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National Journal of Maxillofacial Surgery
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   Table of Contents - Current issue
July-December 2017
Volume 8 | Issue 2
Page Nos. 87-171

Online since Thursday, December 28, 2017

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Dental implants Highly accessed article p. 87
Shadab Mohammad
DOI:10.4103/njms.NJMS_79_17  PMID:29386808
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Oral submucous fibrosis: Newer proposed classification with critical updates in pathogenesis and management strategies Highly accessed article p. 89
Deepak Passi, Prateek Bhanot, Dhruv Kacker, Deepak Chahal, Mansi Atri, Yoshi Panwar
DOI:10.4103/njms.NJMS_32_17  PMID:29386809
Oral submucous fibrosis (OSMF) is an oral precancerous condition characterized by inflammation and progressive fibrosis of the submucosal tissues resulting in marked rigidity and trismus. OSMF still remains a dilemma to the clinicians due to elusive pathogenesis and less well-defined classification systems. Over the years, many classification systems have been documented in medical literature based on clinical, histopathological, or functional aspects. However, none of these classifications have achieved universal acceptance. Each classification has its own merits and demerits. An attempt is made to provide and update the knowledge of classification system of OSMF so that it can assist the clinicians, beneficial in researches and academics in categorizing this potentially malignant disease for early detection, prompt management, and reducing the mortality. Along with this, pathogenesis and management have also been discussed.
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Bone augmentation as an adjunct to dental implant rehabilitation in patients with diabetes mellitus: A review of literature p. 95
Komal Ladha, Ankit Sharma, Bhawana Tiwari, Dwaraka N Bukya
DOI:10.4103/njms.NJMS_16_17  PMID:29386810
The aim of the present article is to review the success of bone augmentation performed as an adjunct to dental implant rehabilitation in patients with diabetes mellitus. A literature review was conducted in PubMed on this topic, which yielded a total of 102 publications. For inclusion, publications had to be human studies, written in English language and should report on the success of bone augmentation as an adjunct to dental implant rehabilitation in diabetic patients. After screening the titles and abstracts, 11 full texts publications were obtained, of which seven were included in the review. These studies provided data on various bone augmentation techniques such as sinus floor elevation (SFE), guided bone regeneration (GBR), and onlay bone grafting. Even though the current review revealed that there are not many studies reporting data relevant to the analyzed topic, the data obtained suggests that; (1) staged GBR technique should be considered more feasible and predictable for bone augmentation, (2) clinicians must take meticulous care when planning and conducting SFE, and (3) block bone augmentation technique should be avoided.
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Estimation of gender using cheiloscopy and dermatoglyphics p. 102
Aanchal Tandon, Abhinav Srivastava, Rohit Jaiswal, Madhvika Patidar, Aashish Khare
DOI:10.4103/njms.NJMS_2_17  PMID:29386811
Background and Objective: Forensic dentistry plays a vital role in detection and resolution of crime, civil proceedings and personal identification. With ever-increasing demands placed upon law enforcement to provide sufficient physical evidence linking a perpetrator to a crime, it makes sense to utilize any type of physical characteristic to identify a suspect of an offense. The least invasive and cost-effective procedure among all methods of human identification is the study of lip prints and fingerprints. This study is done to determine the predominant pattern of fingerprint and lip print in males and females and to correlate it for gender identification. Materials and Methods: The study sample comprised 100 individuals (50 males and 50 females) aged between 20 and 50 years; dark-colored lipstick was applied uniformly on the lips. The glued portion of cellophane tape was dabbed first in the center and then pressed uniformly over the corner of lips. Cellophane tape was then stuck to a white chart sheet for the purpose of permanent record. Lip print patterns were analyzed following the classification of Suzuki and Tsuchihashi. The imprint of left thumb was taken on a white chart sheet using a blue ink stamp pad and visualized using magnifying lens. Fingerprints were analyzed by following the classification given by Kücken. Correlation of lip print and fingerprint was analyzed using Chi-square test. Results: The overall correlation of lip prints with fingerprints in males revealed branched lip pattern associated with whorl fingerprint and in females as vertical lip print pattern associated with loop fingerprint. Conclusion: We conclude that the study between lip print and fingerprint can aid in gender determination.
