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National Journal of Maxillofacial Surgery
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   Table of Contents - Current issue
January-June 2019
Volume 10 | Issue 1
Page Nos. 1-125

Online since Friday, June 7, 2019

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Oral cancer: A study in retrospection Highly accessed article p. 1
Niranjan Mishra
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Heterogeneous conceptualization of etiopathogenesis: Oral pyogenic granuloma p. 3
Supriya Sharma, Shaleen Chandra, Shalini Gupta, Saurabh Srivastava
Oral pyogenic granuloma or granuloma pyogenicum is a conspicuous lesion. The word pyogenic granuloma is a misterm since the situation is not related with pus and histologically does not exemplify a granuloma. An oral pyogenic granuloma is obvious to involve the gingiva generally. Extragingivally, it can present on the buccal mucosa, lips, tongue, and palate. A report of trauma is prevalent in such sites. The pathogenesis of the lesion is still unclear, although it was initially supposed to be a botryomycosis infection. It is suggested that etiology of pyogenic granuloma was the reaction of tissues to minor injury or chronic irritation, thus open a pathway for the entrance of nonspecific microorganisms, although microorganisms are not often expressed within the lesion. Hence, this review recapitulates all diverse concepts of pathogenesis associated with this most often and most mysterious lesion of the oral cavity.
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Metastatic involvement of level IIb nodal station in oral squamous cell carcinoma: A clinicopathological study p. 8
Partha S Chakraborty, Ashok Kumar Das, Ashutosh Vatsyayan, Tashnin Rahman, Rajjyoti Das, Seemanta Kumar Medhi, Kishore Das, Jagganath Dev Sharma
Background: The purpose of this study was to determine the prevalence of Level IIb metastasis in patients with oral squamous cell carcinomas (OSCCs). Materials and Methods: A total of 110 newly diagnosed oral cavity cancer patients requiring surgery as the primary modality were included in the study. Preoperative clinical examinations were done and tumor-node-metastasis staging was noted. Intraoperatively, Level IIb nodal tissue was dissected and sent separately. Results: A total of 129 neck dissections (58 SOHD, 67 modified neck dissections, and 4 radical neck dissections) were carried out in 110 patients (males = 80 and females = 30), 91 patients required unilateral neck dissection, and 19 patients required bilateral neck dissection. Out of these 129 neck dissections, only 4 (3.2%) neck dissections (in a total of 3 patients out of 110 patients) had Level IIb positive (with bilateral Level IIb involvement in one patient). Conclusions: Dissection of the Level IIb region in patients with OSCC may be required only in cases with advanced N stage, positive Level IIa lymph nodes, and extracapsular spread. Furthermore, in tongue cancers (high propensity of isolated Level II involvement), retromolar trigone, and floor of mouth cancers, routine Level IIb clearance should be considered.
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Radiographical and histological evaluation of bioactive synthetic bone graft putty in sinus floor augmentation: A pre- and post-intervention study p. 13
Ankit Arora, Dipankar Khadtale, Bhaskar Agarwal, Rahul Yadav, Ongkila Bhutia, Ajoy Roychoudhury
Objective: The main objective is to evaluate the quantity and quality of bone formed after use of bioactive synthetic bone graft putty in sinus augmentation and to radiographically and histologically evaluate increase in alveolar bone height in augmented sinus. Materials and Methods: It is a pre- and post-intervention study of 15 patients (present at both baseline and at 6 months) with 80% power and 95% confidence level. Results: The mean increase in alveolar bone height is 7.08 ± 1.42 mm ranging from 5.6 mm to 10.7 mm. It is evident from the data that there has been increase in alveolar bone height postbone graft augmentation. P < 0.001 shows that increase in alveolar bone height is highly significant as compared to preoperative bone height. The mean postoperative density is 525.43 ± 104.18 hounsfield unit ranging from 649 HU to 350 HU. This is also a D3 quality bone as per Misch classification. The mean difference in alveolar bone density is 104 ± 125.16 HU. P = 0.0053 shows that increase in alveolar bone density is significant as compared to preoperative bone density. Conclusion: Bioactive synthetic bone graft putty yields sufficient quantity of mineralized tissue for implant placement in patients with 2–6 mm of alveolar bone height before grafting. Histologically, it has shown that it has good osteoconductive properties and good quality of bone is formed within 6 months of its augmentation.
