Aims : To determine the hard tissue surgical cephalometric norms statistically and geometrically in well-balanced faces having clinically acceptable facial profile in the Rajasthan population. To compare the cephalometric analyses of Rajasthanis males and females and to compare the craniofacial pattern of Rajasthani population with Caucasian norms. Materials and Methods: Lateral cephalograms of 200 subjects (100 males and 100 females) in the age group of 18-25 years, class I malocclusion and acceptable facial profile were obtained. Cephalometric analysis was performed and studied. Results: The study revealed that parameters, such as all horizontal skeletal parameters, PNS-N, PNS-ANS, Ar-Go, Go-Pg and upper OP to HP angle show no statistical significant difference between Rajasthani males and females. When comparing Rajasthani males and Caucasian males, the study suggested statistically significant difference in the mean values of parameters, such as PTM-N, L1-MP, 6-MP, Go-Pog, B-Pog, Ar-Go-Gn, U1 to NF and L1 to MP. When comparing Rajasthani females and Caucasian females, the study revealed no statistically significant difference between the mean values of parameters, such as N-A-Pg, N-A, N-B, L1-MP, Ar-Go-Gn, upper OP to HP angle and AB-OP and rest of the parameters showed highly significant difference between Caucasian females and Rajasthani females. Conclusion: This study indicates that Rajasthani population has a bimaxillary protrusion with predominant tendency toward horizontal growth pattern of the mandible and this tendency is further exaggerated in females. Rajasthani females also showed an increased length of the anterior cranial base, maxilla and mandible and in dental parameters they showed increased maxillary dental height and both Males and females showed decreased mandibular dental height.

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For patients whose orthodontic problems are so severe that neither growth modification nor camouflage offers a solution, surgery to realign the jaws or reposition dentoalveolar segments is the only possible treatment option left. One indication for surgery obviously is a malocclusion too severe for orthodontics alone. It is possible now to be at least semiquantitative about the limits of orthodontic treatment, in the context of producing normal occlusion as the diagrams of the "envelope of discrepancy" indicate. In this case report we present orthognathic treatment plan of an adult female patient with skeletal class III malocclusion. Patient's malocclusion was decompensated by orthodontic treatment just before the surgery and then normal jaw relationship achieved by bilateral sagittal split osteotomy.

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Osteomyelitis is a disease which is heterogeneous in its pathophysiology, clinical presentation and management. It is considered to be one of the most difficult-to-treat infectious diseases. Progressive bony destruction and the formation of sequestra are hallmarks of osteomyelitis. We hereby report a rare case of maxillary osteomyelitis, which had actinomycotic osteomyelitis like presentation but was histopathologically diagnosed as a severe form of chronic suppurative osteomyelitis.

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Supraorbital neuralgia is a rare disorder accounting for 4% of incidence with hallmark of localized pain in or above the eyebrow, clinically characterized by the following triad: (1) forehead pain in the area supplied by the supraorbital nerve, (2) tenderness on either the supraorbital notch and (3) absolute, but transitory relief of symptoms upon supraorbital nerve blockade. The pain presents with a chronic or intermittent pattern. The persistence of protracted unilateral forehead/occular pain, tenderness over the nerve and repeated blockade effect strongly suggest the diagnosis. Surgical treatment can be used when the medical treatment fails or in patients who do not tolerate the pharmacological treatment.

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Objective : Bears are strong and agile wild animals that defend themselves, their young ones and their territory, if they feel threatened. Conflicts between humans and bears are common in bear-prevalent areas of the world. Our valley, which is surrounded all around by forests, is a habitat for black bears (U. thiabetanus) only. Maulings inflicted by these black bears are catastrophic events and such attacks have increased considerably in the recent past due to merciless deforestation. The rising incidences of such attacks, especially in maxillofacial region, have urged our department to undertake a study of such attacks and injuries. Materials and Methods: The present study is both a retrospective and prospective study of 200 patients of bear maulings who were admitted and treated in the Department of OMFS, Govt. Dental College, Srinagar, from January 2005 to October 2009. Results: Majority of the patients were from villages. Most of them belonged to fourth decade and majority was males. Black bears only were involved in all the encounters. Claws, paws and combination of both, were the used for attack. In majority of cases, no defense was used for the termination of attack. All the patients had soft tissue injury, deep lacerations, facial viscera, eyes, salivary glands and facial nerve commonly involved.