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The effect of sodium bicarbonate oral rinse on salivary pH and oral microflora: A prospective cohort study p. 106
Siddhartha Chandel, Mohsin Ali Khan, Nishi Singh, Amiya Agrawal, Vinita Khare
DOI:10.4103/njms.NJMS_36_17  PMID:29386812
Aim: Present study is designed to explore the effect of sodium bicarbonate oral rinse on salivary pH and oral micro flora. Materials and Methods: Twenty five healthy subjects were recruited for the study in department of dentistry in Era Medical College. Subjects were abstained from tooth brushing overnight pre rinse (control) samples were collected after one hour of dinner and were asked to rinse with pre calibrated freshly prepared sodium bicarbonate solution. The salivary samples were then collected the following morning using sterile gauze in marked bottles. Aerobic bacterial culture was done by plating the sample directly from the swab on the surface of Blood agar and Mac Conkeys media respectively. The colony forming units and ph were calculated for the pre rinse and post rinse saliva sample. Result: Results shows that salivary pH increased significantly after sodium Bicarbonate oral rinse. There was a marginal decrease in number of CFU/ml for bacteria especially Viridans Streptococci, Moraxella species. Conclusion: Sodium Bicarbonate oral rinse may be considered as a cheap and effective alternative for chlorhexidine and alcohol based mouth wash, especially where long duration usage is required.
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A clinical prospective randomized comparative study on ostyeosynthesis of mandibular anterior fractures following open reduction using lag screws and miniplates p. 110
Gaurav Mittal, Anmol Aggrawal, Ritesh Garg, Siddharth Sharma, Abhishek Rathi, Vishnu Sharma
DOI:10.4103/njms.NJMS_38_17  PMID:29386813
Introduction: The aim of the present study was to compare fixation of mandibular anterior fractures following open reduction using lag screws or miniplates. Materials and Methods: This prospective study was conducted on 20 patients diagnosed with cases of displaced mandibular anterior fractures treated with open reduction and internal fixation. The patients were then randomly allocated to either of two groups – Group A: two 2.5 mm stainless steel lag screws were placed in 10 patients. Group B: two 2.5 mm miniplates were placed in 10 patients for the fixation of fractures. Subsequent follow-up was done on the 1st day, 1st, 4th, and 36th week postoperatively. During every follow-up, patient was assessed clinically for infection, malocclusion, loosening of plate/screw, malunion/nonunion, and masticatory efficiency. Radiographs (orthopantogram) were taken preoperative, 1st, 4th, and 36th postoperative week to compare the osteosynthesis between the two groups. Pain was objectively measured using a visual analog scale. The data collected was subjected to unpaired t-test and paired t-test for statistical analysis. Result: It was found that lag screw placement was rapid in comparison of miniplate placement. 3rd month postoperative assessment revealed Lag screw group to have better biting efficiency, and better bone healing which was statistically significant when compared with miniplate group. Conculsion: Our study suggests that lag screw osteosynthesis can be advocated as a valid treatment modality in the management of mandibular symphysis and parasymphysis fractures.
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Use of 0.5% bupivacaine with buprenorphine in minor oral surgical procedures p. 117
Varun Nagpal, Tejinder Kaur, Sarika Kapila, Ramandeep Singh Bhullar, Amit Dhawan, Yashmeet Kaur
DOI:10.4103/njms.NJMS_53_16  PMID:29386814
Background: Minor oral surgical procedures are the most commonly performed procedures by oral and maxillofacial surgeons. Performance of painless surgical procedure is highly appreciated by the patients and is possible through the use of local anesthesia, conscious sedation or general anesthesia. Postoperative pain can also be controlled by the use of opioids, as opioid receptors exist in the peripheral nervous system and offers the possibility of providing postoperative analgesia in the surgical patient. The present study compares the efficacy of 0.5% bupivacaine versus 0.5% bupivacaine with 0.3 mg buprenorphine in minor oral surgical procedures. Patients and Methods: The present study was conducted in 50 patients who required minor oral surgical procedures under local anesthesia. Two types of local anesthetic solutions were used- 0.5% bupivacaine with 1:200000 epinephrine in group I and a mixture of 39 ml of 0.5% bupivacaine with epinephrine 1:200000 and 1 ml of 300 μg buprenorphine (3 μg/kg)in group II. Intraoperative and postoperative evaluation was carried out for both the anesthetic solutions. Results: The mean duration of postoperative analgesia in bupivacaine group (508.92 ± 63.30 minutes) was quite less than the buprenorphine combination group (1840.84 ± 819.51 minutes). The mean dose of postoperative analgesic medication in bupivacaine group (1.64 ± 0.99 tablets) was higher than buprenorphine combination group (0.80 ± 1.08 tablets). There was no significant difference between the two groups regarding the onset of action of the anesthetic effect and duration of anesthesia. Conclusion: Buprenorphine can be used in combination with bupivacaine for patients undergoing minor oral surgical procedures to provide postoperative analgesia for a longer duration.