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Toward early diagnosis of oral cancer: Diagnostic utility of cytomorphological features, a pilot study p. 20
Zeeba Shamim Jairajpuri, Safia Rana, Apoorva Hajela, Sujata Jetley
Introduction: Early detection of oral cancer is one of the most efficient ways to reduce the high mortality from this disease because of the ready accessibility of the oral cavity. We need to devise urgent diagnostic tools to detect early oral premalignant and malignant lesions. Aim: The aim of the present study was to grade the oral lesions in an attempt toward developing a novel cytological grading system. Further, morphometric analysis of cellular parameters was also performed to compare their significance in differentiating benign from malignant lesions. Materials and Methods: The present study was conducted at a tertiary care hospital catering to the low socioeconomic population. Patients presenting in the various Out Patient Departments with suspicious oral lesions were evaluated by cytology in the Department of Pathology. Results: A total of 72 patients were evaluated with a mean age of 43.54 ± 10.35 years. The involvement of the buccal mucosa was the most common site of oral lesions. Cytologically, the lesions were graded according to the oral/oro-pharyngeal cytology grading system into grades A to F. Cyto-morphometric analysis showed an increasing trend in mean nuclear diameter from benign to malignant cases while the mean cytoplasmic diameter decreased, value of P < 0.05 was observed indicating a statistically significant difference between the two groups. Conclusions: Cytological features of pleomorphism are a unique feature in oral carcinoma reflecting intracellular alterations in cells. Grading of lesions according to cytological characteristics can be helpful in standardizing the reporting of the oral lesion. However, our study was restricted by limited data; we emphasize more extensive studies to assess the usefulness and applicability of such a grading system. We also conclude that the use of cytomorphometry can improve the diagnostic reliability of exfoliative cytology.
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Assessment and correlation between functional and histological staging of oral submucous fibrosis: A clinicohistopathologic study p. 27
Pooja Bhatt, M Manjunath, Deepak Khakhla, Priyanka Gubrellay, Rahul Bhargava, L Guruprasad
Background and Objective: Oral submucous fibrosis (OSMF) is a precancerous condition. It is widespread in the Asian subcontinent, with India bearing most of the burden. It is characterized by mucosal rigidity of varying intensity due to the fibroelastic changes of the juxta epithelial layer, resulting in a progressive inability to open the mouth. Early recognition with accurate staging of the disease and appropriate treatment planning is of utmost importance to prevent the malignant transformation and to improve the quality of life of the patient. In the present study, an attempt is made to clinically evaluate the condition and correlate it with the histopathological findings according to standard criteria. Materials and Methods: A hospital-based study was conducted on sixty OSMF patients. Detailed history was recorded, and functional staging was given depending on mouth opening. Punch biopsy was performed, and histological stages were given based on standard criteria. The data so received were mathematically evaluated to determine whether any correlation exists between the stages using Chi-square test. Results: The sixty patients were in the age range of 16–50 years. Male-to-female ratio was that of 97:3. The statistical analysis using Chi-square test showed statistically significant association (P < 0.001) between the functional and histologic stages. Conclusion: There is a definite correlation between functional and histological stages of OSMF which suggests that clinically advanced OSMF has extensive fibrosis histologically.
