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National Journal of Maxillofacial Surgery
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   Table of Contents - Current issue
January-April 2022
Volume 13 | Issue 1
Page Nos. 1-161

Online since Wednesday, April 20, 2022

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Fellowships post maxillofacial residency- Is it necessary? Highly accessed article p. 1
Srinivas G Reddy, Avani Pandey
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Medication-related osteonecrosis of the jaw: An update Highly accessed article p. 5
Hitesh Bansal
Antiresorptive medications, such as bisphosphonates and denosumab, are an important class of medication used to treat a wide range of diseases from osteoporosis to multiple myeloma. Unfortunately, they are also associated with a rare but devastating side effect – medication-related osteonecrosis of the jaw (MRONJ). First reported in 2003, much research has been done into the area; however, the exact pathophysiology continues to elude clinicians and researchers. What has been ascertained is that intravenous treatment, duration of treatment, and tooth extraction are major risk factors. Staging and treatment guidelines have been proposed; however, there has been no universal acceptance, and clinicians rely on various position papers. Over the next 30 years, the aging population is set to double, and with it, the prescription of antiresorptive medication and incidence of MRONJ will undoubtedly increase. In 2013, Gupta et al. published a paper on bisphosphonate-related osteonecrosis of the jaw; however, there have many changes since then. This paper aims to provide a succinct update on those changes.
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Mitophagy and oral cancers Highly accessed article p. 11
Ripon Md Chowdhury
Mitophagy is a progressive process that selectively targets weakened, old and damaged mitochondria, by an autophagic pathway, causing its destruction. Mitophagy maintains normal cellular physiology and tissue development, thereby controlling the cohesiveness of the mitochondrial pool. The mechanisms of mitophagy, tumorogenesis, and cell death are usually interrelated with each other and could be initiated by definite stressful conditions like hypoxia and nutrient starvation, which leads to the overall reduction in mitochondrial mass. This impedes the production of reactive oxygen species, and conserves nutrition, leading to cell survival in such extreme conditions. The inability to harmonize and regulate mitochondrial outcome in response to oncogenic stress can either stimulate or suppress tumorogenesis. Therefore, the relationship between mitophagy, tumorogenesis, and cell death plays an important role in the identification of potential targets of cell death and selective wiping out of cancer cells. This review portrays the mechanism of mitophagy, along with its role in cancers especially on oral cancers, and its importance in cancer therapeutics.
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Coronavirus: An emerging and future challenge for dental clinicians p. 20
Rohit Singh, Aashana Goel, Pooja Pani, Bhupender Singh Negi, Jagadish Prasad Rajguru, Nagaveni S Somayaji
The first case of pneumonia of unknown origin was identified in Wuhan, the capital city of Hubei province situated in the Republic of China. The pathogenic organism that has been identified as a causative organism is a novel enveloped RNA betacoronavirus which has been designated as' severe Acute Respiratory Syndrome Coronavirus- 2 (SARS-CoV-2). This virus has been found to have a similar phylogeny to SARS-CoV. The novel Coronavirus or COVID-19 can be symptomized through clinical manifestations like- Pyrexia or fever, Cough, Dyspnea/difficulty in breathing, Myalgia/muscle pain, and constant fatigue. In the later stages, these symptoms worsen leading to severe pneumonia, acute respiratory distress syndrome, sepsis, and multiple organ failure. These days, this pandemic is emerging as a major threat for dental health-care professionals. The dental surgeons are at greater risk of novel coronavirus infections due to direct contact with infected patients and exposure to contaminated blood, saliva, and other body fluids. This article deals with viral structure, clinical symptoms, and modes of transmission, recommended measures to prevent its spread in dental operatories.
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A stitch in time saves nine: All about pediatric facial fracture p. 27
Kirtija Gupta, Neeraj Verma, Ashish Katiyar, Shashank Gaur, Sukriti Gupta, Mansi Pandey
Fractures of the pediatric craniofacial skeleton can be challenging to engage in. The initial injury and subsequent treatment can cause long-term growth disturbances yielding problematic secondary deformities. It is important that clinicians involved in the care of these patients understand the differences between children and adult fracture patterns and understand the potential long-term effects on the growth of the pediatric skeleton and how to manage these problems when they occur.
