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National Journal of Maxillofacial Surgery
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   Table of Contents - Current issue
January-June 2018
Volume 9 | Issue 1
Page Nos. 1-114

Online since Monday, May 28, 2018

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Platelet-rich fibrin: Emerging biomaterial in regeneration p. 1
Naresh Kumar Sharma
DOI:10.4103/njms.NJMS_40_18  PMID:29937651
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Literature review of 86 cases of mandibular ameloblastic carcinoma p. 2
Sandeep Pandey, Ongkila Bhutia, Ajoy Roychoudhury, Ankit Arora, Krushna Bhatt
DOI:10.4103/njms.NJMS_33_16  PMID:29937652
Ameloblastic carcinoma is considered to be a rare epithelial malignant neoplasm of odontogenic origin occurring mainly in the mandible. Ameloblastic carcinoma has been a topic of controversy regarding management from past many years. We reviewed 86 cases of mandibular ameloblastic carcinoma from 1981 to 2014, on the basis of the electronic search of peer-reviewed journals in MEDLINE (PubMed) database. Age, sex, tumor size, treatment delivered, recurrence, metastasis, follow-up period, and dead/alive status are tabulated, and the data are analyzed. The mean age was 43.47 years with standard deviation ± 21.09. The age range was between 15 and 91 years, and male to female ratio was 2.18:1. Knowledge gained from the present review would help in establishing the best therapeutic options for ameloblastic carcinoma, and it also encourages the further reporting of ameloblastic carcinoma.
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Correlation of CD133 and Oct-4 expression with clinicopathological and demographic parameters in oral squamous cell carcinoma patients p. 8
Alok Singh, Anand Narain Srivastava, Salman Akhtar, Mohammad Haris Siddiqui, Pooja Singh, Vijay Kumar
DOI:10.4103/njms.NJMS_60_17  PMID:29937653
Objective: Squamous cell carcinoma of oral cavity is one of the most common cancers of Indian subcontinent with the 5-year survival rate of 50% despite the recent advances in the treatment. The aim of the present study was to study cancer stem cell markers CD133 and Oct-4 in oral squamous cell carcinoma (OSCC) patients and their correlation with clinicopathological variables. Materials and Methods: This was a prospective study which included 50 cases of histopathologically proven squamous cell carcinoma of oral cavity. Expression of CD133 and Oct-4 was evaluated by immunohistochemistry (IHC) and their expression was correlated with various clinicopathological and demographic parameters. Results: CD133 expression was seen in 20.6% cases of clinical Stage I–II and in 79.4% of clinical stage of III-IV OSCC patients, the difference being statistically significant with the P = 0.048. There was no statistically significant association between CD133 expression and any other clinicopathological or demographic variable. Oct-4 was expressed only in one case. Conclusions: CD133 expression was significantly seen higher in Stage III–IV tumors, the stem cells may be responsible for the aggressiveness of the OSCCs and these stem cells can be potential prognostic markers and targets for the future targeted therapy.
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Probing natural substitute for formalin: Comparing honey, sugar, and jaggery syrup as fixatives p. 14
Amritaksha Bhattacharyya, Bhavana Gupta, Anil Singh, Kunal Sah, Vivek Gupta
DOI:10.4103/njms.NJMS_57_17  PMID:29937654
Background: Since its discovery in 1859, formalin has been considered as the “gold standard” in tissue fixation. As formalin is highly toxic and carcinogenic, the quest for its substitute has started recently. Literature search reveals very sparse studies on natural substitute for formalin. Here, it is an attempt to explore eco-friendly, economical, and readily available natural substance for formalin substitute. Aim: The aim of our study was to evaluate the efficacy of natural fixatives such as honey, sugar, jaggery, and water in comparison to the standard fixative used like formalin. Materials and Methods: Fresh goat tissues (tongue) were fixed separately with buffered 10% formalin (positive control), honey, sugar syrup, jaggery syrup, and distilled water (negative control). 24 h fixation was done at room temperature followed by conventional processing and routine H and E staining. The stained sections were assessed for cytoplasmic and nuclear detail by three pathologists under light microscope and were graded accordingly. Results: The results showed statistically significant differences between jaggery with other natural fixatives for both nuclear details and cytoplasmic staining. Conclusion: The preservation of tissue by honey, sugar, and jaggery syrup was comparable to that of formalin. Among the three natural fixatives, jaggery syrup excelled. Hence, it can be considered as an equally effective formalin substitute.
