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Table of Contents
September-December 2021
Volume 12 | Issue 3
Page Nos. 295-435
Online since Monday, December 13, 2021
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EDITORIAL
Early diagnosis of oral submucous fibrosis is a boon in the prevention of oral cancer
p. 295
US Pal
DOI
:10.4103/njms.njms_491_21
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REVIEW ARTICLES
Gingival exophytic lesions as first oral manifestation of primary lung adenocarcinomas: Systematic review
p. 297
Sergio Piñeiro Donis, Abel García García, Pilar Gándara Vila, Andrés Blanco Carrión, Pía López Jornet, José M Suárez Peñaranda, Mario Pérez Sayáns
DOI
:10.4103/njms.NJMS_120_20
Metastases from malignant tumors in the oral cavity are rare and comprise approximately 1% of all oral neoplasms, being more frequent in the jaws than in the soft tissues. The presentation of a gingival metastasis as the first manifestation of a primary tumor in the oral cavity is extremely rare. The objective of this review is to update the diagnosis and management of oral metastasis being the first clinical manifestation of the tumor and review all the cases published to date, providing a new original clinical case with very specific histopathological characteristics. We systematically reviewed the literature in order to find all the cases of primary lung tumors that appeared with a gingival metastasis as the first manifestation. The search process involved a total of 1916 articles. After reading the latter, 15 (one of them with two different cases) met the inclusion criteria. Of the 15 articles, 6 were rated as medium quality (40%) and 9 as high quality (60%). We present a lung adenocarcinoma that first manifested as a metastasis in the gum, simulating a benign lesion. The unusually high growth rate of this lesion should conduct to have other diagnostic possibilities, and histopathological confirmation is essential.
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Evidence-based effectiveness of herbal treatment modality for recurrent aphthous ulcers – A systematic review and meta-analysis
p. 303
Adit Srivastava, GC ShivaKumar, Swarnasmita Pathak, Ekta Ingle, Anjali Kumari, Sahana Shivakumar, PG Navin Kumar, Akhilesh Kumar Singh
DOI
:10.4103/njms.NJMS_249_20
Recurrent Apthous Ulcers (RAU) has affected mankind through time immemorial. It is the most commonly prevalent oral mucosal lesion manifesting as painful ulcers involving non – keratinised oral mucosa. This review was done to assess herbal intervention in RAU patients for outcomes of ulcer size and pain intensity. Literature search of published articles in Medline, Scopus, Ovid and Journal of Web upto August 2020 were reviewed for the pre-described outcomes. Revman 5.4 software was used for study analysis. Total 9 articles were finally chosen for qualitative analysis. Meta analytic comparison demonstrated the ulcer reduction (CI = -2.22 to – 0.09; p <0.001) and pain intensity (CI = -4.60 to – 0.08; p <0.001) was reduced in the herbal group as compared to the controls. A definite evidence of herbal intervention was noted in alleviating RAU signs and symptoms.
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Biomedical waste management in dentistry during COVID-19 pandemic: What the guidelines recommend??
p. 311
Gyanendra Kumar, Ferah Rehman, Monica Kelkar
DOI
:10.4103/njms.NJMS_132_20
In the current coronavirus disease 2019 pandemic, dentists, auxiliaries as well as patients undergoing dental procedures are at high risk of cross-infection. Many patients who are asymptomatic may be carriers. For this reason, it is suggested that all patients visiting a dental office must be treated with due precautions. Ample amount of data is available which is mainly focusing on infection prevention and asepsis protocol for dental set ups with little emphasis on biomedical waste (BMW) management which is equally important in curbing the spread of the disease to health-care workers and general population. This article highlights the updated guidelines of BMW management to be followed in various dental set ups to prevent this spread to health-care workers dealing with the disposal of waste generated while treating patients in dental care.
