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National Journal of Maxillofacial Surgery
 
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   Table of Contents - Current issue
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January-June 2020
Volume 11 | Issue 1
Page Nos. 1-155

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EDITORIAL  

Our challenges in practicing oral oncology Highly accessed article p. 1
Akhilesh Kumar Singh
DOI:10.4103/njms.NJMS_87_20  
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REVIEW ARTICLES Top

“Too much information with little meaning,” relevance of preoperative laboratory testing in elective oral and maxillofacial surgeries: A systematic integrative review Highly accessed article p. 3
Taranjit S Kaur, Bijoya P Chatterjee
DOI:10.4103/njms.NJMS_60_19  
Aim: In the recent times due to accessibility of tools and advent of technology advising battery of laboratory tests prior to any electeve surgical procedure has become a norm. This review aims at investigating relevance of such tests in healthy patients undergoing routine elective oral and maxillofacial surgical procedures. Methods: Various search engines were thoroughly searched to identify relevant literature. The population of interest was asymptomatic adults above 18 years of age undergoing elective surgery. Results: The preoperative tests of interest for the current study included complete blood count, coagulation tests, biochemistry, and chest X-rays. An algorithm for preoperative tests has been proposed. Conclusion: We conclude that advising battery of routine tests in such patients leads to further delays and rise in overall cost of the surgery.
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Teleassistance and teleconsultation using smartphones and its contribution in clinical progress of oral and maxillofacial surgery p. 10
Gaurav Singh, US Pal, Madan Mishra, Amit Gaur, Dhritiman Pathak, Yogesh Bahadur Singh
DOI:10.4103/njms.NJMS_9_18  
Smartphones, an advanced mobile device having combined function of a computer and cellular phone, have become an effective communication within and between specialties for management of patients. It provides voice, text, multimedia messages, camera, and E-mail option and helps the surgical team to communicate with each other. The application of computer technology in the field of cranio and maxillofacial surgery opened a new perspective in the preoperative planning and accurate intraoperative realization of treatment concept. A PubMed, EMBASE, and Web of science search of the English literature were done to review the English literature on teleassistance and teleconsultation using smartphones and its contribution in clinical progress of oral and maxillofacial surgery. Fifteen articles were found the relevant data were extracted and tabulated. Conclusion was drawn that teleconsultation using smartphones is a useful tool for specialized consultation, diagnosis, treatment, and follow-up in remote areas. With technological evolution, new methods of delivering better health-care facilities can be possible with the help of smartphones.
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Risks and complications associated with dental implant failure: Critical update p. 14
Shubha Ranjan Dutta, Deepak Passi, Purnima Singh, Mansi Atri, Stuti Mohan, Abhimanyu Sharma
DOI:10.4103/njms.NJMS_75_16  
Risks and complications have been identified with dental implant failure though there is continuous innovation in implant systems and various interceptive treatment modalities. The success rate of dental implants has increased over a period of years as a treatment option for the rehabilitation of missing teeth. The dental implants are designed that best suits the various types of bone. Endosseous implants fail due to many reasons. Different reasons for the implant failure and their contributing factors have been discussed in this review article. A better understanding of the factors responsible for the implant failure will provide clinical decision-making and may enhance the field of implant dentistry. This article summarizes the factors causing implant failure. This paper presents the results of a survey of dentists practicing implant dentistry and updates regarding their knowledge of risk factors that they consider to be important for predicting dental implant failure.
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ORIGINAL ARTICLES Top

