Journal of Maxillofacial and Oral Surgery

Published by Springer Verlag
Online ISSN: 0974-942X
Publications
Article
To clinically evaluate the perioperative use of 0.2% chlorhexidine gluconate for the prevention of alveolar osteitis, to assess the patient compliance to chlorhexidine and to prepare a comprehensive treatment plan to prevent alveolar osteitis after removal of an impacted third molar extraction. A prospective study was done on 50 patients with bilaterally impacted lower third molars which were indicated for extraction. Extraction of impacted mandibular third molar on one side was done without using any mouthrinse. While extracting the third molar on the other side, patients were instructed to use chlorhexidine 0.2% mouth rinse for 8 days, 1 day preceding and 7 days following the surgery. They were instructed to use chlorhexidine 0.2% (Rexidine) mouth rinse for 30 s twice a day (before breakfast and after dinner) with 15 ml of the rinse with 1:1 dilution with clean water. All the patients were evaluated for pain, presence or absence of clot and condition of the alveolar bone for the diagnosis of dry socket. Incidence of dry sockets was 8%, when patients did not use 0.2% chlorhexidine gluconate perioperatively which is statistically significant. It appeared that the incidence of dry socket can be reduced significantly by using 0.2% chlorhexidne gluconate mouth rinse perioperatively (twice daily, 1 day before and 7 days after surgical extraction.
 
Onset and duration of action
Changes in diastolic blood pressure
Changes in pulse rate
Article
Even today the ability to provide the patient with clinically adequate pain control with minimum systemic side effects is one of the major concerns all over the world. Lignocaine, the most commonly used local anesthetic agent in oral surgery due to its rapid onset & reasonably good potency, does not have adequate duration of action, unless used with Adrenaline, a drug known for its cardiovascular effects. Centbucridine, a non-ester, non-amide group local anesthetic agent developed in India at C D R I Lucknow, has advantage of inherent vasoconstrictor property. This study was planned to compare 0.5% Centbucridine and 2% Lignocaine with Adrenaline, in exodontia patients. The results were recorded for their efficacy and C V S action and statistically analyzed. Centbucridine was found to be an ideal local anesthetic agent with no effects on cardiovascular parameters and exhibiting a sufficient degree of local anesthetic activity suitable for use in routine minor surgery cases. This will be advantageous where Adrenaline is absolutely contraindicated due to systemic problems.
 
Article
This study involves mandibular and midface fractures recorded in the trauma reports of OMFS department, SCB dental college, Cuttack, Odisha. The reports were studied between December 2004 and November 2009. The 503 patients had 539 mandibular fractures and 117 midface fractures. Males accounted for 442 (87.87%) and females accounted for 61 (12.12%). Male to female ratio was 7.25:1. The most common cause of fracture was road traffic accident and accounted for 404 (80.31%). The most common site of fracture mandible was parasymphysis where as in middle third fracture it was zygomatic complex fracture. The most common age groups involved in fracture were 21-30 years and the incidence of head injury was 97(19.28%). Many of these variations may be related to socioeconomic, cultural and environmental conditions.
 
Article
Osteomas are benign neoplasm often associated with facial asymmetry, pain and surface ulceration. Peripheral osteomas are more common in the cranio-maxillofacial region. It is prevalent at younger age but maximum seen in the sixth decade, with a female to male ratio is 1:2. The aim of this study was to review the clinical presentations and management protocol of such lesions in cranio-maxillofacial region. The study was conducted at Command Military Dental Centre (EC) during May 2004 to May 2007. Six serving soldiers and their families (four males, two females), age group ranging between 13 and 56 years, mean age 34.5 years were recruited in this study. The tumors were excised using extra oral, intra oral and combined approaches; no complications were reported during post op period. All the cases were operated under GA through extra oral, intra oral and combined approaches with satisfactory results. HPE report was benign in all our cases with no post operative complications reported during follow up. Cranio-maxillofacial osteomas are exclusively benign tumors and not very common entities. Proper diagnosis and precision management alleviates symptoms without any post surgical complications. In our series of six cases the tumors were diagnosed and managed as per standard surgical protocol with excellent result.
 
Patient 14 intraoral condition: severely crowded teeth, bilateral posterior crossbite and midline deviation 
Intraoperative view showing the osteotomies and the interincisive diastema 
Accentuated diastema during the expansion 
Final interocclusal relationship 
Article
The diversity of the proposed techniques in the treatment of maxillary transverse deficiency in adults reflects the conflicting opinions about the primary area of resistance to maxillary expansion in the craniofacial skeleton. In order to evaluate the efficiency of the surgical expansion in which no osteotomies of the pterygomaxillary junction were made, we have carried out a retrospective study with 14 patients with maxillary transverse deficiency, who were treated from 2003 to 2006. In the study, models were made prior to and after surgery, and the intercanine and intermolar distances and the improvement of the interocclusal relationships were analyzed. Breathing function and the complications that occurred during and after the surgeries were also analyzed. All expansions were carried out according to pre-surgical planning so that expansion completely corrected the crossbite, resulting in the desired final occlusion for all patients. Intraoperative complications were limited to one Hyrax appliance deformation. Two patients had minor postoperative complications that included wound dehiscence and pain. Improvements in nasal breathing were observed in all patients that complained of breathing problems prior to the surgery. The satisfactory results obtained turns the surgical protocol described in this study recommended for the treatment of maxillary transverse deficiency in adults. Importantly, we found that pterygomaxillary osteotomy is not essential for maxillary expansion. The morbidity of the procedure was low with fairly minor complications, and surgically assisted rapid maxillary expansion was shown to improve nasal breathing.
 
