Three months later, this CD was converted into implant-supported mandibular overdenture. Conventional CDs have shown less satisfaction rates by patients over a period of time in terms of function. Moreover, there are researches showing increased rate of resorption with these dentures. Thus, IODs are used routinely to provide a better quality of life to edentulous patients.
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A rare case report of pleomorphic adenoma of the upper lip: An unusual clinical presentation p. 225
Chander Prakash, Nishi Tanwar, Sushil Dhokwal, Anju Devi
DOI:10.4103/njms.NJMS_92_20  
Pleomorphic adenoma is the most common salivary gland tumor which accounts for about 60% of all salivary neoplasms. It is also known as “mixed tumor because of its wide cytomorphologic diversity”. Pleomorphic adenoma salivary glands mostly occurs on the palate, but the involvement of the upper lip is rare. The present report describes a case of a 62-year-old male with asymptomatic firm nodular swelling attached with upper lip which was later diagnosed as pleomorphic adenoma in the excisional biopsy.
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TECHNICAL NOTES Top

Multiple pterygoid approach: A novel technique with single-piece implants p. 228
Vivek Gaur, Anita Gala Doshi, Lukasz R Palka
DOI:10.4103/njms.NJMS_137_20  
The intended target site to engage a fixture distal into the tuberosity is the pterygoid apophysis that comprises the maxillary tuberosity, pyramidal process of the palatine bone, and the pterygoid process of the sphenoid bone. Pterygoid implants are incorrectly labeled in literature owing to the fact that they are actually root form conventional implants and should hence be termed as 'tubero-pterygoid implant'. An implant engaging the pterygoid apophysis/pillar taking distal maxillary support and avoiding successfully the cantilever situation is called a pterygoid implant. It essentially does not acquire primary with support of distal maxilla initially from the tuberosity. Instead, it makes its way into the apophysis and sometimes via a transsinus approach. A tubero-pterygoid implant, because of the root form screw shape fixture that is wide at the crestal aspect and converging toward the apex, takes the primary support from the tuberosity and engages the pterygoid pillar apically, thus allowing more bone to implant contact but has its limitation in deficient/atrophied tuberosity.
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Double bridle wire technique: A better alternative for mandibular fracture stabilization p. 237
Neha Jajodia, Virendra Singh
DOI:10.4103/njms.NJMS_77_17  
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