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A randomized controlled clinical trial evaluating the efficacy of zoledronate gel as a local drug delivery system in the treatment of chronic periodontitis: A clinical and radiological correlation p. 22
Abhaya Gupta, Vivek Govila, Vandana A Pant, Rajiv Gupta, Umesh P Verma, Hafsa Ahmad, Sumedha Mohan
DOI:10.4103/njms.NJMS_12_18  PMID:29937655
Background: This study aimed to evaluate the efficacy of local drug delivery system of zoledronate (ZLN) gel as an adjunct to scaling and root planing (SRP) for the treatment of human periodontal intrabony defects clinically and radiographically. Materials and Methods: Forty intrabony defects (three walled and combined defects without involving furcation) in moderate to severely affected forty chronic periodontitis patients (range, 30–50 years) were randomly divided into two groups and treated either with 0.05% ZLN gel (ZLN n = 20; 1 dropout) or placebo gel (control group [CG] n = 20) after SRP. Clinical parameters such as plaque index (PI), gingival index (GI), tooth-specific pocket probing depth (TsPPD), and clinical attachment levels (TsCAL) were assessed at baseline and at 3 and 6 months using occlusal acrylic stent. Radiographic parameters were assessed at baseline and 6 months, utilizing “ONIS 2.5 PROFESSIONAL” and “SYNGO” software compatible with DentaScan to measure the volumetric bone changes in intrabony defects. Results: In intragroup comparisons, both groups showed significant PI and GI reduction (P < 0.001) after treatment at 3 and 6 months. In intergroup comparisons, TsPPD reduction and TsCAL gain were significant only in ZLN at 6 months from both baseline and 3 months. Radiographically, significant reduction in defect depth and buccolingual width with volumetric defect gain of 40.24% ± 7.44% in ZLN compared to insignificant gain of 1.60% ± 4.06% in CG was observed at 6 months. Conclusion: ZLN gel applied subgingivally in intrabony defects resulted in significant improvements both clinically and radiographically.
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Erich arch bar versus hanger plate technique for intermaxillary fixation in fracture mandible: A prospective comparative study p. 33
Parmod Kumar, Govind Menon, Vidya Rattan
DOI:10.4103/njms.NJMS_63_17  PMID:29937656
Introduction: Various methods have been described for intermaxillary fixation (IMF) for treatment of faciomaxillary injuries. Many studies have been described to evaluate the efficacy of different methods. Hanger plate method has not been commonly used. The aim of the present study was to compare the advantages and disadvantages of this method over Erich arch bar in mandibular fracture. Materials and Methods: Sixty patients of only mandibular fracture presenting to trauma center requiring open reduction and internal fixation under general anesthesia were randomly allocated to Group A and Group B comprising thirty patients in each. Group A included patients who received IMF with Erich arch bar. Group B included patients who received IMF with hanger plate method. The two groups were compared for time duration of intermaxillary procedure, total duration of surgery, oral hygiene score, postoperative occlusion, and complications. Results: The average time of intermaxillary procedure, total duration of surgery, and wire prick injuries were more in Group A. Oral hygiene score was significantly better in Group B. Postoperative occlusion was comparable between the two groups. There was screw loosening in four patients in Group B, but none had tooth root injury. The cost of material for IMF was more in Group B. Conclusion: IMF with hanger plate method is more safe and efficacious compared to Erich arch bar in the treatment of mandibular fractures.