Article
Maxillofacial injuries form a major aspect of trauma management in trauma centers. Prompt diagnosis and management is needed to provide better quality of life and cosmetic results as compared to delayed interventions. We present a retrospective study of 189 patients of complex, operable maxillofacial injury with an analysis of patients'; age and gender, mode of injury, vehicle details and associated injuries along with the maxillofacial injuries admitted in a tertiary care hospital in Northern India over one year. Maximum patients were in the age group of 21-30, a decade early as compared to other figures, with fractures of zygoma being predominant associated with head injury as the commonest comorbid condition. Motorized two wheelers were the leading cause with more than 75% patients driving at the time of injury. Majority of the injuries were not singular and in concordance with the literature men were the most affected. Motor vehicle accident is the most common cause for maxillofacial injury worldwide. Being a referral hospital the number of patients were low but the complexity was high with a reverse trend towards the type of injuries seen and the ones found in community hospitals. The stand alone factor of this study with respect to the other publications is the presentation of the associated symptom complex with the specified fracture and the type, number and rotation of fracture segments with each facial bone fracture; the location of the patient at the time of impact in the vehicle, type of vehicle and the associated injuries.
 
Article
To compare and evaluate postoperative complications and treatment outcome in mandibular fracture fixation using 2.0 mm titanium miniplates and 3-D locking plates. Thirty patients were divided randomly into two groups of 15 each (including comminuted and malunited fractures). Group A was treated with open reduction internal fixation using 2.0 mm miniplates and group B with 3-D locking plates. A total of five complications were observed in four patients: implant exposure and infection in miniplate group and postoperative neurosensory deficit, implant failure and implant exposure in 3-D group. For fractures in symphysis and parasymphysis region, severely displaced angle fractures and for comminuted fractures 3-D locking plate could be a better option. In the angle and body region a single miniplate fixed according to Champy's technique is easy to place with less surgical time, less surgical trauma, is more economical and has similar clinical results.
 
Article
The purpose of this clinical study was to compare effectiveness of 2.0-mm locking miniplates and screws with 2.0-mm standard miniplates and screws in treating mandible fractures. A randomized prospective study comprising of 40 samples, where 20 patients (group 1) were treated with locking plates and 20 patients (group 2) were treated with standard miniplates. All the cases were evaluated for the type of fracture, need for the Intermaxillary Fixation (IMF) and its duration, duration of surgery, anatomic reduction, paresthesia / neurosensory changes, occlusal discrepancies, infection at the fracture site and any need for the removal of the plates and screws. In our study Road Traffic Accidents (RTA) accounted for the majority of patients 30 (70%). RTA was more prevalent (52.5%) in 21-30 age group, with assault being more common (67%) in 25-35 years. There was a significant difference between group 1 and 2 in postoperative occlusal discrepancy and need for IMF (p=0.008). There was no significant difference in complication rates between group 1 and group 2 patients. Locking plate/screw system proved to be more rigid than conventional plate/ screw system, thereby reducing the need and duration of IMF. However there was no significant difference in complication rates.
 
Article
The present study aimed to evaluate the efficacy and stability of 2.0 mm Titanium plates in treatment of mandibular angle fractures. A randomized, prospective study was carried out on 17 patients treated by ORIF with 2.0 mm titanium plates. Operative handling of the plate and clinical stability were qualitatively analyzed. The 2.0 mm plate showed good intra-operative handling and adequate clinical stability with follow up of 6 months showing good soft tissue healing. A single 2.0 mm titanium plate provides easy handling and adequate occlusal stability in the post-operative phase as compared to the traditional 2.5 mm plate without post-operative MMF. The online version of this article (doi:10.1007/s12663-010-0128-2) contains supplementary material, which is available to authorized users.
 
Article
To evaluate the sinuses in the cervicofacial region and to identify the focus of infection. It is also to help the clinician in differentiating the sinuses' of odontogenic and nonodontogenic focus of infection. The study has been conducted in 200 patients, aged between 11 and 77 years for a period of 6 and a half years at Narayana Dental College and Hospital, Nellore. History of present illness, clinical, radiological and laboratory examinations were carried out on all the patients. Majority of the cervical sinuses are of odontogenic origin (80%) and non-odontogenic being (20%) of the cases. The literature reveals that many cases have been misdiagnosed and inappropriately treated by many specialties of Medicine and Surgery wherein the odontogenic foci of infection is the main etiological factor for cervicofacial sinuses. A proper diagnosis is important and forms a key to the successful management of these sinuses in the head and neck region.
 