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Parental self-perceived knowledge and attitudes toward emergency management of avulsed permanent teeth in Imphal: A cross-sectional study p. 33
Sharna Ningthoujam, Deepa Gurunathan, Waikhom Robindro Singh, Braj Bhushan Mall
Introduction: Dental avulsion is one of the dental traumatic injuries commonly affecting children aged between 6 and 12 years. One of the major limitations in obtaining a successful outcome while treating dental avulsions is the lack of knowledge on its first aid management among parents. The present study aims to assess the knowledge and attitude of parents in Imphal toward the emergency management of avulsed permanent tooth using a self-reported questionnaire method. Materials and Methods: The present cross-sectional study was undertaken among 777 parents of 6–12-year-old children who were recruited through 2 private schools in Imphal. A questionnaire consisting of 14 closed-ended questions used to assess the parental knowledge and attitude on emergency management of avulsed permanent teeth was distributed to the respondents after obtaining official consent from the respective schools and informed consent from the respondents. Statistical Analysis: Chi-square test was used to assess the association between the results and the educational status, gender, and geographical location of the respondents. Results: The study revealed that only a fraction of the respondents, i.e., 11.8% gave a positive response on attempting “self-replantation” and higher fractions (76.1%) of the respondents reported to have received no previous information on the emergency management of dental avulsion. Conclusion: About 96.1% of the respondents showed interest on acquiring knowledge on the emergency management of dental avulsion. This warrants the urgent need on educating the parents on the first aid emergency management of avulsed tooth.
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A statistical analysis of incidence, etiology, and management of palatal fistula p. 43
Ramneesh Garg, Sheerin Shah, Sanjeev Uppal, Rajinder K Mittal
Objective: The purpose of this study was to retrospectively review the incidence, profile, and the management of palatal fistula occurring in patients operated for cleft palate in our institute. Materials and Methods: A retrospective analysis was performed on all cleft palatal fistula patients who presented during the period from August 2007 to October 2017, to classify their site, age of presentation, surgery performed, and outcome. A record of the type of cleft palate and previous palatoplasty was also obtained. The outcome in terms of incidence and fistula formation depending on Veau's classification was analyzed. Results: Twenty-two patients reported with palatal fistula during this period. The incidence of fistula formation of our institute was 9.6%. Incisive foramen (13/22) was the most common site of fistula formation. Among various techniques used, local and buccal flaps were found to be useful in a maximum number of cases (14/22). The rate of fistula recurrence was 18.2% (4/22). On retrospective analysis of our institutional data, it was found that the incidence of cleft palate fistula was significantly higher in clefts with Veau Types III and IV (13/18) as compared to Veau Types I and II (5/18). Conclusion: This study shows that the fistula rate of our institution was 9.6%. Complete clefts (unilateral or bilateral) involving both primary and secondary palates predispose more to fistula formation.
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A comparative evaluation of immediate versus delayed loading of two implants with mandibular overdenture: An in vivo study p. 47
Param Dev Singh, Varun Kumar, Geeta Arya
Introduction: Implant-supported overdenture has been a common treatment for edentulous patients for the past several years and predictably achieves good clinical results, especially in those patients who were uncomfortable with their conventional dentures, as they provide additional retention and support. The concept of immediate loading is more applicable to completely edentulous patients because of their functional and esthetic requirements. Hence, the present study aims to evaluate the outcomes of immediate loading of mandibular two-implant-retained overdenture and compare it with the conventional delayed loading concept. Method: This in vivo study was conducted to compare immediate versus delayed loading of two implants with mandibular overdenture. A total of 20 completely edentulous patients (10 delayed loading and 10 immediate loading) were included in the study and certain parameters, i.e., bone loss around implants, periodontal pocket depth, pain and discomfort, implant stability, and microflora around implants, were measured immediately and after healing period of 3 and 6 months. Result: It can be analyzed from the observations that patients were more satisfied with delayed loading in terms of comfort, speech, function, pain, and chewing efficiency as compared to immediate loading. Conclusion: It is concluded that implants loaded under delayed protocol seem to have a higher success rate as compared to those that are loaded immediately.