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Comprehensive facial injury (CFI) score as a predictor of surgical time, length of hospital stay, and head injury? Our experience at level I trauma center p. 32
Saurabh Kumar Rawat, Kuldeep Vishwakarma, Bharat Shukla, Ritesh Kumar
Purpose: The present study aimed to evaluate the statistical significance of comprehensive facial injury (CFI) score concerning total surgical time (ST), length of hospital stay (LHS), and head injury in maxillofacial trauma patients. Methods: This retrospective observational study included 288 patients having maxillofacial injuries with or without associated head injury. CFI score was calculated for each of them. One-way ANOVA and Kruskal–Wallis H-test were used to compare ST (minutes), LHS (days), and Glasgow Coma Scale (GCS) score among the CFI score clusters. Head injury among the CFI score clusters was compared using Fisher's exact test. The level of statistical significance was set at P < 0.05. Results: Of total 288 cases (males: 83.68%, females: 16.31%, mean age: 30 ± 15.92 years), road traffic accidents accounted for 76.0% of admissions. A definitive approach (open reduction and internal fixation) was used in 26.38% of cases. Statistically significant association of CFI score was obtained with ST and LHS in high-dependency unit (P < 0.001). Posttraumatic head injury was seen in 21.25% of cases. A significant association of CFI score with GCS score (P = 0.032) and with head injury (P = 0.019) was found. Conclusion: CFI score is a comprehensive yet simple scale to assess ST and LHS. A strong correlation established between CFI score and these variables further validate its reliability as a perfect tool for communication of the maxillofacial morbidity and in making a treatment protocol, although its predictive ability for associated head injuries needs to be studied further.
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Effect of platelet-rich fibrin on extraction socket healing in diabetic patients – A split-mouth crossover study: A prospective clinical trial p. 39
Sangamitra Asoka, Elavenil Panneerselvam, Avadh Rahulbhai Pandya, V B Krishnakumar Raja, Poornima Ravi
Aims: The aim of this study is to evaluate the effectiveness of platelet-rich fibrin (PRF) in postextraction socket healing in diabetic patients. Subjects and Methods: The investigators implemented a randomized, split-mouth study in 100 Type 2 diabetic patients undergoing dental extraction of two or more teeth. Following extraction, the experimental socket was packed with PRF and sutured, while the control socket was sutured without packing. The primary outcome measures were soft-tissue healing (assessed by color, bleeding on palpation, granulation tissue, and incidence of suppuration and dry socket), hard-tissue healing (measured by visual interpretation, area of bone coverage, and grayscale analysis), and visual pain scores. Statistical Analysis: Statistical analysis was done using the independent and paired t-tests, analysis of variance, and Chi-square test Results: Both soft-tissue healing and hard-tissue healing were significantly better in the experimental socket as compared to the control socket. Pain levels, as measured by the visual analog score, were similar in both the extraction sockets. Conclusions: The use of PRF has beneficial effects in extraction socket healing in diabetic patients.
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A retrospective correlative profiling of lung functions, microbiological, radiological, periodontal, hematological parameters in noncystic fibrosis bronchiectasis patients of North India p. 44
Abhaya Gupta, Umesh Pratap Verma, Ajay Kumar Verma, Shyam Chand Chaudhary, Nand Lal, Neetu Singh, Ashutosh Shrivastava, Surya Kant
Introduction: Noncystic fibrosis bronchiectasis (NCFB) is a neglected debilitating condition with scarce epidemiological literature explaining its geographical heterogeneity, especially in lower and middle-income countries. This study aimed to assess and correlate the functional profile of NCFB patients and evaluate the correlation of body mass index (BMI) with several disease variables. Methods: This mixed-method retrospective research study was conducted on 124 radiologically confirmed NCFB patients in terms of various qualitative and quantitative variables. Results: Restrictive ventilatory defect was the most common type with the preponderance of male former smokers. Mean platelet lymphocyte ratio (PLR; 104.08 ± 73.59) revealed certain degree of systemic inflammatory burden with a slightly higher mean peripheral leukocyte count (10665.19 ± 4268.81 cell/mm3) and eosinophilia of >2%. Almost all patients had periodontal disease with a higher prevalence of chronic periodontitis (54.83%). Moderately severe and predominantly cystic radiological type was encountered with 61.2% patients positive for Pseudomonas aeruginosa. Bronchiectasis aetiology comorbidity index (BACI) i.e., 2.34 ± 2.37 represented an intermediate mortality risk in our patients. On basis of BMI, majority were young underweights with poor pulmonary functions while PLR skewed toward overweight patients (nonsignificant P > 0.05). Forced expiratory volume/forced vital capacity displayed a negative weak moderately significant correlation with BACI (r = −0.24; P = 0.008). Peripheral lymphocyte count demonstrated a weak negative but significant correlation with modified Reiff score (r = −0.20; P = 0.023) while serum neutrophil count had a weak negative moderately significant correlation with hemoglobin (r = −0.20; P = 0.023). Conclusions: NCFB bears great heterogeneity with distinct geographical phenotypes and should be correlated thoroughly in terms of peripheral leukocytes count, pulmonary functions, radiology, BMI, and coexisting comorbidities for adequate management.