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An overview of effect of lycopene and curcumin in oral leukoplakia and oral submucous fibrosis
p. 316
Tanveer Ahmad, Imran Khan, M Moshahid Rizvi, Mohd Saalim, Nikhat Manzoor, Asia Sultana
DOI
:10.4103/njms.njms_324_21
The purpose of the current article was to evaluate the recently published researches on the use of lycopene and curcumin in oral leukoplakia (OL) and oral submucous fibrosis (OSF). A comprehensive review of the current researches enveloping PubMed, Ovid, and Cochrane was made using the keywords [(Lycopene) OR (Curcumin) AND (Leukoplakia OR OL OR OSF OR OSMF OR OSF OR Submucous Fibrosis)]. We included only randomized control trials and in the English language. The search covers the data from 1994 to August 2020. Six studies (2 of OL and 4 of OSF) finally qualified are included in the study for the qualitative analysis of the result. Out of these six studies, four were found having high risk, one with unclear risk and one with low risk. Only one study came out as finally suitable for the quantitative analysis of the result. A total of 90 participants were included in this review, with a mean age of 32 with a range of 17–60 years. Out of 90 participants, 70 were male and 20 were female. It is evident from the result of this study that the use of oral curcumin and lycopene has significant improvement in the mouth opening, burning sensation, and cheek flexibility in comparison to the placebo. The use of oral curcumin and lycopene appears to be effective and safe in the treatment of OL and OSF but to read the result of use of oral curcumin and lycopene in OL caution should be taken because of bias.
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Oral cancer diagnostics: An overview
p. 324
Akhilanand Chaurasia, Saman Ishrat Alam, Navin Singh
DOI
:10.4103/njms.NJMS_130_20
Cancer was first mentioned in medicine texts by Egyptians. Ancient Indians studied oral cancer in great detail under Susruta. Cancer has continued to be a challenge to physicians from ancient times to the present. Over the years, cancer underwent a shift in management from radical surgeries toward a more preventive approach. Early diagnosis is vital in reducing cancer-associated mortality especially with oral cancer. Even though the mainstay of oral cancer diagnosis still continues to be a trained clinician and histopathologic examination of malignant tissues. Translating innovation in technological advancements in diagnostic aids for oral cancer will require both improved decision-making and a commitment toward optimizing cost, skills, turnover time between capturing data and obtaining a useful result. The present review describes the conventional to most advanced diagnostic modalities used as oral cancer diagnostics. It also includes the new technologies available and the future trends in oral cancer diagnostics.
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ORIGINAL ARTICLES
Antibiotic therapy for the prevention of osteoradionecrosis following tooth extraction in head-and-neck cancer patients postradiotherapy: An 11-year retrospective study
p. 333
Luiz Felipe Palma, Marcelo Marcucci, Cíntia Maria Remondes, Leandro Chambrone
DOI
:10.4103/njms.njms_413_21
Introduction:
One of the most important complications of radiotherapy (RT) for head-and-neck cancer (HNC) is osteoradionecrosis (ORN) of the jaws, which mostly arises from tooth extractions. The ORN treatment still represents a great challenge; therefore, the prevention is of paramount importance. Thus, the present study aimed to evaluate retrospectively a perioperative systemic antibiotic therapy protocol for the prevention of ORN following tooth extraction in head-and-neck patients post-3D conformal RT.
Materials and Methods:
A retrospective medical record review was performed considering HNC patients submitted to RT in the period between 2008 and 2019. They necessarily received oral antibiotic therapy with Clindamycin 300 mg every 8 h for 10 days, with the first dose 3 days before the tooth extraction.
Results:
Forty-nine patients met the study criteria, with a total of 107 teeth extracted. Regarding the 47 patients who did not develop ORN, 103 tooth extractions were identified (96.3%). Only two patients developed ORN at two adjacent teeth sites (3.7%).
Conclusion:
The proposed perioperative systemic antibiotic therapy protocol seems to be efficient to prevent ORN following tooth extraction in postirradiated HNC patients.
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Evaluation of matrix metalloproteinase 9 gene expression in oral squamous cell carcinoma and its clinicopathological correlation
p. 339
Krishnapriya Umashankar, Gifrina Jayaraj, Herald J Sherlin, KR Don, Archana Santhanam
DOI
:10.4103/njms.NJMS_279_20
Background:
Matrix metalloproteinases (MMPs) are calcium-dependent and zinc-containing endopeptidases which enhance cancer progression by regulating angiogenesis, migration, proliferation, and invasion. Oral squamous cell carcinoma (OSCC) is one of the most common malignancies in India, and it is observed over 90% of cases. In OSCC, MMP9 which belongs to the gelatinase group promotes tumor progression by angiogenesis, disturbing tissue morphology that allows tumor growth which breaks the basement membrane and enables metastasis, and its overexpression in OSCC is proven to have prognostic value.
Aim and Objectives:
To assess the expression of MMP9 in OSCC and to correlate the MMP9 expression with pathological staging of the OSCC.