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Repeated peripheral alcohol injection is an effective treatment of Trigeminal Neuralgia in non-drug compliance patients p. 56
Arunesh Kumar Tiwari, Amiya Agrawal, Anjani Kumar Pathak, Sumit Kumar, Kopal Goel, Siddhartha Chandel
Introduction: Trigeminal neuralgia (TN) is an uncommon disorder seen in dental and neurologic practice, which presents with brief lancinating pain in the face, in the area distributed by the trigeminal nerve. The wide ranges of treatments currently used for TN are ample evidence that there is no simple answer to how it should be managed. Purpose: In this study, we want to evaluate, if repeated peripheral alcohol injection is an effective treatment of TN patients. Material and Methods: Retrospective data analysis of patients treated with peripheral alcohol injections from November 2011 to July 2017 were conducted. We selected the patients who reported at least three times for alcohol injection and duration of pain relief recorded as reported by patients. Results: Effects of 96% absolute alcohol injection alcohol injection ranging from 13 to 15 months pain relief, but in second or third time, this duration was decreased to 11–12 months, whereas no much significant complication were observed. Conclusion: Even single time neurectomy is not permanent cure, so patients choose less invasive option such as peripheral alcohol injections in repeated use instead of a surgical option.
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Study of pattern and prevalence of mandibular impacted third molar among Delhi-National Capital Region population with newer proposed classification of mandibular impacted third molar: A retrospective study p. 59
Deepak Passi, Geeta Singh, Shubharanjan Dutta, Dhirendra Srivastava, Lokesh Chandra, Sonal Mishra, Anchal Srivastava, Manish Dubey
Aim/Objective: The mandibular third molar is the most frequently impacted tooth with incidence varies from 9.5% to 68% in different populations. Hence, the aim was to study the prevalence and pattern of mandibular impacted third molar among Delhi-National Capital Region (NCR) population. Materials and Methods: The study was conducted with data collected from registered hospitals and dental clinics of Delhi NCR region. The study represents a retrospective analysis of panoramic radiographs and intraoral periapical radiograph of patients at these centers from June 2014 to June 2016. Results: Out of 960 patients with the third molar investigated, a total of 250 patients having impacted mandibular third molar (152 [60.8%] males and 98 [39.2%]) females between June 2014 and June 2016 were included in the study. The age ranged from 20 to 55 years, with a mean age of 27.6 years and the standard deviation was 5.8 years. The prevalence of impacted mandibular third molars for this study was 26.04%. Conclusion: This study demonstrated that males (60.8%) were more likely to present with impacted mandibular third molars than females (39.2%). The prevalence of third molar impactions was almost the same on both the left (45.8%) and right (54.2%) sides. This study also noted that mesioangular impactions (49.2%) were the most common type of impaction. The least common form of impactions was the transverse types (2%). The prevalence of impacted mandibular third molars for this study was 26.04%.
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An analysis of approach toward oral and maxillofacial surgery: A survey of 1800 health-care specialists, students, and general people in Odisha, India p. 68
Rajat Mohanty, Vaibhav Singh
Aim: The aim of the study is to assess the perception of oral and maxillofacial surgery (OMFS) by health-care professionals, students, and general public in the state of Odisha, India. Materials and Methods: A questionnaire form was formatted that listed ten clinical situations and given by hand to 1800 individuals, divided into six groups: Group I – general medical practitioners; Group II – specialties of dentistry; Group III – general dental practitioners; Group IV – medical students; Group V – dental students; and Group VI – general public, each comprising 300 individuals. Respondents were asked to indicate who they would expect to treat them if they had one of the specified conditions listed in the questionnaire. We present the results and current awareness levels of this simple questionnaire and in due course educate and inform the society about the treatment OMFS provides. Results: Most of the respondents in Groups II, III, and V agreed that specific conditions listed in the questionnaire were within the domain of OMFS, but such response was not seen in Groups I, IV, and VI (P < 0.05). An overall awareness level of OMFS was found to be 50.8%. Conclusion: The liability and responsibility of creating and improving the awareness and perception of our specialty lies on oral and maxillofacial surgeon. Unified efforts at individual as well as global level will help achieve this goal.