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Odontogenic tumors represents a broad spectrum of lesions ranging from benign to malignant to dental hamartomas all arising from odontogenic residues, that is, the odontogenic epithelium, ectomesenchyme with variable amounts of dental hard tissues formed in the same sequence as in normal tooth development. We report two cases of myxoma, which were misdiagnosed initially and latter, reported as odontogenic myxoma; and were treated by conservative surgical excision in one case and radical resection with hemimandibulectomy in the other case.

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Human growth and development is a meticulously planned and precisely executed process. Even a mild disturbance can have clinically significant manifestations later on. Even today, ancient beliefs and practices override/delay patient's aspiration for seeking treatment as seen in the case report presented here. Congenital bifid tongue in association with various other orofacial abnormalities has been reported, many of which have been linked to various syndromes. But congenital bifid tongue occurring in the absence of other orofacial abnormalities is very rare. Here, we discuss a case of bifid tongue involving the anterior one-third of tongue, reported in a 45-year-old male patient unusually with no other intraoral abnormalities.

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Oral submucous fibrosis is a chronic debilitating disease characterized by gradually increasing fibrosis of the oral cavity and pharynx, mainly the buccal mucosa, resulting in trismus. Prepotency of the disease is seen in the Indian subcontinent, with its highest incidence in South India due to various deleterious habits. In spite of the numerous medical modalities employed in the management of oral submucous fibrosis, occasionally surgical intervention becomes inevitable. Various flaps have been used to reconstruct the surgical defects following excision of fibrous bands. Undoubtedly; the buccal fat pad remains the most versatile because of its excellent blood supply and minimal donor site morbidity. Here we present a case of severe oral submucous fibrosis surgically treated and reconstructed using buccal fat pad.

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A dentigerous cyst is an odontogenic cyst, thought to be of developmental origin. It is associated with the crown of an unerupted (or partially erupted) tooth. The cyst cavity is lined by epithelial cells derived from the reduced enamel epithelium of the tooth forming organ. Most dentigerous cysts are solitary. Multiple/bilateral cysts are usually found in association with a number of syndromes including cleidocranial dysplasia, Maroteaux-Lamy syndrome and Gorlin--Goltz syndrome (multiple OKCs). In the absence of these syndromes, the occurrence of multiple dentigerous cysts is rare. Here, we report the unusual occurrence of non-syndromic multiple dentigerous cysts.

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Odontoma seems to result from budding of extra-odontogenic epithelial cells from the dental lamina. This cluster of cells forms a large mass of tissues that may be deposited in an abnormal arrangement, but consists of normal enamel, dentin, cementum and pulp. World Health Organization (WHO) classification defines a lesion as a malformation in which all the dental tissues are represented in a more orderly pattern than in the complex odontoma so that the lesion consists of many tooth-like structures. This article presents a report of five cases of odontomes.

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Prosthetic rehabilitation of patients with oral submucous fibrosis (OSMF) offers a formidable challenge due to restricted mouth opening. Physiotherapy via interocclusal force application is the mainstay for surgical treatment. Herein, we report a case of a man with OSMF requiring construction of dentures. The main objective was to deliver intra-operative and post operative inter occlusal forces without fracturing the mandible and thus providing rehabilitation to the patient prosthetically. An edentulous male patient reported with grade IVA OSMF to our department to improve his mouth opening for denture construction. The patient was managed successfully using surgical sectioning of the fibrous bands. Inter occlusal force application for mouth opening during the operation and post operative physiotherapy were facilitated using custom-made occlusal splints. Satisfactory mouth opening was achieved, with good healing and no event of infection or fracture. Here, we propose an easy method to achieve adequate mouth opening in an edentulous patient of OSMF, with atrophic ridges; without the chances of fracture of either jaw.

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Dystonia is an involuntary, repetitive, sustained (tonic), or spasmodic (rapid or clonic) muscle contraction. The spectrum of dystonias can involve various regions of the body. Oromandibular dystonia (OMD) can involve the masticatory, lower facial and the tongue muscles which may results in trismus, bruxism, involuntary jaw opening or closure and involuntary tongue movement. Here, we report a case of OMD in a 68 year old man.

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Maxillofacial injuries in pediatric population warrant special attention because of anatomic considerations, potential for growth disturbances and rapidity of healing. We report a case of displaced mandibular fracture in a child who tested positive for hepatitis B surface antigen (HbsAg) and, therefore, was managed conservatively by closed reduction stabilized with acrylic dental splints fabricated on reduced dental models.