Surgical approaches used for TMJ total joint replacements. The left hand picture shows the preauricular and retro-submandibular incisions. The middle picture shows the incision scars 10 days after surgery and the right hand picture shows the barely visible scars 1 year following surgery
Surgical approaches used for TMJ total joint replacements. The left hand picture shows the preauricular and retro-submandibular incisions. The middle picture shows the incision scars 10 days after  
Article
While India boasts the largest collective experience in the surgical management of TMJ ankylosis, times are changing and Indian Surgeons will need to begin thinking about other TMJ disorders that have previously gone under the radar. A growing Indian middle class with greater access to health facilities will demand treatment for TMJ disorders like myofacial pain and dysfunction, internal derangement and osteoarthrosis which Oral & Maxillofacial Surgeons must be prepared to manage. The aim of this paper is to review the role of TMJ surgery and its place in the treatment armamentarium of temporomandibular disorders. Indications, rationale for surgery, risks vs benefits are discussed and complemented with examples of clinical cases treated by the author. As India moves up the economic ladder of success, TMJ disorders that have largely been confined to Western nations will begin to appear in the rising middle classes of India. Indian Oral & Maxillofacial Surgeons must be prepared to recognize and manage disorders which present with more complex symptomatology where the role of TMJ surgery is less clear cut.
 
Article
(1) To collect the data related to distribution of third molar impactions among rural population by clinical and radiological examinations. (2) To collect the information on distribution of third molar impactions among urban population by clinical and radiological examinations. (3) To compare the patterns of distribution of third molar impactions among rural and urban residents with respect to type of impaction, arch, gender and age. A cross-sectional study was conducted in Dharwad district of Karnataka state located in South India involving 630 rural and 270 urban subjects as per demographic profile of India. A two stage sampling procedure was adopted in the selection of the sample. Data was analyzed using STATISTICA-6.0. χ(2) test was used to explore the association between different variables and third molar impactions. A P ≤ 0.05 was considered statistically significant. 14.92% of rural subjects and 27.40% urban subjects were reported to be suffering from third molar impactions. The overall prevalence of third molar impactions among the study subjects was found to be 18.67%. A significant association was noticed between the 'different arches' and distribution of third molar impactions in both rural and urban population. Subjects with vertical impactions were found to be most common in both the groups.
 
Article
This study aims to retrospectively analyze the incidence and pattern of cranio-maxillofacial injuries in the developing world in a hope to emphasize on authorities the need of improvising infrastructural facilities, medical and other. Hospital medical records with available radiographs of 6,872 patients treated for cranio-maxillofacial injuries at major trauma centres in Pune, India over a 22 year period (from July 1989 to June 2010) were reviewed. Relevant data pertaining to patients' age, sex, cause of injury, sites of injury, associated injuries, anaesthesia, various treatment modalities and complications were recorded and analyzed statistically. A total of 6,872 patients sustained maxillofacial injuries of which 5,936 (86.4 %) were caused by road traffic accidents (RTA), followed by fall in 608 cases. Distribution pattern of sex revealed male predominance (M:F-2.5:1) and the third decade age group (2,416) sustained maximum cranio-maxillofacial injuries. Of 12,503 cranio-maxillofacial sites involved, mandible (6,456) predominated, while there was middle third involvement in 5,024 cases. Most of the patients (4,856) were treated with open reduction and internal fixation without maxillo-mandibular fixation and complications were noted in 320 patients. In comparison to similar recent studies reported in the literature, our findings show that RTA remains the most common cause of cranio-maxillofacial injuries with male preponderance. Also RTA remains the major preventable etiological factor of cranio-maxillofacial injuries, which should prompt authorities to take "Herculean effort" to implement rules and educate people.
 
Stepwise protocol for the management of space infection
Etiology of infections 
Type of infections 
Article
The purpose of this study was to retrospectively evaluate a series of patients with space infection. In this study 256 patients with space infection over a period of two years were treated with intravenous antibiotic and prompt incision and drainage followed by culture and sensitivity tests in some cases. Data collection included demographic, anatomic treatment and complication information. The sample consisted of 256 patients with a mean age of 28 years. 7 patients were immunocompromised and 20 female patients were pregnant out of 84 female patients who were included in the study. Caries followed by implant failure were identified to be the most frequent cause for space infection. Trismus and dysphagia were present in over 70% of the cases. The vestibular masticator, perimandibular (submandibular, submental and/or sublingual) and parapharyngeal, submaxillary spaces were involved. Abscess was found in 76% of the cases. All the patients were drained under local anesthesia or conscious sedation except one patient who was drained under GA. Three deaths occurred. This study indicated that prompt incision and drainage along with intravenous antibiotic under local anesthesia or conscious sedation was the mainstay of treatment of severe space infection. Patients were relieved of their signs and symptoms by third day, however trismus may persist for 5-7 days.
 
Article
Conventional two dimensional computed tomography has provided significant advancement in clinical diagnosis with information on cross-sectional anatomy of various parts of the body. However, three dimensional representations are not directly available. This is now made possible by recent development of CAD software and CT equipments and technique such as multiplanar reformation capable of providing 3D reconstruction using 2D CT data. This article evaluates the accuracy of measurements and dimensions in 3D CT reconstruction.
 