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Influence of socioeconomic status on psychological distress and treatment satisfaction levels among patients undergoing prosthetic rehabilitation following maxillectomy: An observational study p. 54
Chanchal Gupta, Veena Jain, Gunjan Pruthi
Aim: The aim of this study was conducted to evaluate the effect of socioeconomic status (SES) on psychological distress and treatment satisfaction levels of patients who underwent maxillectomy and rehabilitation with obturator prosthesis. Settings and Design: Prospective, observational, analytic study. Materials and Methods: Forty-three patients undergoing maxillectomy were enrolled and divided into upper, middle, and lower SES groups, according to the updated Kuppuswamy SES scale. Psychological distress levels were assessed using Hospital Anxiety and Depression Scale (HADS) before maxillectomy (T0) and at 3 weeks after delivery of definitive obturator (T1). Treatment satisfaction levels with obturator prosthesis were assessed using Obturator Functioning Scale (OFS) at T1. HADS and OFS scores were then correlated with the SES of the participants. Results: Out of 43 participants, 7 were lost to follow up. The total number of participants in upper, middle, and lower SES groups was 14, 11, and 11, respectively. Before surgery, there was no significant difference in anxiety levels (P > 0.05) among different SES groups. However, the depression levels were the highest in the lower SES and decreased significantly with increasing SES. Prosthetic rehabilitation led to statistically significant (P < 0.05) fall in the levels of both anxiety and depression assessed at 3 weeks after delivery of prosthesis. The upper SES group was found to be less anxious and depressed compared to middle and lower SES groups after prosthodontic rehabilitation. Treatment satisfaction level was found to be significantly low (P = 0.005) in lower SES group as compared to upper SES group while no difference was found in between the middle SES when compared to higher or lower SES groups. Conclusions: SES has a profound impact on the patient's psychosocial well-being and treatment satisfaction. Patients of lower SES reported with higher psychological distress and lesser treatment satisfaction compared to those belonging to upper SES.
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Effectiveness of low-level laser therapy after surgical removal of impacted mandibular third molars: A randomized clinical trial p. 60
Arup Ratan Das, KC Vidya, MV Srikar, Jugajyoti Pathi, Aryan Jaiswal
Introduction: The low-level laser therapy has been accepted globally as cell bio-modulator, used to reach ideal therapeutic effects, acting in the reduction of the pain response, with anti-inflammatory effects, stimulating local micro-circulation and wounds repair, promoting a rapid recovery, which brings a better quality of life to the patient. In this study, we aim to to determine the effectiveness of low-level laser therapy on reducing the pain and swelling after removal of impacted third molars. Materials and Methods: In this present prospective randomized clinical study, third molar surgeries were performed in thirty patients who were divided into two equal groups (placebo group and study group) a placebo group with routine treatment and a study group with low-level laser therapy which was applied both intraorally and extraorally after the surgical extraction of mandibular third molar. Results: The parameters such as postoperative pain, edema, and trismus were assessed on 1st and 7th day. All these parameters showed statistically significant results in patients with low-level laser therapy. Conclusions: Low-level laser therapy was effective in reducing the postoperative pain, edema, and trismus in the third molar surgeries.