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With the scientific advancements in the management of malignant diseases, the treatment is expensive and bears high morbidity in term of oral mucositis. It is a debilitating condition and has been researched extensively for its pathogenesis and treatment. Various treatment options include barrier forming, mucosal protectants, mouth rinses, growth factors, lasers and midline-sparing procedures. Some agents are used locally while others are administered systemically. Despite the availability of a wide range of treatment options for mucositis, a cost-effective treatment is yet to be evolved.

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Necrotizing fasciitis of the head and neck is an uncommon, potentially fatal , soft tissue infection characterized by extensive necrosis and gas formation in the subcutaneous tissue and fascia. The purpose of this report is to heighten the awareness of this infection. The article also outlines an appropriate management strategy for use in the treatment of these patients and reviews the literature along with a report of a case which was successfully managed.

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Mini dental implants (MDI) are ultra-small diameter (l.8 mm width), biocompatible titanium alloy implant screws, conceived and designed over 20 years ago by a board-certified Manhattan dentist, Sendax Victor. Dr. R. A. Bulard added a single-piece "O-ball" design to Dr. Sendax Victor concept. These implants can be used in atrophic ridges, flabby ridges, or in other cases where there is denture instability or lack of retention due to poor availability of residual bone. In this article, a case report of 55-year-old female patient is presented, with a severely atrophic mandibular ridge that was managed by the MDI system with an overdenture.

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Aim : The first step in the management of Temporomandibular Disorders (TMD) is usually noninvasive, especially if the disorder is in the early stages. Clinically, pain and clicking are early signs and symptoms of TMD. The management of TMD usually includes "splint therapy" and analgesics. In this study, we report our long-term outcomes in the treatment of patients suffering from early TMD. Materials and Methods: We assessed the records of 138 patients who were referred for management of TMD. Selection was based on pain and/or clicking of the Temporomandibular Joint (TMJ), no pathologic lesions of the TMJ, no anterior disc displacement without reduction (closed lock), no Degenerative Joint Disease, no history of migraine, trauma, osteoarthritis, metabolic disease, or malocclusion (deep bite, cross bite, jaw deformity, etc). The patients were treated with an acrylic maxillary Interocclusal Splint (IOS) cuspid-rise type and were told to refrain from biting, yawning and chewing hard food. The outcome of the treatment, potential etiologic factors (Bruxism), signs and symptoms and patient demographics (such as age, sex, treatment duration, etc.) were assessed. The data were analyzed using the Chi-square test to correlate significance. Results: One hundred thirty-eight patients (26 males and 112 females) with early signs and symptoms of TMD (pain and/or click of the TMJ) were treated from 2001 to 2010; 81% were females and 19% were males. All the 138 patients used the IOS at night only. The patients were followed-up for 1-9 years. Data analysis showed that 64% of the patients were completely relieved of signs and symptoms; 22% were moderately relieved (decreased severity of signs and symptoms) and 14% had no noticeable post-treatment changes in clicking or pain (P = 0.001). Patients with bruxism and those presenting with both pain and clicking showed a better response to IOS treatment (P = 0.046 and P = 0.001, respectively). The results also showed that age, sex, severity of symptoms and duration of the treatment did not influence treatment results in this group of patients with early TMD. Conclusion: In this population, TMD was significantly higher in females. Treatment of early TMD with IOS was effective and moderately effective in long-term in over 80% of the patients during the follow-up period of 1-9 years. Bruxism had a significant etiologic role in TMD; occlusal attrition of the dentition, pain of all the teeth, early morning pain of the masticatory muscles and the TMJ are signs and symptoms to suspect nocturnal bruxism. Use of an IOS is recommended to prevent potential damage to the dentition, periodontium and the TMJ in early TMD.

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Objectives : The study was conducted to assess the value of ultrasonography (USG) for lymph node metastasis in patients with carcinoma of oral cavity. Materials and Methods: A total of 20 cases were selected with primary tumor of oral cavity. Ninety-two lymph nodes were detected by ultrasound of 5 mm or more in diameter. The patients were examined preoperatively for palpable lymph nodes clinically and ultrasonographic examination of bilateral neck. Ultrasonographic parameters, such as size, shape, boundaries (well-delineated/ poorly delineated) and internal echoes for the lymph nodes were recorded. Results: The histologic positive rate was 25%, 80% and 93% for nodes between 5 and 10 mm, 10 and 15 mm and for nodes 15 mm or more in size, respectively. Ultrasonographic findings showed a high significance as the size of nodes increases. The positive rate of 86% for the round nodes of 9 mm or more in size showed a high significance. The positive rate was 93% for well-delineated nodes and 68% for poorly delineated nodes. The most frequent echo pattern was homogenous followed by hypoechoic with positive rate for metastasis ranging from 83% to 88%. Conclusion: The diagnostic validity of USG as compared with histopathology showed sensitivity of 86% and specificity of 73% with overall efficiency of about 82% in detecting lymph node metastasis. USG is useful for preoperative evaluation of the neck, as the most reliable, inexpensive and easily available method. It is essential for diagnosis, staging and therapy choices.