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Immediately placed dental implants in smokers with plasma rich in growth factor versus without plasma rich in growth factor: A comparison Highly accessed article p. 39
Shilpi Gangwar, US Pal, Sunita Singh, RK Singh, Vibha Singh, Lakshya Kumar
DOI:10.4103/njms.NJMS_74_17  PMID:29937657
Introduction: The placement of implants into fresh extraction sockets was introduced in 1970. This approach has been reviewed extensively during the past decade. Immediate postextraction implant placement is a well-accepted protocol. The concept of placement of dental implants soon after the removal of a tooth in smokers, however, is still a matter of controversy. Purpose: (i) To access failure rate of dental implant in smokers (ii) To evaluate added advantage of plasma rich in growth factors (PRGFs) in immediate placement of dental implants in smokers. Materials and Methods: The sample of 30 patients was obtained from the different Outpatient Department of Faculty of Dental Sciences; King George's Medical University, Lucknow, who had visited for rehabilitation of missing teeth by implants between April 2013 and July 2015. They were randomly divided into two groups (without use of PRGF and with use of PRGF) of 15 each. Pre- and postoperative assessment included a thorough history and clinical examination, regression of pain and swelling, implant stability by resonance frequency analysis (RFA), and implant stability according to the bone type as well as radiographic interpretation for measurement of bone loss on the mesial and distal surfaces of the implant. Results: In this study, pain and swelling were significantly (P < 0.05) higher in Group A than in Group B across the time interval. RFA score for implant stability was lower in Group A across the period than Group B. At the end of 3 months, RFA score (mean) in Group A was having 72.55 ISQ value, and in Group B, it was 75.71 ISQ value. In this study, postoperative crestal bone loss was more in patients in Group A as compared to patients in Group B. There was significant difference in mesial (P = 0.003) and distal (P = 0.001) crestal bone loss at 6 months between the groups. Conclusion: The immediate placement of dental implants in smokers with use of PRGF is shown to be efficient in relation to postoperative pain and swelling, stability, stability according to bone type, as well as bone loss.
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The maxillofacial injuries: A postmortem study Highly accessed article p. 48
Raja Rupani, Mousami Singh, Vijay Kumar, Raghvendra Singh, Sachil Kumar, Pradeep Yadav
DOI:10.4103/0975-5950.233295  PMID:29937658
Objectives: The aim of our study is to evaluate the incidence and etiology of maxillofacial fractures in autopsy cases of KGMU, Lucknow. Materials and Methods: The sample consisted of 444 autopsy cases with maxillofacial injuries, who were brought to the mortuary of KGMU, Lucknow, for postmortem in the last year. Parameters such as gender, age, cause, type, and site of injury are evaluated. Result: The results of this study show that road traffic accidents are the main reason for maxillofacial injuries in the deceased, followed by railway accidents. Maxillofacial injuries are more common in adult males than in females. Majority cases also involved maxilla and zygomatic along with mandible. The most common type of facial fracture was Le Fort-2 fracture. Conclusion: Maxillofacial injuries are commonly seen in adult males, due to RTA, involving maxilla, zygomatic and mandible and presenting as Le Fort-2 fracture.
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A comparative evaluation of the antimicrobial efficacy of calcium hydroxide, chlorhexidine gel, and a curcumin-based formulation against Enterococcus faecalis p. 52
Rakesh Kumar Yadav, Aseem Prakash Tikku, Anil Chandra, Promila Verma, Rhythm Bains, Harsh Bhoot
DOI:10.4103/njms.NJMS_47_17  PMID:29937659
Aim: This study aimed for a comparative evaluation of the antimicrobial efficacy of calcium hydroxide, chlorhexidine gel, and a curcumin-based formulation against Enterococcus faecalis. Methods: Thirty single-rooted teeth were taken. Access preparation was done. Biomechanical preparation was done using Protaper universal file till F3. Teeth were decoronated to a standardized root length of 14 mm, and the apical end from outside was sealed using paraffin wax. Teeth were autoclaved under standard conditions and after autoclaving, Phosphate-buffered saline solution was introduced into the roots and was incubated for 24 h to check for the disinfection of roots. Once the disinfection of roots was achieved, the wild strain of E. faecalis, i.e., ATC 29212 strain, was introduced into the teeth and allowed to incubate for 24 h. Following bacterial colonization inside the roots, antimicrobials were introduced and efficacy was checked. The data obtained were subjected to statistical analysis using paired t-test for significance. Results: Significant difference was observed between all the test groups. However, chlorhexidine gel showed the best value of mean difference, indicating it as the best antibacterial medicament. Conclusion: Within the limitations of this study, it can be concluded that chlorhexidine gel showed better antimicrobial properties against E. faecalis than other medicaments.