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Comparison of the effectiveness of Tokuyama and GC II metal primer on the bond strength of acrylic resins to Ti-6Al-7Nb p. 125
Sunit Kumar Jurel, Niraj Mishra, Pooran Chand, Himanshi Aggarwal, Raghuwar Dayal Singh, Balendra Pratap Singh
DOI:10.4103/0975-5950.221704  PMID:29386815
Statement of Problem: Because of the toxicity of vanadium in Ti-6Al-4V alloy, next generation of titanium alloys is proposed to focus on niobium-containing alloy, but for clinical applications, it is crucial for this alloy to bond with acrylic resins with or without the use of primers. However, literature was lacking about the effect of primers on bonding of autopolymerizing resins to Ti-6Al-7Nb. Objectives: To evaluate the effect of different metal primers on the shear bond strength of acrylic resin to Ti-6Al-7Nb. Materials and Methods: A total of 30 dis-shaped wax patterns (10 mm in diameter and 2 mm thickness) were prepared and casted using Ti-6Al-7Nb. After casting, the disk surfaces were finished with abrasive paper under water. Specimens were equally divided into three groups on the basis of the use of primer: metal primer (GC II metal primer) (Group 1), Universal Tokuyama primer (Group 2), no primer (Group 3). Tape of 50 μm thickness was applied on each of the specimens. Then, self-cure acrylic resin was mixed and applied on the center part of the tape, on which Bernouilles tube was placed. The tensile bond strength was measured with a universal testing machine. The data were obtained for all the specimens and analyzed using Statistical Package for Social Sciences version 17.0 at a statistically significance level of <0.05. Results: Mean tensile force was maximum for Group 2 (28.58 ± 39.40 N) and minimum for control Group 3 (6.24 ± 10.97 N), thereby showing a significant inter-group difference (P < 0.001). On applying post hoc test (Tukey HSD), both the Group 1 and Group 2 showed a statistically significant difference as compared to control Group 3; however, the difference between two experimental groups was not statistically significant (P > 0.05). Conclusions: Tokuyama primer and GC II metal primer had a significant effect on improving the bond strength between autopolymerizing denture base resin and Ti-6Al-7Nb.
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Aqueous intralesional bleomycin sclerotherapy in lymphatic malformation: Our experience with children and adult p. 130
Ankur Bhatnagar, Vijai Datta Upadhyaya, Basant Kumar, Zafar Neyaz, Ajay Kushwaha
DOI:10.4103/njms.NJMS_6_17  PMID:29386816
Objectives: Lymphatic malformations (LMs) are aberrant proliferation of sequestrated lymphatic vessels during early embryogenesis and do not communicate directly with the general lymphatic system. The absence of vascular flow is the hallmark of LMs and is usually symptomless apart from painless disfiguring mass with concerns regarding cosmesis. Design: Sclerotherapy has gained prominence as a preferred treatment modality for macrocystic lesions. Here, we present our experience with use of aqueous bleomycin as intralesional sclerosing agent, an economical first-line treatment for macrocystic variant of LMs in children and adults. While bleomycin microsphere in oil has been commonly used in many previous studies, we have used aqueous bleomycin solution as the sclerosing modality which is easily available and economical. Materials and Methods: Twenty-seven patients of macrocystic LM including adults and children underwent bleomycin sclerotherapy under ultrasonography guidance. Number of sessions, dose administered, and the response to therapy along with all side effects were noted. Results: Sixteen patients received 3 or less sessions while rest needed 4–6 sessions of sclerotherapy for desired response. The response was excellent in 22 patients while 5 patients showed good response. Eleven patients developed minor side effects in form of fever, local infection, intracystic bleed, and local skin discoloration. Postsclerotherapy, surgery was performed in two patients. Conclusion: The better response in the present study can be attributed to targeting of individual cysts in multiloculated lesion, ultrasound-guided aspiration of the cysts content before drug delivery, and postprocedure compression which increases the contact time between cyst wall and bleomycin reducing the chances of postprocedure seroma formation. Since the drug acts on the endothelial lining of the cyst, volume of the cyst is the major determinant in response. Aqueous bleomycin had comparable results with oil-based microsphere establishing it as an economical alternative treatment modality.