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Estimation of serum immunoglobulin G and immunoglobulin A levels in oral submucous fibrosis patients p. 67
Anand N Swami, Lata M Kale, Sneha H Choudhary, Ashok Kumar Singh, Sami D Aldhuwayhi, Amar Thakare
Background: Oral submucous fibrosis (OSMF) is a disabling, chronic, insidious potentially malignant condition of the oral cavity seen predominantly in the Indian subcontinent. Due to the idiopathic nature and various immunological changes seen in some OSMF patients, it can be considered an autoimmune disorder. Hyperimmunoglobulinemia is often seen with OSMF. Aim and Objectives: (i) To estimate the serum immunoglobulin G (IgG) and immunoglobulin A (IgA) levels in OSMF patients; (ii) to correlate the serum IgG and IgA levels with age and gender of OSMF patients; (iii) to correlate the serum IgG and IgA levels with clinical stages of OSMF; (iv) to correlate the serum IgG and IgA levels with the content of the habit in OSMF patients. Materials and Methods: Serum samples were collected from a total of 50 patients (25 OSMF cases and 25 controls) of both genders and IgG and IgA levels were estimated by NEPHELOMETRY. Results: As compared to the control group, the mean serum IgG level was marginally increased among the OSMF patients and the mean serum IgA level was marginally decreased among the OSMF patients, but this was not statistically significant. Furthermore, there was only a weak correlation between serum immunoglobulins and content of the habit and no significant correlation was found between the serum IgG and IgA levels and age and sex of the OSMF patients. Serum IgG was increased and IgA was decreased with increasing stages of OSMF. Conclusion: The results of the present study suggested that there is an alteration in serum immunoglobulin levels in OSMF patients as compared to the control group.
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Evaluation of awareness regarding pictorial warning on tobacco packets and its effect on cessation among tobacco users in Lucknow p. 72
Vinay Kumar Gupta, Pallavi Parasramka, Gaurav Mishra, Sumit Kumar, Seema Malhotra, Nishita Kankane, US Pal
Introduction: Tobacco use has been identified as the leading cause of the preventable death worldwide and estimates that it currently causes 5.4 million deaths/year. In fact, India is suffering a phase of tobacco epidemic. Aim: The aim of the study was to evaluate the awareness regarding pictorial warning on tobacco packets and its effect on cessation among tobacco users. Materials and Methods: A study was conducted among 200 patients having tobacco habit, attending the outpatient department of Public Health Dentistry, KGMU, Lucknow. A self-structured questionnaire was made in English and Hindi language, pertaining to demographic details, type of tobacco products used, frequency, duration of tobacco habits, and awareness regarding pictorial warning. Results: Use of multiple tobacco habits was most prevalent 61 (30.5%) across all age groups, majority 185 (92.5%) of subjects had seen the tobacco warnings, and 113 (56.5%) participants had seen both types of warning (pictorial and written warning). One hundred and ten (55%) of subjects said that warning should be on both sides. Eighty-two (41%) study participants had never tried to quit tobacco habits, 43 (21.5%) of participants tried to quit tobacco habits because of peer pressure and 75 (37.5%) subjects said that after seeing a warning on tobacco packets, they will think to quit tobacco habit. Conclusion: Majority of study participants have observed the warnings on tobacco packets and most of them believe that they could recognize and understand warnings. The study participants believe that warnings on tobacco packets create alertness about various deleterious effects of all tobacco habits and help in dropping or give up these habits. Pictographic warnings were more effective than text warnings.
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Comparison of Vazirani-Akinosi and Kurt-Thoma technique for mandibular anesthesia: An observational clinical study p. 78
Amit Mahajan, Hardik Patel, Monika Surana, Viren Abhani
Introduction: Different techniques have been developed over the years for achieving mandibular nerve anesthesia. Many methods have been proposed back and forth in order to perform effective anaesthesia. Aims and Objective: The main aim of our study was to carry out comparison of clinical efficacy of mandibular nerve anaesthesia by Kurt Thoma technique with that of Vazirani-Akinosi nerve block technique. Materials and Methods: 10 adult patients requiring bilateral mandibular teeth extraction were selected randomly to receive Kurt Thoma technique and Vazirani-Akinosi technique for nerve block randomly. Results: There is no statistically difference between two techniques in terms of need of additional injection, pain, complications, onset of action. Conclusions: By this study we conclude that both the techniques are equally effective and all the oral and maxillofacial surgeons should learn these techniques so that they can use in various patients where conventional mandibular nerve block techniques are not feasible.