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Oral squamous cell carcinoma profile in North-Eastern regions of India from habits to histopathology: A hospital-based study p. 56
Parikshit Sharma, Tushar Deb, Jay Gopal Ray, Akhilesh Kumar Singh, Gautam Gupta, Abhishek Das, Shweta Srivastava
DOI:10.4103/njms.NJMS_59_15  PMID:29937660
Background: Head and neck cancers constitute about 5%–8% of total body cancers in Europe, America, but in India, this figure is somewhat higher. The aim of this study is to evaluate the current burden of oral cancers in India, particularly North-East India. Materials and Methods: A full-length study starting from patient counseling to clinical and histopathological examination and grading was planned. The study was conducted under the guidance of clinician, oral surgeon, oral pathologists, and statistician. Results: In the 3 years study, all the patients with oral lesions are examined clinically, out of them suspected oral cancer patients were histopathologically confirmed as oral squamous cell carcinoma patient. The socioeconomic profile of oral cancer patients in relation to all examined patients was summarized, and results are drawn. Conclusion: The studied population is heavily indulgent tobacco consumption. Education for cancer prevention, early detection, and treatment is needed.
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Salivary hamartoma with a bifid tongue in an adult patient p. 61
Ravisankar Nutalapati, Nadeena Jayasuriya
DOI:10.4103/njms.NJMS_28_17  PMID:29937661
Congenital anomalies of tongue are rare disorders usually associated with syndromes. In present article we describe a case of a non-syndromic adult patient with bifid tongue with salivary hamartoma on the dorsum of the tongue. We described the clinical features, problems faced by the patient and management. As etiology is uncertain we should have proper understanding of embryology.
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Basaloid squamous cell carcinoma – A rare and aggressive variant of squamous cell carcinoma: A case report and review of literature p. 64
Bhavana Gupta, Amritaksha Bhattacharyya, Anil Singh, Kunal Sah, Vivek Gupta
DOI:10.4103/njms.NJMS_14_17  PMID:29937662
Basaloid squamous cell carcinoma (BSCC) is a rare and aggressive variant of oral squamous cell carcinoma with a predilection for the tongue and in other locations, such as floor of the mouth, palate, retromolar trigone, and gingival mucosa. Here, we present a case of BSCC of oropharynx in a 60-year-old male patient.
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A case of cleft lip and palate with severe maxillary retrognathism treated by distraction osteogenesis and custom made intraoral rapid maxillary expansion appliance: A 2-year follow-up of retention p. 69
Gowri Sankar Singaraju, Prasad Mandava, Praveen Chirivella, Sridhar Reddy Kanabaddy
DOI:10.4103/njms.NJMS_14_18  PMID:29937663
Herewith, a case is reported of an adolescent female patient with maxillary retrognathism due to restricted growth arising out of the previous cheiloplasty and palatoplasty surgeries treated for cleft lip and palate. She also presented an oroantral fistula in the scarred tissues of the palatal region. There was anterior crossbite and distorted occlusion in the anterior segment with crowding and open bite. There is maxillomandibular discrepancy of 6 degrees°. The distraction osteogenesis was performed so as treat the maxillary hypoplasia. This allows undermanding adaptation of the soft-tissue structures to the modification in the skeletal structures as a result of surgical procedures and ensures long-term stability. A custom made intraoral rapid maxillary expansion device was prepared utilizing the hyrax screw for the distraction of the bony segments. At the end of the treatment and a retention period of 24 months, the patient exhibited improved facial profile and hence esthetics.
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Traumatic pseudoaneurysm of the superficial temporal artery p. 74
Pulkit Khandelwal, Francis Akkara, Vikas Dhupar, Archana Louis
DOI:10.4103/njms.NJMS_64_15  PMID:29937664
Aneurysms of the facial vasculature due to various accidental, violent, and surgical injuries have been reported since mid-17th century. Approximately 386 pseudoaneurysms of the superficial temporal artery (STA) have been reported in the literature since 1644. Traumatic pseudoaneurysm of the STA is a rare lesion. It manifests as a painless pulsatile mass in the temporal region following trauma. The unusual incidence and confusing presentation require the clinicians to have a thorough knowledge of its presentation and diagnosis. We present a case of traumatic pseudoaneurysm of the STA, which developed a few weeks later, after sustaining blunt trauma to the head. We have also reviewed the anatomical challenges and pathophysiology that promotes the formation of pseudoaneurysm and the optimal approach to diagnose and manage the lesion. Pulsatile lesions or lesions that are continuous with the STA should be regarded with extreme caution. The sole treatment modality is surgical resection of the pseudoaneurysm. This will avoid any future complications such as hemorrhage or compression of adjacent nerves and vessels.