Materials and Methods:
Ten OSCC tissue samples and normal tissue samples were collected. Total RNA was extracted and the complementary DNA was generated. The specific primers used in the primers were synthesized. Total reaction volume was 20 μl. The polymerase chain reaction condition included 95°C for 30 s followed by 40 cycles of two steps: 95°C for 5 s and 60°C for 30 s. The relative quantification of genes was evaluated.
Results:
Upregulation of MMP9 gene regulation was observed in OSCC tissue samples when compared to the controls. Correlating with the pathological staging, we observed that 30% tumors were stage IVA with involvement of adjacent structures and 30% had lymph node involvement.
Conclusion:
This study is done to assess the possibility of MMP9 gene expression as a prognostic biomarker for OSCC.
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Augmentation rhinoplasty using olecranon bone graft
p. 344
Jitendra S Mehta, Manish P Zade, Dhananjay V Nakade, Shitiz Gupta, CV Akhila
DOI
:10.4103/njms.njms_359_21
Background:
Correction of saddle nose deformity is one of the most frequently sought surgeries by patients seeking rhinoplasty in Asian countries. Nasal dorsal augmentation always requires graft material to achieve the desired result. Various autologous grafts and alloplastic materials have been described in the literature with their advantages and disadvantages. We report our study on the use of olecranon bone graft for augmentation rhinoplasty in severe saddle nose deformity and discuss our experience with it.
Materials and Methods:
In this observational study, 12 patients who underwent dorsal nasal augmentation using olecranon bone graft from August 2011 to December 2020 were studied. All ten patients with congenital deformity underwent graft insertion through a closed rhinoplasty approach, whereas two patients with posttraumatic deformity were operated through old scars over the nasal dorsum. The graft was fixed with screws at nasion in both posttraumatic cases. All the patients were evaluated postoperatively at regular intervals for graft resorption by clinical photographs and X-ray nasal bone.
Results:
The age ranged from 20 years to 48 years. No immediate complications related to graft placement were noted. One patient had a hairline fracture of the ulna at the donor site on the 3
rd
postoperative day which was managed conservatively with a cast. The mean follow-up period was 2 years. No nasal dorsum projection loss or signs of bone resorption were observed for up to 5 years after surgery. One patient with posttraumatic deformity required removal of fixation screw which got exposed after 2 years of surgery.
Conclusion:
Olecranon bone graft is a suitable material for nasal dorsal augmentation in severe saddle nose deformity because of ease of harvest and minimal donor area morbidity. The appropriate thickness of the cortex of the olecranon process allows custom molding and provides resistance to resorption in long term, thereby giving a desirable outcome.
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A comparative evaluation of bone regeneration using mesenchymal stem cells versus blood coagulum in sinus augmentation procedures
p. 349
Akash Sanjay Gupta, Jitender Kumar Aurora, KN Dubey, Himanshu Chauhan, Mohit Saxena, Sagar Ramesh Ganvir
DOI
:10.4103/njms.njms_358_21
Objective:
The present study evaluated the quality and quantity of new bone formation in the maxillary sinus lift procedures and stability of implants in posterior atrophic maxilla.
Materials and Methods:
This prospective randomized controlled split-mouth study included 20 patients (16 males and 4 females having a mean age of 36.7 years) having atrophic maxilla. They were divided randomly into two groups: Group A using mesenchymal stem cells and Group B into blood coagulum. They were radiographically evaluated using cone-beam computed tomography (CBCT) for residual bone height preoperatively and availability of new bone formation around implants, density, and stability of implants 6 months postoperatively.
Results:
The placement of dental implants in posterior maxilla is challenging due to rapid resorption of alveolar bone after extraction of teeth due to pneumatization of maxillary sinuses. In both the groups, more pain and swelling were observed in the 2
nd
postoperative day which gradually decreased over a period of 7 days. Membrane perforation occurs in only four cases (20%). A significant gain in alveolar bone height was observed in Group A (7.69 mm ± 2.5 mm) and Group B (9.32 mm ± 2 mm) after 6 months. On comparing both the groups, there is a similar significant increase in bone density in Hounsfield units postoperatively at various levels buccally and palatally. Total 40 sinuses were lifted and 42 implants were placed, respectively. All implants showed primary stability.
Conclusions:
Such findings provide a significant contribution in future perspective studies that the use of stem cells had the same success rate as blood coagulum.