"v" Poisson ratio (adimensional) "E" Young's modulus (Pa) Material Particular 
A spiral family implant Fig. 2 Mesh formation where the single finite elements were connected among them by nodes 
Article
Spiral family implants are a root-form fixtures with increasing thickness of tread. This characteristic gives a self-tapping and self-condensing bone properties to implants. To study spiral family implant inserted in different bone quality and connected with abutments of different angulations a Finite Element Analysis (FEA) was performed. Once drawn the systems that were object of the study by CAD (Computer Aided Design), the FEA discretized solids composing the system in many infinitesimal little elementary solids defined finite elements. This lead to a mesh formation where the single finite elements were connected among them by nodes. For the 3 units bone-implant-abutments several thousand of tetrahedral elements having 10 parabolic nodes were employed. The biomechanical behaviour of 4.2 mm × 13 mm dental implants, connecting screw, straight and 15° and 25° angulated abutment subjected to static loads, in contact with high and poor bone quality was evaluated by FEA. A double system was analyzed: a) FY strength acting along Y axis and having 200 N intensity; b) FY and FZ couple of strengths applied along Y and Z directions and having respectively 200N and 140N intensity. The materials were considered as homogeneous, linear and isotropic. Then the FEA simulation was performed hypothesizing a linearity between loads and deformations. The lowest stress value was found in the system composed by implants and straight abutments loaded with a vertical strength, while the highest stress value were found in implants and 15° angulated abutment loaded with a angulated strength. In addition, the lower is the bone quality (i.e. D4) the higher is the distribution of the stress within the bone. Spiral family implants can be used successfully in low bone quality but a straight force is recommended.
 
Article
In the present study, 20 patients with mandibular fracture were included to evaluate the versatility of titanium 3D plate in comparison with conventional titanium miniplate fixation. The patients were alternatively allocated to either the 3D plate group or Miniplate group. The patients were evaluated for the clinical assessment of mobility after fixation, pre and post-surgical occlusal relationship, adequacy of reduction on post operative radiograph and any post surgical complications. All 25 fractures in 20 patients were found to be adequately fixed when checked intra-operatively. No post-operative IMF was required in either of the groups. The mean radiographic score at post operative time interval in Miniplate group was found to be 2.80 ± 0.42 and in 3D Plate was found to be 2.90 ± 0.32. The mean radiographic score at 3 months time interval in Miniplate group was found to be 2.70 ± 0.48 and in 3D Plate was found to be 2.70 ± 0.48. Radiolucency at 3 months period was found in 1 patient (10%) in the miniplate group and it was not found in any patients in the 3D plate group. None of the patients in both the groups had complications of non-union or mal-union. In miniplate group, 2 patients (20%) had infections and in 3D plate group 1 patient (10%) had infection. 3 patients in miniplate group had occlusal discrepancies (30%) and 1 patient in 3D plate group had occlusal discrepancies (10%). Overall, complications were found in 6 patients (60%) in miniplate group and 2 patients (20%) in 3D plate group. The data when compared was statistically significant (P < 0.05). The 3D plating system was found to be advantageous over conventional miniplates. It uses lesser foreign material, reduces the operation time and overall cost of the treatment. Thus 3D plate can be used as an alternative to conventional miniplates. The system is reliable and effective treatment modality for mandibular fractures.
 
Article
The aetiology of Oculo-Auriculo-Vertebral Spectrum (OAVS) is unkown. We report a case following a prenatal diagnosis of 45,X/46,XY mosaicism in a pregnancy achieved by In-Vitro Fertilization (IVF) and describe evidence for the interrelationships of these phenomena and multiple births. This report extends the phenotypes associated with prenatally diagnosed 45,X/46,XY mosaicism and supports the association of OAVS and IVF.
 
Article
Between 2006 and 2009, 74 cases of salivary gland neoplasms were analyzed retrospectively, of which 44 (60%) were benign and 30 (40%) malignant. 61 % percent of neoplasms were in the parotid gland, 22% in the minor salivary glands including sublingual salivary glands, and 17% in the submandibular glands. The most common benign neoplasm was pleomorphic adenoma (64%), and the most common malignant neoplasm were adenoid cystic carcinoma (17%) and mucoepidermoid carcinoma (23%). We analyze the incidence and distribution of all types of salivary gland neoplasms in our series, and provide data for comparison with other epidemiological studies from different geographical sites and races. Demographic data from these studies help us to a better understanding of the biological and clinical characteristics of the disease. Further epidemiological surveys should be encouraged for better understanding of the disease and to provide early and better treatment of salivary gland neoplasms.
 
Enucleated cyst with abundant hairs 
Article
Dermoid cysts are developmental cysts and considered to develop from enslavement of epithelial debris in the midline during closure of the mandibular and hyoid brachial arches. These cysts are painless, slow growing and most commonly occur in young adults with no gender predilection. They are uncommon in the head and neck region. Oral dermoid cysts are found usually in the submental or sublingual triangle in variable relation to mylohyoid, geniohyoid, and genioglossus muscle. The cyst is lined by epidermis like epithelium and contains dermal adnexal structures in the cyst wall. We report a case of dermoid cyst arising in the sublingual region of a young adult male with abundance of hair which is rare finding.
 
Clinical studies that reported similar rates of failure in compromised and acceptable bone with calculated effect estimates 
Article
Survival rates for conventional dental implant systems are relatively high in normal healthy bone. However, there are subgroups of patients that are at an increased risk of implant failure. In particular, patients with compromised quantity or quality of bone present a significant challenge to the dental implantologist. To perform a review of the literature in an attempt to quantify the relative risk of implant failure in compromised bone compared to good or acceptable bone and to identify whether certain anatomical regions are at greater risk. We conducted a systematic electronic database search of Medline, Cinhahl and the Cochrane Library through March 2006 identifying articles meeting the eligibility criteria. We calculated an increased risk of implant failure in compromised bone compared to healthy bone in both the maxilla and the mandible using conventional dental implant systems. Relative risks ranged from 2 to 12 with the highest risk of failure in the maxilla. Conventional systems are often used in combination or after bone augmentation procedures or more innovative methods for stimulating bone growth in patients with compromised bone. These approaches do have their limitations including high costs, the accumulation of the surgical risks, and delayed time to loading. Quantifying the risk of implant failure in patients with compromised bone should assist the implantologist in treatment decision making and patient counseling. Alternative methods for treating patients with compromised bone include zygomatic and lateral implants, neither of which typically require bone augmentation procedures. More studies are needed to evaluate their safety and efficacy.
 