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Evaluation of effect of submucosal administration of depomedrol in management of postoperative sequelae in mandibular fractures: A randomized clinical trial study p. 84
Janani Kandamani, Sudarssan Subramaniam Gouthaman, Divya Sanjeevi Ramakrishnan, M P Santhosh Kumar, MR Muthusekar
Introduction: The mandible is a commonly fractured bone in the face, a fact related to its prominent and exposed position. Open reduction and internal fixation (ORIF) of mandibular fractures has been associated with trauma to the surgical site and the surrounding tissues. Purpose: The purpose of this study is to evaluate the effects of immediate postoperative submucosal depomedrol administration on postoperative pain, edema, and trismus after ORIF for mandibular fractures. Materials and Methods: We conducted a prospective, randomized, controlled, double-blind study of forty patients who required ORIF for mandibular fractures under general anesthesia. The patients were divided into two groups, an experimental group who received immediate postoperative submucosal 40 mg of depomedrol injection through the surgical incision site, and a control group who did not receive any drug. Pain was assessed using a Visual Analog Scale score and the frequency of analgesic consumption at various postoperative intervals. The maximum interincisal distance and facial measurements were compared before surgery and at 24, 48, 72 h, and 7 days after surgery. Results: Statistical analysis of the data indicated a significant decrease in edema, trismus, and pain in the depomedrol group. No clinically apparent infection, disturbance of wound healing, or other corticosteroid-related complications were noted. Conclusion: The results of our study suggest that submucosal administration of depomedrol injection after ORIF for mandibular fractures is effective in reducing postoperative pain, edema, and trismus.
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Evaluation of association between potential stress markers and periodontal health in medical and dental students: A questionnaire-based study p. 90
Prerna Agarwal, Hirak S Bhattacharya, Pavitra Rastogi, Manvi Chandra Agarwal, Ashutosh Agarwal
Aims and Objectives: Psychological conditions, particularly psychosocial stress, have been implicated as risk indicators for periodontal disease. The aim of the present study was to explore the role of psychosocial stress on periodontium through questionnaire and serum cortisol level. Subjects and Methods: Two hundred medical and dental undergraduates were recruited for the study. Case group included 82 examination going and control group had 79 nonexam going students. Their stress level was evaluated using a standard questionnaire (perceived stress scale). Gingival index, periodontal disease index, bleeding on probing index, serum cortisol level, and serum alpha-amylase level were also measured. Statistical Analysis Used: Bivariate correlations and multiple regression tests were done. Results: A positive correlation was found among stress scores, salivary cortisol, alpha-amylase, and periodontal disease measures. Conclusion: Periodontitis can be related to immunologic changes related to psychological states
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Comparison of effect of intra socket ketamine and tramadol on postoperative pain after mandibular third molar surgery p. 95
Ashutosh Avinash Deshpande, OR Hemavathy, Sneha Krishnan, Rezin Ahmed
Aim: This study compared the analgesic efficacy of intra socket application of tramadol versus ketamine for preventing pain after mandibular third molar surgery. Materials and Methods: Thirty patients who had undergone third molar surgery were randomly divided into three groups: Group T (tramadol 1 mg/kg), Group K (ketamine 0.5 mg/kg), and Group C (saline 2 mL). The treatment was applied to the extraction sockets using resorbable gel foam. Average time taken for the procedure was recorded. Pain was evaluated postoperatively using a visual analog scale (VAS) at 6 and 24 h postoperatively. Furthermore, the number of analgesics taken in the 1st 24 h was recorded. The relevant information was gathered and tabulated. IBM SPSS 2.0 was used to analyze the results and one-way ANOVA test was used to determine the statistical significance. Results: The VAS scores after extraction were statistically higher in Group C than in either treatment group. Group K had the lowest pain intensity. During the 1st 6 h, patients reported statistically lower pain intensity scores in Groups K and T versus Group C. At 24 h, Group K had the lowest pain intensity and Group T had less pain than Group C. The number of analgesics taken in the 1st 24 h was highest in Group C. Conclusion: This study shows that intra socket use of tramadol and ketamine can be used as effective alternatives for decreasing pain after third molar surgery.