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Evaluation of surface changes of stainless steel miniplates and screws following retrieval from maxillofacial trauma and orthognathic surgery patients: A comparative study
p. 357
Mouneshkumar Chapi Devendrappa, Madhura Dattatraya Kulkarni, Nazia Haidry, Pranay Kulkarni, Flora Verma, Dhanashree Anand Pawar
DOI
:10.4103/njms.NJMS_257_20
Background:
Metal implants have the potential to degrade body fluids. Corrosive degradation has been demonstrated in laboratory tests, both under simulated clinical conditions and by electrochemical methods, as well as in studies of retrieved metal implants. The clinical importance of degradation of metal implants is evidenced by particulate corrosion and wear products in tissue surrounding the implant, which may ultimately lead to bone loss.
Materials and Methods:
The present study is to evaluate the surface changes such as corrosion, surface roughness, and microfractures and for the tensile strength of 18 stainless steel miniplates and 18 stainless steel screws which were used as rigid internal fixation in the management of maxillofacial fractures and orthognathic surgeries.
Results:
In this study, surface roughness and microfractures were found in all the miniplates and screws that is 100%. Corrosion degradation was found in 12 of 18 plates that is 66.66%.
Conclusion:
Our results through scanning electron microscopy and stereo electron microscopy showed surface roughness, microfractures, and corrosion. However, tensile strength was not affected when the plates were
in situ
. Through our study, we recommend their retrieval after the purposes of rigid fixation have been fulfilled.
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Effect of platelet-rich fibrin versus chitosan-based Axiostat hemostatic agent following dental extraction in cardiac patients on antiplatelet therapy: A comparative study
p. 361
Kamala Rajendra, Swetha Vempalli, Mithileswer Kadiyala, Vidushi Sharma, Swetha Karipineni, Srikanth Gunturu, Dipak Baliram Patil
DOI
:10.4103/njms.NJMS_270_20
Background:
Platelet-rich fibrin (PRF) is a biomaterial that promotes wound healing. It has a fibrinous matrix wherein platelets, pro-inflammatory cytokines, and various growth factors along with few cells are entrapped while Chitosan is a naturally occurring cationic biopolymeric material that is derived from an animal product, chitin. It has demonstrated biological properties which include acceleration in wound healing, hemostasis, enhancement of immunological response, mucosal adhesion by eliciting biological responses, and anti-microbial action.
Aim:
The aim of this study was to evaluate the effect of PRF and Axiostat (A chitosan-based product) on hemostasis after tooth extraction among cardiac patients on antiplatelet medication.
Materials and Methods:
This prospective study was carried out on 300 patients undergoing tooth extraction. Participants were divided into two categories (
n
= 150, respectively) as Group I (PRF dressing) and Group II (Axiostat dressing). Time to achieve hemostasis was observed using a stopwatch. Average pain score calculation was performed using visual analog on the 7-day postoperative period. Descriptive statistics were done, and data analysis was performed using the Mann–Whitney U-test.
P
< 0.5 and < 0.001 were considered statistically significant and extremely significant, respectively.
Results:
Average pain score was 1.86 ± 0.06 in Group I and 1.05 ± 0.87 in Group II. Thus, lower postoperative pain was seen with Axiostat dressing. Hemostasis was achieved in Group II participants in 1.25 ± 0.06 min and in 1.89 ± 0.54 min in Group I.
P
< 0.01 was obtained, although no statistically significant difference in postoperative pain scores (
P
= 0.8) was seen.
Conclusion:
Chitosan is a superior wound dressing material in achieving hemostasis in cardiac patients on antiplatelet medication after tooth extraction.
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Nasal changes in different age groups
p. 367
Dipti Shastri, Pradeep Tandon, Ankita Singh
DOI
:10.4103/njms.NJMS_246_20
Objective:
The objective of this study was to evaluate nasal changes in different age groups and to detect gender difference in nasal dimensions.
Materials and Methods:
Clinical measurement and profile photographic records of 279 randomly selected subjects were obtained for the evaluation of nasal changes. Thirty-nine subjects were excluded, and the final sample consisted of 240 subjects. The subjects were divided into four groups by age: Group 1 (16–20 years), Group 2 (21–30 years), Group 3 (31–40 years), and Group 4 (41–50 years). Each group was further subdivided on the basis of gender. Data were collected and analyzed by two-way multivariate analysis of variance with Duncan's multiple range
post hoc
test.
Results:
In both males and females, nasal height and breadth increased with except nasal index and nasolabial angle. More nasal changes were seen in males as compared to females of the same age group.
Conclusions:
Nonconsistent age-related changes were found for nasal index and nasolabial angle. The rest of the nasal parameters increased with age and differ between the genders. Larger nasal changes were seen in males as compared to females of the same age group.