Article
Purpose of this study to introduce a new minimal access technique for management of anterior mandible fracture with several advantages over conventional methods. Four cases of undisplaced anterior mandibular fracture were selected. Tension band was achieved either by arch bar fixation to mandible or placement of interdental wire followed by intermaxillary fixation. With a 1 cm vertical incision was placed adjacent to fractured line. Fractured segment was immobilized with lag screw with minimal stripping. All patients were followed for 6 months. All four cases shown good stable segment after 6 months of post operative follow up. OPG revealed well placed lag screw and there were no surgical complications, for example parasthesia, scarring and odema. Fixation of anterior mandible fracture using this technique can achieve good stability and appropriate compression. The technique is simple and easily performed, reducing the surgical time, reduce the chances of infection due to less exposure and promote the healing process by producing stress in the fracture lines.
 
Details of microscopic evaluation of margins 
Comparative statistical analysis of frozen with paraffin sections 
Article
To study the accuracy of intraoperative frozen section diagnosis in assessing margins in oral cancer resection and to evaluate the role of frozen section diagnosis as a guide in resection of oral cancer lesions. The fresh tissue samples from the margins of lesions of patient with preoperative diagnosis of oral squamous cell carcinoma were used. The frozen sections are prepared immediately and examined by oral pathologist for the study. The results of these sections were compared with the results of histologic findings obtained by routine paraffin embedded Haemotoxylin and eosin method. The total of 184 margins, from 47 patients were examined. 178 margins showed concordance with the permanent section of the same tissue sample (seven false negative and one false positive), an accuracy rate of 96.74%. Frozen section is a helpful tool in intraoperative decision making in indicated situation. The results are highly specific but only moderately sensitive. The surgeon and the pathologist must understand the limitations of frozen sections.
 
Article
The cephalometric prediction of orthognathic treatment outcome is an important part of the surgical planning and the process of informed consent. The orthodontic and surgical changes must be described accurately prior to treatment in order to assess the treatment's feasibility, to optimize case management and to increase patient's understanding and acceptance of the recommended treatment. The aim of the present article was to investigate on the factors that could influence the accuracy of cephalometric prediction in planning orthognathic surgery. Review of the literature revealed that, besides factors directly related to the prediction method and its use, there exist a considerable number of factors which could affect significantly the accuracy of soft tissue response. These factors could be biological ones such as relapse, centre of mandibular rotation and individual variation in response to treatment and others such as gender, race, pre-operative soft tissue thickness and data bases for mean ratios of soft to hard tissue movement changes. Some of the factors affecting the accuracy of prediction of soft tissue response following orthognathic surgery are inevitable and there are others, difficult to control and predict. However, patients should be informed that predictions are only a guide, may not represent the actual result of the surgical outcome, and as such they should be implemented.
 
Article
To compare the efficacy of Ibuprofen and Aceclofenac in controlling pain, swelling and trismus following removal of impacted mandibular third molar teeth. To assess the patient's acceptability of these drugs. The present double blind study was conducted on 60 adult patients for the surgical removal of impacted mandibular third molars. Drugs administered were Ibuprofen and Aceclofenac. Both the drugs were packed separately and coded with equal in number. After removal of impacted mandibular third molars, following parameters were studied: (1) Analgesic activity, (2) Maximum mouth opening, (3) Swelling. The scores were recorded preoperatively and on 1st, 3rd, 5th and 7th postoperative day. Ibuprofen has a marginal edge over Aceclofenac. Both the drugs were well accepted by the patients with no reported adverse effects.
 
Intraoral view with mandibular removable partial prosthesis placed 
Intraoral view of metal plaque on which were soldered 2 patrix inserted into buccal surface of right denture base of mandibular removable partial prosthesis 
Definitive acrylic resin splint inserted on mandibular removable partial prosthesis 
Article
Patients undergoing hemimandibulectomy suffer from mandibular deviation. The purpose of this article is to describe a new therapeutic possibility for the prosthetic management of these patients using only one device both for physiotherapy and eating. A 56-year-old man's pre-existing mandibular removable partial prosthesis was modified to use as a partial prosthesis as a device to correct mandibular deviation. In fact, two precision attachments patrix were inserted into buccal surface of partial prosthesis base and corresponding matrix were inserted into a transparent acrylic resin guide-flange. In this way the patient can use only one prosthesis both for physiotherapy and eating simply inserting and removing the guide flange. The transparent resin employ is important for the day by day use. This technique permits to use only one device both for mechanical correction of mandibular deviation and masticatory function while literature shows that two different devices are usually used in patients with mandibular deviation to satisfy both these functions.
 