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Concurrent prescribing: Evaluation of its knowledge among dentists p. 73
Amit Sharma, Kopal Sharma, Kanu Neemawat, Lokendra Sharma, Dinesh Pilania
Introduction: Considering the staggering number of drugs being prescribed to the patients for dental ailments, the ability of the dentists to recognize potential drug–drug interactions (DDIs) is essential to reduce their occurrence. This study aims to assess the dentist's ability to recognize the potentially clinically significant DDIs in clinical practice. Subjects and Methods: This questionnaire-based study was carried out among the dentists working at private tertiary care teaching dental hospitals in Jaipur city. Eighty-five dentists working as faculty members in various departments and having postgraduate degree in their respective specialty were enrolled after taking their written informed consent. A prevalidated close-ended questionnaire was given to the respondents to check their knowledge about common DDI possible in clinical dentistry practice. Statistical Analysis Used: Statistical analysis was done using descriptive statistics. Data were collected in a predesigned Microsoft Excel 2010. Continuous variables were presented as mean values ± standard deviation, and categorical variables were presented as percentages. Results: Among 85 dentists recruited for the study, no one had knowledge about all the common DDIs in dental practice. The participants could correctly identify only 47.86% of drug pairs. Drug information services available on the Internet were the most common source (32%) of knowledge of DDIs among them. Knowledge of the prescribed drug (40%) and complete drug history including over-the-counter and herbal products (35%) were the two important ways identified by them for avoiding unwanted drug interactions in clinics. Conclusion: The study revealed that the existing knowledge of the dentists was not adequate. Hence the knowledge of the dentists about DDIs pertinent to dentistry should be enriched and should be reinforced by arranging training sessions at constant intervals of time.
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Comparative evaluation of neodymium-doped yttrium aluminum garnet laser with nanocrystalline hydroxyapatite dentifrices and herbal dentifrices in the treatment of dentinal hypersensitivity p. 78
Rakesh Kumar Yadav, Umesh Pratap Verma, Rini Tiwari
Background: The aim of this study was to compare and evaluate the efficacy of neodymium-doped yttrium aluminum garnet laser with and without herbal and nanohydroxyapatite dentifrices in management of dentinal hypersensitivity (DH). Materials and Methods: A total of 180 patients who responded to air-blast test and cold-water test using verbal rating scale (VRS) were included in this study. The patients were randomly assigned to six groups (n = 30): control group (CG), scaling and root planning (SRP) + nanocrystalline hydroxyapatite dentifrices, SRP + nanocrystalline hydroxyapatite dentifrices + laser, SRP + herbal dentifrices, SRP + herbal dentifrices + laser, and SRP + laser. Each group was evaluated at baseline, 1 week, 1 month, and 6 months. In every visit of each patient, their clinical examination was done. Results: Among all groups', repeated ANOVA measures and Kruskal–Wallis test was performed in which laser groups showed maximum reduction in DH in all indices while the CG showed minimum reduction in DH. The VRS values showed maximum reduction in SRP + nanocrystalline hydroxyapatite dentifrices + laser group with mean of 0.3 ± 0.5 and minimum reduction in CG with mean of 3.0 ± 0.5 (P < 0.001). Conclusion: Among all the groups, SRP + Nanocrystalline hydroxyapatite + Laser can be an effective treatment modality for DH.
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Facial tumor as a presenting complaint in a patient with primary Sjögren's syndrome p. 87
Alicia Gonzalez-Mourelle, María Pombo Castro, Inés Vázquez Mahía, Javier Collado López, David Neagu, José Luis López-Cedrún
Sjögren's syndrome is a chronic autoimmune disorder of the exocrine glands with associated lymphocytic infiltrates of the affected glands. Dryness of the mouth and eyes results from involvement of the salivary and lacrimal glands. Up to one-half of affected individuals also develop extraglandular involvement in organs distinct from the salivary and lacrimal glands, including the joints, skin, lung, gastrointestinal tract, nervous system, and kidneys. The disease also occurs in conjunction with other autoimmune disorders, such as systemic lupus erythematosus and rheumatoid arthritis. We report a case of a 76-year-old woman who presented to our department with a swelling on the left cheek. Investigations revealed Sjögren's syndrome as the underlying cause of the facial tumor.