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Microbiological profile of aerobic and anaerobic bacteria and its clinical significance in antibiotic sensitivity of odontogenic space infection: A prospective study of 5 years
p. 372
Hemavathi Umeshappa, Akshay Shetty, Kiran Kavatagi, GK Vivek, N Vaibhav, Imran Mohammed
DOI
:10.4103/njms.NJMS_1_20
Introduction:
Odontogenic infections are mixed aerobic-anaerobic microbial flora. Infections caused by anaerobic bacteria are serious and life-threatening. The microbial specificity in odontogenic infections is technique sensitive depending on the sampling and culturing of specimens.
Materials and Methods:
A prospective study was carried out on 100 consecutive cases of odontogenic infections treated at our institute over a period of 5 years by surgical intervention and intravenous antibiotics. This study evaluates the pathogenic potential and virulence factors of aerobes and anaerobes as well as its synergistic interrelations with other infectious flora, by culturing of specimens and testing antibiotic sensitivity in standard microbiological methodology in correlation with patient demographic factors.
Results:
Of the 100 patients of odontogenic space infection, males were more affected, between third and fourth decades. Caries is the most common etiology with involvement of mandibular molars. Submandibular and buccal space is commonly involved. The most common microorganisms isolated being Staphylococcus aureus and Streptococcus viridans are facultative anaerobes which belong to aerobes and
Peptostreptococcus
predominated among obligate anaerobes. The empirical antibiotic regimen followed is amoxicillin plus clavulanic acid with Metronidazole, followed by surgical treatment. Clindamycin was preferred as the second line of choice in patients resistance to penicillin drugs with comparable efficacy in it.
Conclusion:
Our study expanded the knowledge base of the microbial flora associated with odontogenic infections, with special reference to anaerobes. Successful management of odontogenic space infection lies in decompression, removal of etiological factors, and also in selecting appropriate antimicrobial therapy depending on microbial flora isolated, for recovery of patients and preventing complications associated with fascial space infection.
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Assessment of the anterior and caudal extent of inferior alveolar nerve canal, location of inferior alveolar canal and mental foramen, and the depth of submandibular fossa using computed tomography
p. 380
Deepak Kumar, Ramandeep Brar, Tahir Ahmad, Chintan Narad, S. P. S. Sodhi, Amandeep Kaur
DOI
:10.4103/njms.NJMS_186_20
Background:
A well-versed knowledge of the precise location of various anatomical landmarks is necessary to avoid complications during surgery. The study was conducted for the assessment of the anterior and caudal extent of the inferior alveolar nerve canal, location of inferior alveolar canal and mental foramen, and the depth of the submandibular fossa using computed tomography (CT).
Materials and Methods:
One hundred CT scans were randomly selected for this study accounting for 200 hemimandibles. Both axial and coronal images were obtained and evaluated concurrently. Results were subjected to statistical analysis for correct inferences.
Results:
A total of 200 hemimandibles (
n
= 200) from 100 patients with a mean age was 23.89 ± 1.75 years ranging from 21 to 33 years were evaluated. The mean length of the anterior loop was 0.95 mm for all of the observation combined and measurement range from 0 to 5.1 mm. The total frequency of type I, type II, and type III of mental nerve was found as 71%, 4.5%, and 24.5%, respectively. At the level of the first molar, the mean distance from the center of the inferior alveolar canal to the external surface of the buccal cortex (Q) was 5.44 ± 1.38 mm ranging from 2.4 to 10.4 mm. Furthermore, there was no statistically significant difference in MF-IMB (mental foramen to the inferior border of mandible) between the right and left sides of the mandible. (
P
= 0.87).
Conclusion:
Our study demonstrates that analyzing CT scans using the methods described in this study can be a useful tool in avoiding the iatrogenic injuries to inferior alveolar nerve and arteries during various maxillofacial surgical procedures.
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Isolation and identification of oral
Candida
species in potentially malignant disorder and oral squamous cell carcinoma
p. 387
Chandra Prakash Arya, Rohit Jaiswal, Aanchal Tandon, Amol Jain
DOI
:10.4103/njms.NJMS_80_19
Context:
Oral cancer is one of the ten most common cancers in the world. More than 95% of the carcinomas of the oral cavity are of squamous cell type in nature. Oral
Candida
is a “yeast-like opportunistic pathogen.” The
Candida
genus is comprised of over 150 species of asporogenous “yeast-like” fungi.