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Efficacious use of a Calgigraf Ag foam dressing in complete healing of a difficult-to-heal, long-standing ulcer of osteoradionecrosis p. 78
Nyer Firdoose, Umer Hasoon
DOI:10.4103/njms.NJMS_69_17  PMID:29937665
A number of dressings containing silver have been recently introduced into the wound care market as increased resistance to antibiotics has become a problem in treating infected wounds. A 54-year-old male, with adenoid cystic carcinoma treated by segmental resection and reconstruction of mandible using reconstruction plate with concomitant radiotherapy, resulted in a deep extraoral nonhealing necrotic, exuding, malodorous, and painful wound. Erythema, eczema, and trophic changes were surrounding the skin. Previous treatment was removal of exposed reconstruction plate and primary closure. Culture samples reported methicillin-resistant Staphylococcus aureus positive and sensitivity to linezolid. Repeated failed attempts to approximate the wound, prompted the use of Calgigraf Ag foam as dressing for the wound. Evidence of new tissue growth and subsequent reduction in wound area and exudate were significant. Chronic nonhealing wounds involving progressive tissue loss give rise to the biggest challenge to wound-care researchers. Despite proper care, some wounds fail to heal in normally and become chronic. The use of ionic silver with negative pressure therapy is safe and effective in difficult nonhealing wounds. This case illustrates the potential benefit of ionic silver combined with negative pressure and moist wound healing as management of a patient with long-standing, nonhealing, and osteoradionecrosis wound. Calgigraf Ag Foam a silver alginate dressing is optimal for maintaining moist environment vital to promote wound healing. It needs less frequent dressing changes with additional benefits such management of excessive exudate minimising malodour and maintaining a moist wound environment.
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Rehabilitation of hemi-maxillectomy with a definite one piece hollow bulb obturator p. 82
Preeti Chaubey, Rahul Tripathi, Ajay Singh
DOI:10.4103/njms.NJMS_85_16  PMID:29937666
Maxillary intraoral defects due to surgical resection create an open link between the oral and nasal cavities causing difficulty in deglutition, speech, and an unaesthetic appearance. Prosthetic innervention is required to restore the needs of speech, mastication as well as closing the oroantral communication. This article shows a case report of systematic approach for fabrication of immediate plate just after surgery, followed by interim feeding plate 2 weeks after surgery, and finally definitive one piece hollow bulb obturator 6 months after surgery.
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The aberrant extraction of a maxillary canine and two lower incisors p. 86
Chetna Kumar, Kamlesh Garg, Parmender Kumar Vaidik, Akanksha Mangal, Priyanka Parmar
DOI:10.4103/njms.NJMS_11_18  PMID:29937667
Extractions are a common place in orthodontics. The present article discusses a rare case, in which a left maxillary canine along with two lower incisors was extracted. Atypical extractions such as these need to be duly justified and thought over before being carried out. In the case mentioned, all these teeth in question were ectopically erupted. When attempts were made to retract the canine in its right position, it exhibited gingival recession which would only go on increasing further as the distance from the transposed position in between the left central and lateral incisor to the original position was considerably large. It was planned that the 1st premolar would be converted to canine on completion of the treatment. The lower incisors too would have shown severe periodontal damage had attempts to align them was made. Not only were these two teeth lingually erupted but they also were rotated along their long axis. Derotation along with labial movement would have caused breakage of the supracrestal and transseptal fibers resulting in periodontal breakdown leading to mobility of these teeth. An esthetically and functionally balanced outcome was achieved following these extractions. In the upper arch, although the midline remained compromised, it was not worsened. In the lower arch alignment was achieved with preservation of the intercanine width. Complicated cases such as these require a thorough scrutiny of all available options. Whatever the treatment plan may be, the ultimate goal of functional and esthetic balance should be achieved.
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An innovative approach to the prosthodontic management of Class III mandibular defect p. 90
Saumya Pandey, Sushil Kar, Naresh Kumar Sharma, Arvind Tripathi
DOI:10.4103/njms.NJMS_31_17  PMID:29937668
Class III mandibular resection due to surgical treatment of jaw tumor produces a discontinuity in the mandible which is severely incapacitating to the patient. It leads to a deviation and rotation of the mandible which depends on the amount of tissues resected the manner of surgical site closure, loss of proprioceptive sense of occlusion, the presence, and condition of teeth, and the time of initiation of prosthodontic therapy. These put together makes the task of prosthodontic rehabilitation quite arduous. Guide flange prosthesis is a comparatively simple and cost-effective method of restoring the esthetics and function to an acceptable level. This clinical report describes an innovative and simplified approach to impression making (sectional two-step impression) to minimize trauma to the underlying and circumoral fragile tissues postsurgery, and to the fabrication of buccal guide flange (wrought wire supported and reinforced guide flange) for prosthetic rehabilitation of a patient with Class III mandibular resection.