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Full-mouth rehabilitation with immediate loading basal implants: A case report p. 91
Pankaj Ghalaut, Himanshu Shekhawat, Babita Meena
The aim of this article was to study a case report of full mouth rehabilitation in a severally periodontally compromised patient in which 18 single piece basal implants were inserted and functionally loaded with both maxillary and mandibular cement retained fixed partial denture. Basal implants were loaded immediately, and excellent results were obtained. Bone loss was measured and values were recorded immediately after implant placement and after 6 months. Basal implants are used to support single and multiple unit restorations in the upper and lower jaws. They can be placed in the extraction sockets and also in the healed bone. Their structural characteristics allow placement in the bone that is deficient in height and width. Basal implants are the devices of the first choice, whenever (unpredictable) augmentations are part of an alternative treatment plan. The technique of basal implantology solves all problems connected with conventional (crestal) implantology.
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Modified micro-marsupialization as an alternative treatment for the management of ranulas in children p. 95
Sucheta Prabhu Matondkar, Chandrashekar Yavagal, Praveenkumar S Mandroli
The anatomical location of ranulas is challenging to the dental surgeon in terms of their management. The regional complexities of the area call for a skilled approach because of a number of vital structures within. Although complete excision with removal of the sublingual gland continues to be the gold standard of treatment, recent literature highlights successful outcomes by simple modification of the conventional ranular marsupialization technique. This micro-marsupialization option is minimally invasive and advantageous in children due to shorter procedural time, minimal discomfort, and no postoperative complications. The following case report highlights the successful management of a case using a modified micro-marsupialization technique.
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Bone augmentation with sticky bone and platelet-rich fibrin by ridge-split technique and nasal floor engagement for immediate loading of dental implant after extracting impacted canine p. 98
Romesh Soni, Aditi Priya, Himanshi Yadav, Nitesh Mishra, Lakshya Kumar
Nowadays, dental implants are the best treatment option for tooth loss, but implant placement requires sufficient bone volume. In defect area of alveolar ridge, augmentation is done by various available methods. Utilizing the growth factors such as platelet-rich fibrin (PRF) derived from patient's blood platelets improve treatment outcome. PRF accelerates the wound healing, enhances osteogenic activity as well as regulates the inflammation. Bone grafting, guided bone regeneration, and ridge-split technique promote new bone formation. The aim of this case report is to demonstrate an efficient method of bone augmentation using sticky bone along with PRF membrane, followed by ridge-split technique and engagement of nasal floor to place implant.
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An unexpected and rare outcome of a common nodular mass on upper lip in a pediatric patient with a history of trauma – Schwannoma p. 102
Jimish Desai
Schwannoma is usually a solitary, slow-growing, encapsulated benign tumor derived from the Schwann cells with no pathognomic features. Schwannomas are commonly seen in the fourth decade of life. They have a propensity for head-and-neck region. Schwannomas of the oral cavity, more particularly of the upper lip, are very rare. We present an interesting case of schwannoma of upper lip in a pediatric age group associated with a presenting history of trauma, making the diagnosis unexpected. The case is one of the very few reported cases of schwannoma of upper lip and probably one of its kinds associated with a presenting history of trauma. The patient is under clinical control with no signs of recurrence.
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Recreating first digit with silicone prosthesis p. 105
Amit Mahadeo Gaikwad, Sabita M Ram, Jyoti B Nadgere, Naisargi P Shah
The hand is an integral part of our body. Any deviation in hand anatomy not only affects the day-to-day function but it even results in unesthetic appearance. Rehabilitation of these deformities is done either by microsurgery or with the help of silicone prosthesis. Nonsurgical treatment was carried out, where rehabilitation of the first digit was done with customized silicone prosthesis. Replacement of these deformities with silicone prosthesis is usually done by prosthetist. However, we being an oral and maxillofacial prosthodontist, replacement of these missing complete or partial fingers, thumb, ear, and nose is also done by prosthodontist. Rehabilitation of these deformities with silicone prosthesis can offer psychological, functional, and esthetic advantages. Recent advances in materials and skill of an individual made it possible to fabricate esthetically pleasing prosthesis. Mini implants are widely used for retaining silicone prosthesis; however, they are expensive and need surgical intervention. Vacuum-retained silicone-retained silicone prosthesis is a good and minimal invasive option for these patients. This clinical report describes a straightforward technique for fabricating silicone thumb prosthesis for a patient with amputated thumb.