Aim and Objectives:
The aim of study is to correlate the association of oral fungal infection in progression of oral squamous cell carcinoma (OSCC) and potentially malignant disorders. The current study was undertaken to probe the isolation and identification of oral
Candida
species in potentially malignant disorder and OSCC versus normal oral mucosa.
Materials and Methods:
Twenty patients for each abovementioned three lesions were randomly selected by using swabs. These swabs were subsequently inoculated in agar medium.
Candida
grows as white, convex colonies. Samples growing 1–3 colony-forming units (CFUs) were considered normal flora of the oral cavity. The specimens showing moderate to heavy growth were subjected to tests for identification of species of
Candida
. The chromogenic medium, HiMedia CHROMagar, has chromogenic substances which helps in the quick detection of
Candida
species, based on the reactions between the extract enzymes of the dissimilar species and the chromogenic substances.
Statistical Analysis:
Chi-square test, one-way analysis of variance test, and
post hoc
Tukey's test were utilized.
Results:
According to our study,
Candida albicans
,
Candida krusei
,
Candida tropicalis,
and
Candida parapsilosis
in the culture were found to be in increasing incidence from healthy, OSCC, and oral potentially malignant disorders (OPMDs). These results clearly indicated that
Candida
species are increasing in the CFUs (
P
< 0.0001).
Conclusion:
Our study showed a higher intensity of
Candida
in OPMD and squamous cell carcinoma patients with results. The increasing CFU level and hyphae of
Candida
species in individual biopsy tissue with oral potentially malignant lesions to OSCC suggest that this pathogen plays a role in disease development and could aid in identifying the pathogenic commensal.
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Temporomandibular joint ankylosis: A tertiary center-based epidemiological study
p. 392
Nitesh Mishra, Naresh Kumar Sharma, Neeraj Kumar Dhiman, Chandresh Jaiswara, Preeti Tiwari, Akhilesh Kumar Singh
DOI
:10.4103/njms.NJMS_57_20
Introduction:
Limitation of mouth opening can be caused by bony or fibrous ankylosis of the temporomandibular joint (TMJ) as a sequel to trauma, infection, or autoimmune diseases. The incidence of TMJ ankylosis differs significantly in different parts of the world. The purpose of this study was to analyze the etiological incidence of TMJ ankylosis at our tertiary-level center, which covers a huge population from parts of Bihar and eastern Uttar Pradesh.
Materials and Methods:
This study was conducted from July 2016 to April 2019, and a total of 1607 children were screened in the duration of 33 months. Participants were included in this study as per the inclusion and exclusion criteria.
Results:
After screening of the 1607 children, 128 TMJ ankylosis cases were identified. Out of the 128 cases of TMJ ankylosis, 33 cases were bilateral and 95 cases were unilateral (48 left sided and 47 right sided). Most of the patients (83.5%) were in the 10–15-year-old age group (mean age was 12.1 ± 2.83 years). There was a female preponderance, and the male-to-female ratio was 7:10. Overall, the most common cause of ankylosis was found to be childhood trauma.
Conclusion:
The major etiologic factor of TMJ ankylosis was found to be birth/childhood trauma. TMJ ankylosis cases were detected in significant numbers in this study. This increased prevalence may be due to the lack of knowledge about this pathological entity among the general population and health-care professionals at primary level, which leads to poor initial management.
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Comparative evaluation of crestal bone levels following placement of implant in delayed implant bed: An
in vivo
clinical study
p. 397
Chhavi Rana, Abhishek Nagpal, Vishwas Bhatia, Jasneet Singh Kalra
DOI
:10.4103/njms.NJMS_54_20
Background:
Restoring lost dentition using dental implant is one of the most promising treatment modality, for both complete and partially dentulous situation. In order to have more predictable outcome, the quest for coming up with a surgical protocol has been never ending. Keeping the same in mind the present study was conducted to place implant in delayed implants beds, i.e., 14 days after the osteotomy site was prepared.
Materials and Methods:
For the purpose of the study, ten implants measuring 4.2 mm × 10 mm were placed in ten healthy individuals with missing mandibular first molars in site prepared 14 days before actual placement of implants, i.e., delayed implant beds.
Results:
The study revealed that, on evaluation of the bone levels at the time of placement of prosthetic loading revealed, a bone gain was maximum after 3 months of prosthetic loading.
Conclusion:
A significant bone gain with a mean of 0.8 mm makes this technique of placing implants in delayed implant beds a more predictable technique than conventional protocol.