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Dentascan an excellent tool for assessment of variations in the management of periodontal defects p. 136
Virendra Kumar, Jaya Dixit, Nand Lal, Umesh Pratap Verma, Puja Debnath, Anjani Kumar Pathak
DOI:10.4103/njms.NJMS_63_16  PMID:29386817
Background: The purpose of the present study was to envisage the effectiveness of demineralized freeze-dried bone allograft (DFDBA) and bovine bone graft (BBG) for promoting defect fill in periodontal intrabony defects using dentascan. Materials and Methods: A total of 13 subjects (15 intrabony defects) aged between 24 and 56 years affected by moderate to severe periodontitis were randomly divided into Control (CG) and Test groups (TG1 and TG2). In CG only debridement, TG1 debridement plus DFDBA, and TG2 debridement plus BBG were performed. The clinical parameters probing pocket depth (PPD), clinical attachment level (CAL) was used. The radiological analysis was done by dentascan, which is a single-slice spiral computed tomographic scanner. Six months after, regenerative treatment clinical measurements were recorded. The bone fill was assessed using Dentascan as previously mentioned. Results: PPD reduction and CAL gain were significant in all the groups after 6 months whereas, on intergroup comparisons, insignificant finding was observed both at baseline and after 6 months. Coronoapical bone status decreased significantly in all groups, buccolingual measurements decreased significantly in TG1 and TG2, but no such trend was seen in CG. Significant reduction in mesiodistal bone status was noticed only in TG1 whereas insignificant on intergroup comparisons. Conclusion: Dentascan-based analysis attested that DFDBA was superior to BBG.
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Efficacy of decalcified freeze-dried bone allograft in the regeneration of small osseous defect: A comparative study p. 143
Yashmi Jaiswal, Sanjeev Kumar, Vijay Mishra, Puneet Bansal, Kumar Rakshak Anand, Sukumar Singh
DOI:10.4103/0975-5950.221714  PMID:29386818
Aim: To access the efficacy of decalcified freeze-dried bone allograft (DFDBA) in the regeneration of bone following small osseous defect in minor oral surgery. Objectives: To evaluate the ability of DFDBA to enhance the rate of wound healing and assess radiographic bone density, pain, and infection preoperatively and postoperatively. Materials and Methods: Twenty patients with cysts were assessed. Ten patients were filled with DFDBA (Group 1) and ten without bone graft (Group 2), respectively. Radiographic bone density was assessed on preoperative, intraoperative, and postoperative radiographs on 1st day, 3rd month, and at 6th month using Adobe Photoshop CS6 - Grayscale histogram. Results: Bone density in Group 1 was found to be significantly higher than in Group 2 on 3rd and 6th month postoperatively with a P = 0.024 and P = 0.016 which was statistically significant. The percentage increase in bone density between both the group was determined and yielded no difference over a period of time, but the difference in percentage increase was markedly higher in Group 1 compared to Group 2 at all the time intervals. Conclusion: Bone formed as depicted by bone density is significantly higher when DFDBA is used in small bony defects.
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Trigeminal schwannoma p. 149
Aviral Agrawal, Virendra Singh, Seema Rohilla, Bindu Sharma
DOI:10.4103/njms.NJMS_82_14  PMID:29386819
Schwannoma is a benign tumor of the nerve sheath arising from the perineural schwann cells. The nerves most commonly involved in schwannomas of the head and neck are the vagus and the cervical sympathetic chain. Trigeminal schwannomas are rare tumours. A 17 year old male patient with a chief complaint of swelling on face was diagnosed as suffering from bening tumor extending from cranial base (from foramen ovale) to the parapharengeal space. Mandibular access osteotomy was done to expose the tumor. Surgical excision of the tumor was done along with the preservation of the nerve. Schwannomas can occur along the pathway of any somatic or sympathetic nerve. Superficial schwannomas require simple exposure and excision but the one which are deep and large, may require complex access osteotomies. Careful surgery is required to preserve the nerve function. Once completely excised, the prognosis is excellent.