Article
Vacuum formed and heat cured acrylic splints have been used in the diagnosis and treatment of temporomandibular disorders. The aim of this study was to evaluate patient's preference to either the vacuum formed or the heat cured acrylic splint. Twenty patients planned to receive splints were chosen from the dental school. Both types of occlusal splints were fabricated for each of them. Each patient used the splints alternatively on a nightly basis for 3 weeks. After 3 weeks, each patient completed a questionnaire regarding the comfort, fit, retention, occlusal contact, taste, gingival and lip irritation, smoothness and smelling. Statistical analysis was conducted by the MacNemar's Chisquare test. There was no statistical difference in patient's responses to the different splint materials except for the comfort of wearing through the night. The vacuum formed and heat cured acrylic splint may be equally worn in patient preference for treatment of temporomandibular disorders.
 
CT scan showing multilocular radiolucency  
Postoperative OPG Fig. 13 Postoperative frontal view  
Article
Condylomata acuminatum is a sexually transmitted infectious disease caused by human papiloma virus on the skin. The transmission is mainly by close contact with infected person and autoinoculation. In oral cavity the condition manifests as soft pink nodules which proliferate and coalesce rapidly to form diffuse papillomatous clusters of varying size. Odontogenic myxoma is a rare tumor of jaws which occurs in the tooth-bearing areas of the mandible and maxilla. It is an uncommon, benign, but locally aggressive neoplasm. This case report highlights a 17-year-old girl with two lesions in oral cavity with soft tissue growth on the palate which has been diagnosed as Condyloma Acuminatum, treated by surgical excision and a large swelling on the right side of the mandible in the same patient diagnosed as odontogenic myxoma where marginal resection was performed.
 
Diclofenac requirements 
Visual Analogue Score during postoperative period 
Article
Purpose of this study was to evaluate the combined analgesic effect of gabapentin and transdermal fentanyl patch, on acute and chronic pain after surgery for maxillary cancer. The Study was double blind and prospective. 100 subjects belonging to ASA grade I and II, 30-50 years age group, scheduled for maxillary cancer surgery were randomized into two groups; treatment group (GT): to receive gabapentin, transdermal fentanyl patch or control group ©: two placebos. For acute postoperative pain (Visual Analogue Score) and analgesic requirements were assessed 2, 4, 8 hours and 7 days after surgery. Subjects were also assessed for chronic pain 2, 4, 6 months later. Subjects in treatment group required lesser dose of analgesic, as compared to control group, in the post operative period. Visual Analogue Scores were also significantly lower in the treatment group throughout the post operative period. Occurrence of side effects was non significant between both groups. 2, 4 and 6 months after surgery, 40, 35 and 28 subjects respectively, out of total 45 subjects of the control group, reported chronic pain. In comparison, 25, 10 and 4 subjects out of 42 subjects in the treatment group reported chronic pain 2, 4, 6 months respectively after surgery. 15, 10 and 6 out of 45 of the control group required analgesics, whereas 2, 0 and 0 out of 42 in the treatment group, required analgesics respectively 2, 4 and 6 months after surgery Acute and chronic pain after maxillary cancer surgery is significantly reduced by multimodal analgesia.
 
Collapsed lung secondary to pneumothorax 
Progressive expansion of lung after chest drain insertion 
Complete expansion of lung 
Article
Laceration and perforation of the membranous trachea are uncommon. We present a case of bilateral Pneumothorax, which developed subsequent to iatrogenic injury during tracheostomy.
 
Master chart group I: patients in whom acute normovolumic haemodilution was done
Comparison of Hb% in both groups at various time intervals 
Comparison of mean PCV% in both groups at various time intervals 
Article
The aim of the study is to assess the efficacy of Acute Normovolaemic Haemodilution (ANH) in reducing the perioperative homologous transfusion, to compare the results of acute normovolaemic haemodilution and homologous blood transfusion in terms of Hb%, PCV%, and to assess the cost effectiveness of ANH with homologous transfusion. 30 healthy patients between the age of 14-70 years, who required a maxillofacial surgical procedure under general anaesthesia with haemoglobin level of 12 gm% or above, PCV 30% or above and where postoperative blood transfusion was not expected to be beyond one pint, were selected. The patients were randomly divided into two groups of 15 patients each. The group I patients were subjected to ANH and the group II patients were transfused 1 pint of compatible banked, homologous blood and mean haemoglobin and PCV was compared in 1st, 3rd and 7th post-operative day in both the groups. Patients who received ANH had p < 0.05 than patients who received homologous transfusion by using student's paired t-test in terms of Hb% and PCV%. It was concluded that ANH is more effective compared to homologous bleeding time.
 
Axial CT scans of the OAC. Its diameter was reduced on the 8th and the 12th weeks. a 1st day, b 2nd week, c 4th week, d 8th week and e 12th week
Mean density values of the groups*
Histopathological appearance of the groups at the 12th week. a Control group. Presence of thick osseous trabeculae and connective tissue in the oroantral communication. HE, 960. b Control group. Connective tissue and thick osseous trabeculae in the lumen of the oroantral communication. HE, 9300. c Curacel group. Thin connective tissue surrounds the oroantral communication. HE, 960. d Curacel group. Thin connective tissue surrounds the oroantral  
Curacel group. 12 weeks postoperative. Thin connective tissue surrounds the curacel material. An osseous trabeculae and some giant cells present in this connective tissue. HE, 9300  
Article
In this study, the effects of Curacel TM oxidized regenerated cellulose and bone wax on the healing bone were compared to each other by means of CT based bone density measurement and histopathological evaluation. The bone density measurements of the control group were significantly higher than those of both Curacel and bone wax groups. There was no significant difference between Curacel and bone wax. Histopathologically, the bone wax group showed more osteoblastic activation than Curacel group. For all measurement parameters (osteoblastic activation, osteoclastic activation, fibrous connective tissue, osseous trabeculae), Curacel and bone wax groups had worse results than control group. It is concluded that Curacel has no superiority over bone wax in terms of osseous healing in the oroantral region. There is no need to use oxidized regenerated cellulose or bone wax for small oroantral openings since the healing is better without any intervention. In addition, bone density measurement and histopathological evaluation were consistent in terms of osseous healing of the oroantral opening.
 