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Closure of oroantral fistula: Comparison between buccal fat pad and buccal advancement flap: A clinical study
p. 404
Bharat Shukla, Gaurav Singh, Madan Mishra, Gourab Das, Abhishek Singh
DOI
:10.4103/njms.njms_323_21
Background:
The oro antral fistula (OAF) is an unnatural epithelialized communication between oral cavity and maxillary sinus. It may heal spontaneously but a larger fistula requires surgical intervention. OAF causes excruciating pain, escape of fluids from nose, escape of air from mouth into nose, epistaxis, change in voice due to resonance, purulent discharge in case of chronic OAF, post nasal discharge, popping out of antral polyp into oral cavity and sinusitis. Closure of OAF is strenuous, technique sensitive and challenging.
Aims and Objectives:
To compare and evaluate the efficacy of buccal fat pad and buccal advancement pad for closure of oroantral fistula.
Materials and Methods:
Twenty patients of age ranging from 24–64 years with complaint of OAF were included in this prospective, comparative analytic study. In group I, OAF was treated with a buccal advancement flap and in group II, BFP was sutured over the defect. All patients were called for follow up on 1
st
, 7
th
, 14
th
and 21
st
day post operatively. Pain, mouth opening, edema, infection and wound dehiscence were evaluated on each visit.
Result:
The mean age of selected patients in both the treatment groups was comparable. The mean age of patients in group I was 45.00 ± 13.33 years whereas in group II the mean age was 44.00 ± 13.13 years. Pain, edema was less in Group I. Mouth opening was less in group II. We did not encountered infection and wound dehiscence in any case.
Conclusion:
Various techniques can be utilized for the closure; regardless of the technique used, success of the surgical procedure depends on effective removal of fistulous tract and complete extermination of any sinus pathology and/or infection. The major factors determining the type of surgery for closure of OAF are dimension and location of the defect. The other decisive factors could be the adequacy and health of adjoining tissue. We observed buccal fat pad to be better option for closure of OAF, despite of its more morbidity; as all the complications were of some time period and when evaluated for long term.
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CASE REPORTS
The superior eyelid crease approach with retroseptal dissection: A modified access to the superomedial intraconal space. Treatment of a cavernous hemangioma: Case report and literature review
p. 410
Francesco De Feudis, Riccardo Girotto, Paolo Balercia
DOI
:10.4103/njms.NJMS_420_21
The orbit can be affected by primary intraconal lesions as well as cavernous hemangiomas. This article illustrates for the first time the retroseptal dissection (RD) route combined to the superior eyelid crease approach (SECA) to treat a symptomatic hemangioma inside the superomedial intraconal space. It also reviews the main studies about the argument. A 42-year-old woman affected by a mild painful proptosis and some accommodation difficulties in her right eye. The magnetic resonance imaging revealed a soft intraconal mass in the superomedial quadrant of the right orbit. The lesion was removed performing a SECA with RD through an incision inside a natural eyelid crease. Disappearance of pain with an improvement of accommodation was reported immediately. During the whole follow-up, the visual acuity, field examinations, and ocular motility did not reveal any impairment. Our approach represents a valid, quick, not technically demanding and mini-invasive method to access the superomedial intraconal space. Finally, it gives excellent functional and cosmetic results.
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Treatment of a central giant cell lesion in the mandible
p. 414
Bernardo Correia Lima, Giulianna Lima Pinheiro, Leonardo Augustus Peral Ferreira Pinto, Maria Aparecida de Albuquerque Cavalcante
DOI
:10.4103/njms.NJMS_227_20
Central giant cell lesion (CGCL) is a benign intraosseous lesion that usually accompany the gnathic bones in the anterior region, mostly crossing the midline. Its clinical features involve cortical expansion, tooth displacement, and root resorption. Pain may occur in 20% of cases. Histopathological characteristics are like other pathological entities, being necessary discarding them. In this case, a 53-year-old female presented an expansive legion in the anterior mandible with tooth displacement and pain. After incisional biopsy, the result was CGCL. Surgical planning involved manufacturing a biomodel, bending the reconstruction plate to give the correct mandibular arch perimeter. After that, it was performed a segmental resection and installation of a reconstruction plate using a cervical approach. The patient is under follow-up with no signs of recurrence or complications.