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Fronto-orbital reconstruction using polymethyl methacrylate implant p. 153
Samiran Ghosh, Debolina Pramanick, Amit Ray, Richi Burman, Ashistaru Saha
DOI:10.4103/njms.NJMS_10_17  PMID:29386820
The objective of this article is to show a case of fronto-orbital reconstruction with prefabricated polymethyl methacrylate prosthesis. A 35-year-old male with alleged history of trauma following road traffic accident 3 months back reported with unaesthetic scar and deformity in right supraorbital region to us. As there was no functional deformity, the management was aimed at correcting the contour and esthetic only. The correction was achieved by overlaying the defect with a polymethyl methacrylate implant fabricated over a three-dimensional stereolithographically printed rapidly prototyped model. Postoperative phase was uneventful and esthetic outcome was satisfactory. The patient after 4-year follow-up reported with no discomfort and definite improvement in facial contour.
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Unilateral swelling of cheek p. 157
Aviral Agrawal, Virendra Singh, Pradeep Kumar, Amrish Bhagol, Anjali Narwal, Ishwar Singh
DOI:10.4103/0975-5950.221703  PMID:29386821
A 55 year old male patient reported in the department of oral and maxillofacial surgery with a chief complaint of swelling on right side of face from last 2 months. He reported a progressive increase in the swelling. Pain and discomfort was present from last 7 days with increased swelling, and reduced mouth opening. On examination, the face appeared asymmetrical with a swelling in the right cheek which was small, smooth, dome shaped, present approximately 1.5 cm anterior to tragus. Overlying skin was of normal colour. The patient was afebrile. Mouth opening was 25 mm.
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Osteitis fibrosa cystica of mandible in hyperparathyroidism-jaw tumor syndrome: A rare presentation and review of literature p. 162
Anupama Singh Satpathy, Arjun Dasgupta, Chirajit Dutta, NV K. Mohan, Shouvanik Satpathy
DOI:10.4103/njms.NJMS_48_17  PMID:29386822
Brown's tumor, also referred as osteitis fibrosa cystica is a rare nonneoplastic diagnostically challenging consequence of hyperparathyroidism (HPT) which occurs due to increased parathormone secretions in blood, causing excessive calcium resorption from kidneys, bone resorption, and phosphaturia. Brown's tumor is a misnomer, presenting as cystic expansile lesions in bone, often misdiagnosed as neoplastic lesion or granuloma or abscess in bones. It can affect long bones, clavicle, ribs, and pelvis. According to literature, skeletal manifestations of Brown tumor is relatively rare and occurs in <2% of the cases of HPT. We present a case of a female 15-year-old patient who presented with bleeding gums and an expansile lesion in mandible whose previous investigations elsewhere suggested a malignant lesion. However, further investigations revealed it to be Brown's tumor with primary HPT which is a rare genetic disorder, known as HPT-Jaw Tumor Syndrome (HPT-JT).
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Congenital cyst of the orbit: A case report p. 167
Richa Gupta, Rajesh B Dhirawani
DOI:10.4103/njms.NJMS_80_15  PMID:29386823
Dermoid cyst is an example of choristoma (i.e., tumors that originate from aberrant primordial tissue which result in normal appearing tissue in an abnormal location). This particular type of cyst is formed at the site where 2 suture lines of the skull close during embryonic development, and during this time, dermal or epidermal elements are pinched off which later convert to form cysts. Approximately, 50% of these tumors that involve the head are found in or adjacent to the orbit. This article presents a similar case of the orbital dermoid cyst with its management and also a review on other varieties of dermoid cysts of the head and neck region.
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Modified orthopedic wire twister for fixing and removing screws in craniomaxillofacial osteosynthesis p. 170
Suresh Kumar Ganesan, Balaji Shanmugam Thandapani, Nithin Joseph Jude, Saravanan Rajendiran, Suraj John Thomas
DOI:10.4103/njms.NJMS_45_16  PMID:29386824
Internal fixation is the routinely performed surgical procedure in craniomaxillofacial surgery. At present, available kit for internal fixation includes large number of armamentarium. To overcome and reduce this, we have modified orthopedic wire twister for fixing and removing screws. This single device can replace self-holding screwdrivers with different sizes.
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