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Maxillofacial injury from a leopard attack p. 96
Sudhir Ramlal Pawar, Rajesh Ashok Kshirsagar, Pratik Hemantkumar Raut, Amod Pramod Patankar
DOI:10.4103/njms.NJMS_41_16  PMID:29937669
Although leopards are found worldwide, the incidence of leopard attack on humans is reported most often from India and Nepal. Usually, leopards avoid contact with people, but humans may occasionally be targeted as prey. Animal bite wounds may express as punctures, abrasions, tears, or avulsions. The force and bluntness of the teeth increase the probability of a crush injury with devitalized tissue. The clinical presentation and appropriate treatment of infected bite wounds vary according to extent of the wound. These wounds are considered complex injuries infected with a unique polymicrobial inoculum. As the bite injuries are commonly found on the face, an oral and maxillofacial surgeon should be familiar with the management of animal bites. This article reviews a case of a victim attacked by the leopard, the treatment provided to the victim, and brief notes on the management of such facial animal bite injuries.
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Marginal resection in a case of juxtacortical chondrosarcoma of the mandible p. 100
Srimathi Panchanathan, Arunkumar Kamalakaran, Karthikeyan Duraisamy, Maya Saranathan
DOI:10.4103/njms.NJMS_47_15  PMID:29937670
Chondrosarcomas usually invite extensive surgical resection. These are malignant tumors of cartilaginous origin and their involvement in the maxillofacial region is rare. Juxtacortical chondrosarcoma, a distinct malignant cartilage-forming tumor arising from the external surface of a bone, is extremely rare in the mandible. Here, one such case with a relatively good prognosis is presented where marginal resection as a surgical option yielded good result.
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Fine-needle aspiration cytology as a useful diagnostic adjunct in the management of ameloblastoma: A report of four cases p. 103
Aprna Gupta, Surya Narayan Das, Sangram Patro, Subhrajit Raut
DOI:10.4103/njms.NJMS_51_17  PMID:29937671
Ameloblastoma is a locally aggressive common odontogenic tumor of the jaws. Although histopathological and radiological findings have been extensively studied for the diagnosis of ameloblastoma, usefulness of fine-needle aspiration cytology (FNAC) has not been explored much. Here, we have reported four cases of ameloblastomas diagnosed by FNAC and subsequently confirmed by histopathology.
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Management of mandibular fracture in pediatric patient p. 106
Sumaiya Nezam, Arvind Kumar, Jeevendra Nath Shukla, Shabab Ahmed Khan
DOI:10.4103/njms.NJMS_54_17  PMID:29937672
A pediatric mandibular fracture can cause a child severe pain and the parent or caregiver extreme worry. While the pattern of fractures in children is similar to adults, however, due to a number of factors, including the anatomical complexity of the developing mandible, management of such fractures differs from that of adults and can greatly challenge the pediatric dentist. Various treatment modalities of managing mandibular fracture are available, such as closed/open cap splint with circummandibular wiring, arch-bar fixation, and cementation of the cap splint.
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Oral myiasis in paralytic patients with special needs: A report of three cases p. 110
Sonal Priya Bhansali, Anjali Dave Tiwari, Dinesh Kumar Gupta, Sumit Bhansali
DOI:10.4103/njms.NJMS_82_17  PMID:29937673
Oral myiasis is invasion of the soft tissues of oral cavity by the parasitic larvae of the flies. This condition affects debilitated, mentally challenged individuals. These patients are not physically or mentally endowed to ward off flies or complain about worms burrowing their way into oral wounds. This study describes three cases of orofacial myiasis, removal of the live maggots, supportive treatment, and management of the cases with application of turpentine oil and also highlights oral health care in the patients with special needs.
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Revision flap surgery with compromised airway: Increasing numbers, a concern for anesthesia p. 113
Tanmay Tiwari, Nidhi Gupta
DOI:10.4103/njms.NJMS_84_17  PMID:29937674
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