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Novel technique for esthetic root coverage with titanium prepared platelet-rich fibrin
p. 418
Shivani V Sachdeva, Harish Saluja, Amit Mani
DOI
:10.4103/njms.NJMS_276_20
Leukocyte- and platelet-rich fibrin (L-PRF) can be defined as an autologous leukocyte and platelet-rich biomaterial. Unlike other platelet-rich products, this technique does not require an anticoagulant or bovine thrombin. However, it is simply centrifuged blood without any additives, which makes it possible to avoid all of the legal restrictions related to the reimplantation of blood-derived products. L-PRF is composed of a fibrin matrix polymerized in a tetramolecular structure and is involved in the joining of platelets, leukocytes, cytokines, and circulating stem cells. The use of silica- coated test tubes is arising a lot of queries about the safety of L-PRF prepared within these test tubes. So, to avoid the use of silicacoated test tubes, titanium prepared PRF has come in practice now, as titanium is biocompatible metal and has property of histoconduction. The present case report is about successful esthetic root coverage around mandibular anterior teeth with clinical attachment loss of 4–5 mm at baseline. The patient had reduced sensitivity, CAL was 1 mm, and attached gingiva covered denuded root surface after 15 days and after 3-month recall appointment.
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Acquired partial auricular defect rehabilitation aided by four-part mold technique and spectrophotometer
p. 422
S Ramya, Kaushal Kishor Agrawal, Saumyendra Vikram Singh, Pooran Chand
DOI
:10.4103/njms.NJMS_115_20
Patients with auricular defects benefit greatly by an ear prosthesis. However, during the fabrication of auricular prosthesis, difficulties can be faced in obtaining a satisfactory outcome, such as tearing of the prosthesis, fracture of the mold and poor color matching. An 18 year old male lost part of his left auricle in an assault and battery because of which the patient was suffering from adverse psychosocial impact. Surgical reconstruction was ruled out because of patient's desire and financial constraints. Partial auricular prosthesis using four part mold technique and spectrophotometer was fabricated leading to a desirable outcome. Four part mold technique prevented fracture of mold and made retrieval of prosthesis easier. Spectrophotometer reduced the duration of patient visit and the artistic skill required for colour matching in tral and error method.
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Diversifying the rehabilitation of calvarial defects: Rejuvenating precision: A case series
p. 426
Abhishek Kumar Gupta, Mamta Kumari, Rekha Gupta, Shubhra Gill
DOI
:10.4103/njms.NJMS_288_20
Cranial vault defects are either congenital or acquired in origin. Cranioplasty is most commonly done in patients after trauma, decompressive craniectomies, tumor resections, infections or because of congenital malformations. The purpose of a Cranioplast is to protect the underlying brain tissues, reduce pain, and to improve the calvarial contour, symmetry, and esthetics. Rehabilitation of these defects possesses a challenge to the surgical team and prosthodontist. With advancement in three-dimensional (3D) engineering technology, the use of rapid prototyping technology (RPT) can be used in the fabrication of 3D skull eliminating conventional impression for recording defect region. Custom-made cranial prosthesis now can be fabricated using the conventional method of wax-up and lost-wax method. Case 1 had a history of road traffic accident followed by decompressive craniectomy, which led to frontoparietotemporal defect of the right side. The 3D model was fabricated using RPT technology. The wax pattern fabricated on 3D prototyped skull was contoured using digital photographic superimposition method. Case 2 had a history of trauma on the head causing intracerebral hemorrhage followed by decompressive craniectomy which led to frontoparietotemporal defect of the right side. The 3D model was fabricated using RPT. The wax pattern fabricated on 3D prototyped skull was contoured using the compass method. The use of these methods with the added advantage of RPT resulted in prosthesis with good esthetics and better fit. The contour of the prosthesis was replicated in the same manner as compared to the contralateral side. These techniques are easy to use and are less time consuming and had few chances of errors.
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Neonatal vascular malformation of parietal bone
p. 431
NK Sahoo, Sudarshan Bhat, Sanjay Kumar
DOI
:10.4103/njms.NJMS_253_20
Vascular malformations (VaMs) are congenital lesions and are present at birth. They grow commensurately with age. These lesions often affect the soft tissues with intraosseous involvement of the scalp being rare. Here, we discuss a case of intraosseous VaM in a 2-month-old infant which was involving the parietal bone.
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NOTICE OF RETRACTION
Retraction: Evaluation of osseintegration between traditional and modified hydrophilic titanium dental implants – Systematic analysis
p. 435
DOI
:10.4103/njms.njms_503_21
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© National Journal of Maxillofacial Surgery | Published by Wolters Kluwer -
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Online since 5
th
September, 2010