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Ameloblastoma is a tumor derived from epithelium involved in odontogenesis. Although it is considered a benign tumor, its clinical behavior may be regarded as lying between benign and malignant. It is characterized by slow but persistent growth, local infiltration into adjacent tissues and recurrences; however, metastases are rare. Diagnosis mainly from tissue biopsy and characteristic finding on plain X-rays does assist in differentiating between types of ameloblastoma. The challenges in the management of this tumor are to provide complete excision as recurrence may occur in incomplete removal and also to reconstruct the bony defect in order to give reasonable cosmetic and functional outcome to the patient.

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Aim : The purpose of this study was to evaluate the postoperative pain control and mouth opening in patients undergoing temporomandibular joint interpositional gap arthroplasty by either placing an epidural catheter in the incision wound and infusing ropivacaine 0.25% or by using a transdermal fentanyl patch. Materials and Methods: The study was prospective, randomized and double blind. Eighty patients belonging to American Society of Anesthesiologists grade I and II, 18-32 years of age, scheduled for temporomandibular joint interpositional gap arthroplasty were randomized into 2 groups; ropivacaine group (G rop): to receive 0.25% ropivacaine infusion and transdermal fentanyl group (G tf): to receive transdermal fentanyl patch. For postoperative pain (Visual Analog Score [VAS]) and analgesic requirements were assessed 2, 4 and 8 h after surgery and each morning, until and 4 days after surgery. Results: Time to first analgesic requirement was found to be significantly (P < 0.0001) higher in G rop (49 ± 6.7) as compared with G tf (32 ± 9.1) VAS were also significantly lower in G rop throughout the postoperative period. Postoperatively, mouth opening was better in G rop as compared with G tf, which was statistically significant. Conclusion: It was concluded that by placing an epidural catheter at the incision wound and continuously infusing with ropivacaine 0.25% effectively controls the postoperative pain in patients undergoing temporomandibular joint interpositional gap arthroplasty and provides better postoperative mouth opening.

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Hemimaxillectomy patients present with abrupt alterations in the physiologic processes of the maxillae, along with increased anxiety levels due to sudden impairment in esthetics, mastication, speech, deglutition and hypernasal speech. Such patients should be rehabilitated as early as possible, in the postoperative phase with the help of careful preoperative planning by the surgeon and the prosthodontist. This case report illustrates the multidisciplinary approach to rehabilitate a patient, who had undergone maxillectomy on the right side, due to carcinoma alveolus. The transitional prosthesis given in this case used Tissue conditioners, which, because of their viscoelastic nature, ensure continuous adaptation, helping peripheral seal and retention. This greatly reduces discomfort and nasal reflux and improves speech.

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Aim : The literature focuses little attention on factors that influence third molar post extraction pain (PEP). One factor that may play a role in PEP is saliva. We undertook a study in patients subjected to third molar extraction with the aim of assessing the influence of salivary pH on PEP. Materials and Methods: Thirty-one healthy patients with one impacted inferior lower third molar with mean age of 21.02 th + 2.05 years, underwent surgery for similar impactions. The process of pH measuring was carried out without delay after saliva collection, with a combination electrode connected to a PHM 62 pH meter. Pain assessment was done at 4, 8, 12, 18 and 24 hours on the first day. The scale ranged from 0 to 10 in which 0 and 10 denoted 'no pain' and 'maximum pain,' respectively. Results: The multivariate analysis suggests that the factors that influence pain are patients' sex (B = - 0.466) and the saliva pH (B = - 1.093). According to the findings of our study, PEP intensity is assumed to have a reverse correlation with salivary pH and is also assumed to be greater in females. Conclusion: Due to the fact that no previous study has indicated such findings so far, further studies are needed to assess the importance of preoperative pH value and its clinical significance on the level of PEP.

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