Circular cannon-ball radio-opacities of varying sizes within both lung fields  
a Photomicrograph showing trabecular and tubular differentiation with abundant extracellular mucin. (H & E stain. Magnification is 2 9 220). b Photomicrograph showing the pseudo-cribriform pattern of polymorphous low-grade adenocarcinoma. (H & E stain. Magnification is 2 9 220)  
Article
Polymorphous low grade adenocarcinoma (PLGA) is an uncommon tumour that affects minor salivary glands mainly. It was known to be clinically benign and histologically polymorphic; sometimes misdiagnosed as pleomorphic adenomas, monomorphic adenomas, malignant pleomorphic adenomas, adenoid cystic carcinomas and adenocarcinoma not otherwise specified. More information about PLGA is cumulating in the current literature with new evidences suggesting that the tumour may not be as indolent as it was previously thought. A thorough understanding of the clinical and histological behaviour of the lesion has serious implications in management. Here, a case of lower lip lesion with suspected lung metastasis is reported to exemplify how the clinical behaviour of the lesion may affect management.
 
Article
Polymorphous low-grade adenocarcinoma is a rare, malignant salivary gland tumor, which is found almost exclusively in minor salivary glands. It is more frequent in the third-seventh decade of life, with a clear female predilection in a 2:1 ratio. It is usually located in the hard or soft palate, although it may be found in the rest of the oral cavity too. It is rare in major salivary glands. In general it has good prognosis, with recurrence rates in the range of 17-24%. Although rare, metastasis to regional lymph nodes has been reported. We report a case of 38 year old female patient who reported with recurrent low grade polymorphous adenocarcinoma in the hard palate, who has been treated with wide excision of the lesion, with reconstruction of the defect using temporalis myofacial flap.
 
Article
Adenoid cystic carcinoma is a malignant neoplasm most commonly originating in salivary glands of head and neck region. Here we present a case report of a 50 year old male who was diagnosed with adenoid cystic carcinoma of the right buccal mucosa. The peculiarity of the lesion and the approach we made is the key factor in the presentation.
 
Article
Pleomorphic adenoma is a benign tumor of the salivary glands that has elements of both epithelial and mesenchymal tissues. The tumor most commonly arises in the parotid or submandibular glands. Infrequently, it may arise from the minor salivary glands and present as an intraoral mass over the palate or lip. We report a patient with PA over the hard palate, which resembled common intraoral diseases like oral papilloma, squamous cell carcinoma and condyloma acuminate.
 
Article
Basel cell adenoma is a benign epithelial salivary gland tumor that appears to have unique histologic characteristics. The diagnosis of this entity must be established by histological study. It commonly occurs in parotid gland and very rarely in submandibular gland. Here we report a case of basel cell adenoma of submandibular gland.
 
Article
Pleomorphic adenoma is the commonest benign salivary gland tumour, accounting for almost three fourths of all such tumours. Pleomorphic adenoma most commonly occurs in the parotid gland; however it is also encountered in the submandibular, sublingual and minor salivary glands. Almost half of all salivary gland tumours are malignant, pleomorphic adenoma is the commonest benign lesion. A case of pleomorphic adenoma arising denovo in the minor salivary glands is discussed.
 
Article
We present a case of carcinoma ex pleomorphic adenoma on the right buccal mucosa in a 52-year-old Japanese woman. Based on the histopathology, the excised tumor was the non-invasive type, but the majority of the tumor consisted of poorly-differentiated adenocarcinoma cells. We performed proton radiation after the surgery. The patient was well, without evidence of disease, 48 months after surgery. Carcinoma ex pleomorphic adenoma in the buccal mucosa has been reported in only four cases during the past twenty years. Therefore, our case was comparatively rare.
 
Article
Pleomorphic adenoma is the benign tumor of salivary glands, which originates from the myoepithelial cells and intercalated duct cells. This tumor is more common in major salivary glands. This case report describes a rare and unusual lesion in a 55-year-old female, which was diagnosed as pleomorphic adenoma of the minor salivary glands in the upper lip. The tumor was a circumscribed, submucosal nodule, about 2.0 cm in diameter and was characterized by slow growth and rubbery consistency. Complete excision was performed and the histopathological analysis showed an epithelial salivary gland tumor with islands of plasmacytoid cells, duct like structures, in a variable stroma with chondroid, fibrous and myxoid appearance. No recurrence was observed 1 year after the surgery.
 
Article
The Adenomatoid Odontogenic Tumour (AOT) is a progressively growing asymptomatic benign non-invasive lesion. A rare subvariant of the extrafollicular type of AOT may mimic periapical disease radiographically. We report a 45-year-old male with a periapical radiolucent lesion affecting maxillary central incisor tooth. Initially suspicious of periapical pathology, although clinical findings seemed to indicate a nonendodontic cause. The lesion was surgically explored and histopathological examination revealed the presence of AOT. This particular subvariant is very rare indeed, as available literature only 8 cases have been reported.
 