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Comparative assessment of cephalometric with its analogous photographic variables p. 99
Shraddha Gupta, Pradeep Tandon, Gyan P Singh, Dipti Shastri
Objective: The purpose of this study was to evaluate the accuracy of photographic measurements and compare it with its analogous cephalometric variables. Materials and Methods: Lateral cephalograms and standardized facial profile photographs were obtained from a sample of 120 subjects (92 females, 28 males; age 12–22 years with mean age of 17.5 years). A total of 4 linear and 7 angular measurements along with 3 ratios analogous to one another were measured on both. Descriptive statistics for all measurements were computed. Pearson's correlation coefficients were computed between analogous measurements, and regression analysis was done for each variable measured on the photograph to accurately predict the cephalometric variable. Results: The reliability of the standardized photographic technique was satisfactory. Most photographic measurements showed highly significant correlations (P < 0.001) with cephalometric variables. Among all measurements used, the A'N'B' angle was the most effective in explaining the variability of its analogous cephalometric (r2 = 0.35). The Frankfort-mandibular plane angle' angle showed best results for vertical assessment (r2 = 0.81) along with anterior face height (AFH) and lower anterior facial height (r2 = 0.859) and ratio lower posterior facial height/AFH (r2 = 0.702). Conclusions: Although we cannot rule out lateral cephalogram as the primary record in orthodontics, photographic assessment can always be used through proper standardization, as an alternative diagnostic aid, and also for large-scale epidemiological purposes and places with unavailability of cephalostat.
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Unilateral pure trigeminal motor neuropathy and neurovascular conflict: More than a coincidence! p. 108
Malika Berrada, Mohamed Amine Mouhdi, Salma Bellakhdar, Mohamed Abdoh Rafai
Sensory disturbances are usual manifestations of trigeminal neuropathy, but only a few cases of isolated unilateral pure trigeminal motor neuropathy were reported. We describe a rare case of a 65-year-old woman who presented with a 4-year history of progressive facial asymmetry and chewing weakness which was shown on imaging to be caused by unilateral atrophy of masticatory muscles, probably due to a neurovascular conflict between the third trigeminal branch and superior cerebellar vein. To the best of our knowledge, this probable association has never been described. We aimed through this article to describe the clinical presentation of this entity that clinicians might face in their daily practice and radiological aspect of it.
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First case of deep neck and descending mediastinal abscess caused by dentoalveolar Eggerthia catenaformis infection p. 111
Stefania Galassi, Roberto Meranda, Jacopo Cambi, Sante De Santis
Descending mediastinal abscesses arising from oral (dental or peritonsillar abscess) or deep neck infections (DNIs) often become fatal without surgical drainage. Odontogenic origin was the most common cause of DNIs. We report the first clinical case of a patient with descending mediastinal abscess caused by DNI from Eggerthia catenaformis a Gram-positive anaerobic rod that can be rarely a human pathogen. The patient underwent the extraction of carious molars, cervical and thoracic surgical drainage, and targeted antibiotic therapy with resolution of the infection.
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High-power laser for oral excisional biopsy in an oncologic patient with pancytopenia p. 114
Luana Campos, Sandra Bastos Rezende, Luiz Felipe Palma, Alyne Simões, Ricardo Yudi Tateno, Roberto Luiz da Silva, Maria Cristina Macedo
Oral surgical procedures are a great challenge in cancer patients, especially those with pancytopenia, given the risk of both hemorrhage and opportunistic infection. Thus, we report herein a case of a patient with refractory acute myeloid leukemia, severe pancytopenia, and some episodes of febrile neutropenia, who presented asymptomatic, bilateral lesions on the tongue, requiring excisional biopsy. Considering the high risk of bleeding, surgical intervention was proposed with a high-power laser (HPL) at the bedside. There was no considerable bleeding and stitches were not needed. Within 48 h postoperatively, the patient reported neither pain nor further bleeding and her tongue presented normal function. The patient was under a follow-up period of about 8 months, with no lesion relapse. The HPL seems to be of great value for preventing excessive bleeding and late infection in patients with pancytopenia submitted to minor oral surgeries.