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Central mucoepidermoid carcinoma: Case report with review of literature p. 109
Harmurti Singh, Arvind Kumar Yadav, Sharad Chand, Abhishek Singh, Bharat Shukla
Occurrence of central mucoepidermoid carcinoma within the jaw bones from aberrant salivary tissues is extremely rare and accounts for 2%–4% of all central mucoepidermoid carcinoma. Mandible is more commonly affected than maxilla in a ratio of 2:1. The origin of mucoepidermoid carcinoma is controversial and questionable. Central mucoepidermoid carcinoma is frequently misdiagnosed radiographically and clinically as a benign odontogenic tumor or cyst. Hence, it is important to detect malignant signs and histopathological feature of central mucoepidermoid carcinoma of the mandible to confirm the diagnosis. This paper reports a case of central mucoepidermoid carcinoma of the mandible in a 56-year-old patient with review of literature.
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A rare nonsyndromic case of adenomatoid odontogenic tumor associated with multiple impacted supernumerary teeth p. 114
Rajat Mohanty, Vaibhav Singh, Arka Kanti Dey, Shibabrata Behera
Adenomatoid odontogenic tumour (AOT) is a rare benign odontogenic tumour characterized by a progressively slow growing pattern and symptomless behavior. The differential diagnosis between AOT and other odontogenic tumours, such as ameloblastoma, should be well conducted in order to avoid extensive ablative surgery. The present case report is of a 27 year old female who reported with a chief complaint of mild intermittent pain and a swelling which was gradually increasing in size, on the left mid-facial region since 6 months. Radiographic Investigations revealed a round uni-locular radiolucent image of an intra-osseous lesion with a well defined border in the left maxilla. The tumor was encapsulated and was attached with 2 impacted supernumerary teeth which were fused and shaped as maxillary premolars. The images also showed multiple impacted supernumerary teeth in the maxilla and mandible. The clinical and radiographic diagnostic hypothesis of Adenomatoid odontogenic cyst and a differential diagnosis of Dentigerous Cyst was given. Surgical enucleation of the lesion was done under General Anaethesia. The histological sections were consistent with AOT.
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Tuberculous parotitis: A series of eight cases and review of literature p. 118
Malti Kumari Maurya, Sunil Kumar, Hitendra Prakash Singh, Ajay Verma
Although tuberculosis is a common health problem in developing countries such as India, tuberculous parotitis (tubercular involvement of parotid gland) is rarely encountered. Because of very low incidence and nonspecific symptoms, it is often misdiagnosed as parotid neoplasm. Ultrasonographic and computed tomographic findings are also noncontributory for this entity. Hence, to increase awareness about this rare entity, here, we report a series of eight cases of tuberculous parotitis which were diagnosed on fine-needle aspiration cytology (FNAC) and successfully treated with antitubercular drugs. Majority of our cases (five cases) presented as asymptomatic unilateral swelling or acute tender painful swelling (two cases) in the parotid region. FNAC smears showed caseous necrosis, epithelioid granulomas along with variable amount of mixed inflammatory exudates, and few benign ductal or acinar cell clusters. One case had unilateral recurrent swelling in the preauricular region with fistula. Superficial parotidectomy was done and histological examination revealed the diagnosis of tubercular parotitis. Following diagnosis, all patients were kept on antitubercular treatment and responded well to treatment with no evidence of recurrence on 9-month regular follow-up.
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Volumetric expansion of ocular defect with progressive conformers: An objective assessment p. 123
Himanshi Aggarwal, Vinit Shah, Saumyendra Vikram Singh, Deeksha Arya
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