Article
Due to the destruction of osseous landmarks of the skull base or paranasal sinuses, the anatomical orientation during surgery of frontobasal or clival tumors with (para) nasal extension is often challenging. In this relation, Neuro-navigation guidance might be a useful tool. Here, we explored the use of Neuro-navigation in an interdisciplinary setting. The surgical series consists of 3 patients who underwent Lefort-I access osteotomy and surgical decompression of the tumor. The procedures were planned and assisted by neuro-navigation techniques with image fusion of CT and MRI. Two of the patients were diagnosed to have clival chordoma and one had extensive JNA. The application of Neuro-navigation in the combined approaches was both safe and reliable for delineation of tumors and identification of vital structures hidden or encased by the tumors. There was no perioperative mortality. Tumors were either removed completely, or subtotal resection was achieved. Craniofacial approaches with intra-operative neuro-navigational guidance in a multidisciplinary setting allow safe resection of large tumors of the upper clivus and the paranasal sinuses involving the anterior skull base. Complex skull base surgery with the involvement of bony structures appears to be an ideal field for advanced navigation techniques given the lack of intraoperative shift of relevant structures.
 
Site of Injection 
Article
Large skeletal discrepancies are sometimes only minimised but not eliminated by orthognathic surgeries. Administration of Botox has been advocated as an effective minimally invasive procedure to tackle aesthetic compromises like gummy smile and the like. This article elaborates on the surgical management of a case of severe vertical maxillary excess with Botox as an adjunct therapy.
 
Article
Lignocaine hydrochloride is the most widely used and easily available local anaesthetic agent. Adrenaline is frequently combined with lignocaine to enhance the duration of anaesthesia, decrease toxicity, to achieve vasoconstriction and to provide a bloodless field. This study was conducted to do the comparative evaluation of local anaesthesia with adrenaline and without adrenaline on blood glucose concentration in patients under going tooth extraction. The study was conducted on 120 patients comprising of 60 healthy and 60 diabetic patients. All these patients were in need of multiple extractions. The patients were in the age group of 18-50 years. On their first visit the patients were given plain lignocaine and tooth extraction was carried out. One week later the same patient was given lignocaine with 1:80,000 adrenaline to carry out tooth extraction. Serial blood glucose estimations were done at definite intervals (prior to administration of local anaesthetic, immediately after injecting the LA, 10 and 20 min following the injection of LA) on both the occasions. The mean blood glucose concentration increased from the base line level of 84.81 to 85.09 mg/dl in healthy patients and from 206.82 to 207.09 mg/dl in diabetic patients 10 min following the injection of 2% plain lignocaine. This increase in blood glucose concentration following the administration of plain lignocaine was statistically not significant (P > 0.05). There was statistically significant (P < 0.005) increase in the blood glucose concentration from 88.81 to 105.55 mg/dl in healthy, and 208.77 to 242.46 mg/dl in diabetic patients 20 min following the injection of lignocaine with adrenaline. While assessing the generalized effects of local anaesthetic solutions, metabolic as well as haemodynamic responses should be investigated. Adrenaline containing LA should be used with caution in Type 2 diabetics as adrenaline causes suppression of insulin release.
 
Measurement in UCLA, 2 point in buccal cusp in second molar, 2 point in buccal cusp in the first molar, 1 point in buccal cusp of first premolar, second premolar and canine.  
Box whisker plot of the maxillary arch width (in mm) in unoperated adult UCLA subject compared to the control group  
Article
The transversal measurement on the dento-alveolar fragments of the maxilla, in the unoperated adult patients with unilateral cleft lip and alveolus are rare and have not been well documented and archived in the scientific journals. The effect of the congenital malformation is obvious in the Unilateral Cleft Lip and Alveolus (UCLA) patients and is well documented. The aim of this study is to investigate whether there are any influences of the final transversal development of the maxilla based on the location and extent of the defect in patients with UCLA. 168 adult unoperated UCLA patients (study group) and 24 non cleft patients (control group) participated in this study. Plaster of Paris (POP) casts were made of the maxillary dentition and mesurement were taken using coordinate measuring machine (CCM) (Zeiss Numere, Carl Zeiss, Stuttgart, Germany). The mean values of maxillary transverse measurement of first premolar through the second molar of the UCLA and control group patients showed no statistically significant difference. The inter-canine distance was significantly smaller in the UCLA patients than non-cleft patients The maxillary inter-canine distance in untreated UCLA patients were significantly different from that of non cleft patients. There is narrow and constricted maxillary growth in UCLA patients causing maxillary morphological changes and cosmetic facial changes.
 
Article
Lymphatic malformation is an uncommon anomaly that commonly occurs in the posterior triangles of infants. The case presented here was an adult male patient with swelling in submental region. This site often leads to misdiagnosis of other common pathology including plunging ranula or lipoma. However, USG and MRI were done for diagnosis of the lesion by which final diagnosis of lymphatic malformation was made. Surgical excision was carried out and histopathology confirmed the primary diagnosis. No recurrence is seen in one and half year follow-up period.
 
Top-cited authors
Shadab Mohammad
Hari Ram
  • King George's Medical University
Madan Lal Brahma Bhatt
  • King George's Medical University
Rituraj Konwar
  • Central Drug Research Institute
Jayanta Sarkar
  • Central Drug Research Institute