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Mini - Retromandibular access to sub condylar mandibular fractures - Our experience p. 117
Saravanan Kandasamy, Reena Rachel John
Condylar fractures alone accounts to about 25% to 40% of all the fractures of mandible. Management of condylar fractures has always been a controversy. Nowadays there has been more emphasis on open reduction of condylar fractures by the surgeons.The reasons could be the result of complications of closed reduction where the patient may not be able to masticate properly and deviation still present thereby the structural and functional loss forcing the surgeons' choice to open up. The anterior parotid approach has lesser risk of injury to parotid gland and also to facial nerve we attempted to use mini retro mandibular access for such fractures. So the aim was to explore the feasibility of the mini retro mandibular approach to sub condylar fractures. The patients reported to the department of oral and maxillofacial surgery department clinically and radio logically diagnosed and treated for condylar fractures were included. The maximal mouth opening, protrusive and lateral excursive movements, midline orientation with opposing arch, scar visibility, sialocele and facial nerve weakness were all recorded post operatively and compared with pre-operative recording. The mini retro mandibular access with anterior parotid transmessetric approach to sub condylar fractures can be the choice for the surgical management of sub condylar fractures which is absolutely easy, reliable, with less visible scar and with less chances of landing in facial nerve complications.
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Efficacy of diode lasers in oral verrucous hyperplasia: A case series p. 121
Aditya Mohan Alwala, Arvind UD , Kasireddy Shravan Kumar, Kranthi Kiran, B Hari Vinay, Lakkaraju Ravindra Babu
Oral verrucous hyperplasia (OVH) is a potentially malignant lesion that may transform into an oral cancer. Cases without local metastases can be conservatively managed with local excision, laser therapy, photodynamic therapy, chemotherapy, etc. The aim of this article is to present a case series showing treatment outcomes of OVH excised with laser. A total of 5 cases of OVH diagnosed histologically were included. All the 5 cases were excised using a diode laser and the specimen was sent for histopathological examination. Histopathological examination of excisional biopsy specimen with adjacent normal epithelium result has shown to be verrucous hyperplasia excluding the chance of verrucous carcinoma in any of the case. All the 5 cases were followed up for 18 months. All the 5 patients have shown excellent healing and epithelialization by 1 month and have shown full range of healing by the end of 3rd month. There were no complications reported over a follow up period of 18 months. Verrucous hyperplasia is a challenging pathological state for success after excision. A high degree of chance for recurrence and scarring of the tissue compromises treatment outcomes. In our experience use of diode laser for excision has shown satisfactory healing with minimal scarring and there were no cases of recurrence after 18 months follow up.
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A novel technique of reconstruction of vermilion by pedicled myomucosal labial vestibular flap in traumatic defect of lower lip p. 125
Rahul Sahai, Sudhir Singh, Akhilesh Kumar Singh
We present a new technique of reconstruction of a partial defect of vermilion in a case of post traumatic defect of lower lip. The vermilion defect was reconstructed by the myomucosal flap taken from the labial side of lip posterior and below the anterior lip defect. The lower rounded part of this 3 cm × 2 cm rectangular flap was brought on the outer anterior lip defect through a hole made by splitting the orbicularis oris muscle below the vermilion and its lower end was rotated upward to reconstruct the defect in the anterior and inferior part of vermilion. The secondary defect on the inner lip was closed by mobilization of mucosa. The triangular-shaped skin loss of anterior lower lip and its underlying muscle was closed in anatomic layers meticulously after mobilization of muscle and skin on both sides. The orocutaneous communication created was closed after 3 weeks by a minor operation under local anesthesia. The mouth opening remained normal between the period of lip repair and closure of iatrogenic orocutaneous communication. Good shape with normal color of vermilion and length having proper lip fullness was achieved without any microstomia. The surface of vermilion was smooth without any irregularity. The single scar of lower lip was supple and mobile over the underlying muscle. There was no deglutition, chewing, labial phonation, or any drooling saliva problems. The procedure provided functionally and esthetically satisfying result. We authors have not found a similar technique of lip reconstruction in the literature.
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Adjunctive use of a surgical splint for leveling the curve of Spee following mandibular advancement p. 130
Swapnil D Ghodke, Satinder Pal Singh, Ashok Kumar Jena
Deep curve of Spee is a very common problem among Class II malocclusion patients associated with mandibular deficiency. The curve of Spee is maintained and leveled following surgical mandibular advancement. The same surgical splint which is used to guide the mandibular advancement can also be used for the leveling of deep curve of Spee. This case report highlights the leveling of deep curve of Spee by the same surgical splint used during the surgical mandibular advancement. Thus, it helps to increase the lower facial height and also improves the overall facial appearance.
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Reconstruction of cranial defect with patient-specific implants: Four different cost-effective techniques p. 136
Dushyant Chauhan, Probodh Kumar Chattopadhyay, Ashish Thakur
Cranial defects secondary to trauma, surgery or pathological causes, result in large cranial imperfection, which affects the appearance of the patient as well as results in sinking flap syndrome. Rehabilitation of such a defect can be done using prosthetic options like custom-made polymethyl methacrylate (PMMA) cranial prosthesis or surgical options like outer table calvarial graft segments. It is usually observed that the conventional moulage impression of the defective site is the most difficult task. The accuracy of the prosthesis is affected by conventional moulage impression, a moulage cast of the defect and techniques of fabricating wax pattern. Orthodox method is to mark the tentative outline of the defect and make a conventional moulage impression of the site. However, this is an arbitrary method which offers challenges to accurate replication of the borders of the defect. Recently, medical imaging and digital modeling in dentistry have paved the way for digital dental practice and additive manufacturing replacing most manual or subtractive procedures. The use of computerized tomography scan to obtain a 3 D digital image of cranial defect for fabricating a replica with rapid prototyping has markedly improved the accuracy at the margin of the defect/prosthesis interface, resulting in a better fit and optimal contour lending itself to the improved esthetic outcome. It is a more reliable method of fabricating a cranial implant prosthesis, which requires minimum adjustment when the patient is on the OT table. These case reports compare rehabilitation of cranial defect with custom-made PMMA cranial prosthesis using the conventional methods as well as rapid prototyping technique. It is seen that the rapid prototyping method is expensive but accurate and gives a better esthetic outcome.
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Utilization of non-vascularized bone graft with regional flap as an alternative for facial reconstruction p. 143
B Bala Guhan, Vinod Krishna Krishnaswamy, GR Karthikeyan, A Mathan Mohan
Mandibular resections decision is one of the most important steps in oral cavity malignant or nonmalignant lesions associated with the mandible. The role of mandibular reconstruction is not only for cosmesis, but it is also indicated for functional rehabilitation such as swallowing, phonetics, and for facial symmetrical. Even though the free tissue transfer is considered a gold standard for mandibular reconstruction, the importance of nonvascularized bone grafts (NVBGs) such as fibula, calvarium, rib, sternum, and iliac are still persisting in mandibulectomies condition like patient who have not taken radiotherapy or not willing to undergo radiotherapy or not fit for free tissue transfer and provides a good contour of mandibular replacement. The success rate of NVBG depends upon patient selection, preoperative planning, and meticulous nursing care. Addition to NVBG, regional flaps such as pectoralis major myocutaneous (PMMC) flap will help in soft-tissue replacement of the defect as well as it will help in the situation where primary closure and airtight closure is not possible. This case report will discuss in detail about the management of anterior segmental mandibulectomy due to oncological resection and reconstruction with NVBG with fibula and PMMC.
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A case series of orthodontic traction of maxillary impacted canine p. 147
Sneha Singh, Ajit Vikram Parihar, Thakur Prasad Chaturvedi, Neeteesh Shukla
Impacted maxillary canine is frequently encountered in clinical practice. Being the cornerstone of the dentition, orthodontic traction of impacted canine is always desirable in order to achieve successful functional occlusion. The aim of this case series is to illustrate different methods employed for orthodontic traction of maxillary impacted canine.
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Zygomatic approach with single-piece implants: A technical note p. 153
Vivek Gaur, Anita Gala Doshi, Lukasz Palka
Single piece zygomatic implant, or a remote anchorage implant, is an effective tool for the rehabilitation of the atrophic/resected jaws with least postoperative complications such as screw loosening, screw fractures, bone loss, mucositis, and peri implantitis. The aim of this paper was to summarize a technique for the use of a zygomatic approach for single piece implants. We used the key-words 'single piece implants” and the search revealed 700 papers in the PubMed database. After screening through the abstracts, we selected 50 articles that we finally reviewed. Zygomatic fixtures avoid the grafting procedures and cantilever situation, restoration of atrophic or postablative jaws are completed with immediate loading. It is advisable placement of zygomatic implant flapless with surgical guide, but the author believes more on the tactile perception and when the splint is at mucosal or bone level, a small change in orientation will lead the dramatic error in desired angulation leading to unwanted complication.
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