Orbital volume measurements from magnetic resonance images using the techniques of manual planimetry and stereology p. 20
Georgios Bontzos, Michael Mazonakis, Efrosini Papadaki, Thomas G Maris, Styliani Blazaki, Eleni E Drakonaki, Efstathios T Detorakis
DOI:10.4103/njms.NJMS_9_20  
Introduction: Current volume measurement techniques, for the orbit, are time-consuming and involve complex assessments, which prevents their routine clinical use. In this study, we evaluate the applicability and efficacy of stereology and planimetry in orbital volume measurements using magnetic resonance imaging (MRI). Materials and Methods: Prospective imaging study using MRI. Sheep craniums and human subjects were evaluated. Water-filling measurements were performed in animal skulls, as the standard validation technique. Planimetry and stereology techniques were used in each dataset. Intraobserver and interobserver reliability testing were applied. Results: In stereology customization, 1/6 systematic sampling scheme was determined as optimal with acceptable coefficient of error (3.09%) and low measurement time (1.2 min). In sheep craniums, the mean volume measured by water displacement, planimetry, and stereology was 17.81 ± 0.59 cm3, 18.53 ± 0.24 cm3, and 19.19 ± 0.17 cm3, respectively. Planimetric and stereological methods were highly correlated (r = 0.94; P ≈ 0.001). The mean difference of the orbital volume using planimetry and stereology was 0.316 ± 0.168 cm3. In human subjects, using stereology, the mean orbital volume was found to be 19.62 ± 0.2 cm3 with a CE of 3.91 ± 0.15%. Conclusions: The optimized stereological method was found superior to manual planimetry in terms of user effort and time spent. Stereology sampling of 1/6 was successfully applied in human subjects and showed strong correlation with manual planimetry. However, optimized stereological method tended to overestimate the orbital volume by about 1 cc, a considerable limitation to be taken in clinical practice.
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An appraisal of bone resorption in completely edentulous diabetic and nondiabetic patients at prospective implant site in anterior mandible using digital volumetric tomography and its correlation with glycemic control: A case–control study p. 28
Rohit Ashok Mistry, Sweta Kale Pisulkar, Surekha Godbole, Seema Sathe, Anjali Borle
DOI:10.4103/njms.NJMS_100_19  
Purpose: The prospective case–control study aimed at comparing bone resorption at prospective implant sites in anterior mandible between diabetic and nondiabetic patients using digital volumetric tomography (DVT) and establishes a correlation between glycemic control and residual ridge resorption. Materials and Methods: Twenty apparently healthy and 20 type 2 diabetic edentulous male patients between the age group of 55–65 years providing with written consent were recruited in the present study. First-time denture wearers were considered who were edentulous for at least 1 year. Glycated hemoglobin (HbA1c) analysis of all individuals were done to affirm the diagnosis and quantify glycemic control. DVT of all the individuals were performed and bone height was determined at 5 prospective implant sites were determined, on the same scans Wical and Swoope method was used to determine the residual ridge resorption on the right and left side of mandible for all the individuals. The data wer tabulated and descriptive and analytical statistics were performed to compare bone resorption between diabetic and nondiabetic groups. Pearson's correlation was carried out to establish correlation between glycemic control and residual ridge resorption. Results: There was no statistical difference between the bone height measurements at prospective implant sites between diabetic and nondiabetic groups. The residual ridge resorption was more in diabetics when compared to nondiabetics, and a significant moderate negative correlation existed between the glycemic control and residual ridge resorption on left (r = −0.541; P ≤ 0.001) and right (r = −0.408; P = 0.009) side of the mandible. Conclusion: It can be concluded from the present study that bone resorption at prospective implant sites is statistically similar in diabetics when compared to nondiabetics. Patients with poor glycemic control show increased residual ridge resorption.
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Ultrasound-guided autologous blood injection in patients with chronic recurrent temporomandibular joint dislocation p. 34
Sahil Parvez Gagnani, Yatin Rameshbhai Kholakiya, Ankit Arora, Ongkila Bhutia, Ashu Seith, Rohit Kumar Khandelwal, Ajoy Roychoudhury
DOI:10.4103/njms.NJMS_57_18  
Objective: To evaluate the accuracy and effectiveness of ultrasound (US) guided autologous blood injection (ABI) for the treatment of chronic recurrent TMJ dislocation. Design: Prospective cohort study. Setting: Centre for medical education and research. Participants (or Animals, Specimens, Cadavers): Ninteen patients with chronic recurrent TMJ dislocation (Fifteen bilateral and fourteen unilateral). Interventions: Autologous blood injected, 2ml in superior joint space (SJS) and 1 ml in peri-capsular tissue (PT) under ultra sound guidance. Main Outcome Measure(s): Reduction in number of dislocation episodes, maximal mouth opening, pain ( visual analogue scale) and TMJ sounds (present or absent) at the end of 2 weeks, 3 months, 6 months and 1 year. Results: At 2 weeks post operatively 18 patients (95%) were asymptomatic only one patient (5%) complained of Recurrence of dislocation and was treated successfully by a 2nd injection. At subsequent follow up visits none reported dislocation. Conclusion(s): US guided ABI for patients with chronic recurrent TMJ dislocations serves as an alternative, minimally invasive, highly effective and accurate modality of treatment since it includes exposure without radiation, real-time visualization of soft tissues, visualization of the needle tip advancement, local anesthetic spread relevant to the surrounding structures which can be performed on an outpatient basis.
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Effect of 4% nebulized lignocaine versus 2% nebulized lignocaine for awake fibroscopic nasotracheal intubation in maxillofacial surgeries p. 40
Lohith Kumar, Haider Abbas, Nikhil Kothari, Monica Kohli, Satish Dhasmana
DOI:10.4103/njms.NJMS_71_17  
Introduction: Securing a difficult airway during maxillofacial surgeries is a great challenge for anesthetists, and the flexible fiber-optic bronchoscope is the gold standard while managing such cases. While passing the flexible bronchoscope by the nasal route, the success rate is higher as compared with oral approach as the nasopharynx is in line with the larynx and prevents acute angulation in the oropharynx. Materials and Methods: A randomized control trial was planned in 73 patients out of whom sixty patients gave consent for the procedure. The patients we randomly divided into two groups (n = 30) with application of 4% nebulized lignocaine in one group and the use of 2% nebulized lignocaine in the other group, and the patient's comfort was noted using five-point Puchner scale. Results: The mean value of patient comfort Puchner scale of Group A was 1.30 ± 0.08 and of Group B was 2.23 ± 0.12. The mean value of Puchner scale of Group B was significantly higher (41.8%) as compared to Group A (t = 6.208; df = 51; P < 0.0001). The secondary outcome measures were optimal intubating conditions and hemodynamic changes during awake fiber-optic nasotracheal intubation. The procedural time of two groups when compared showed that the mean procedural time of Group A was shorter (29.67 ± 5.40 min) than the time consumed in Group B (34.93 ± 5.52 min). Conclusion: Four percent nebulized lidocaine provided adequate airway anesthesia and optimal intubating conditions along with stable hemodynamics for awake fiber-optic intubation as compared to 2% nebulized lidocaine.
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Immediate dental implant placement with or without autogenous bone graft: A comparative study p. 46
Sonalika Kabi, Rosalin Kar, Dipti Samal, Kumar C Deepak, Indu Bhusan Kar, Niranjan Mishra
DOI:10.4103/njms.NJMS_59_19  
Introduction: Immediate dental implants are the most accepted contemporary treatment option for the replacement of missing teeth. One pitfall of immediate implant use, however, is the inevitable residual space that remains between the implant and the socket wall, called the jumping distance, which may lead to bone resorption and formation of a bony defect, decreasing the implant stability. When this jumping distance is more than 2 mm, use of bone grafts is recommended. However, the use of grafts when the jumping distance is <2 mm is not defined in the literature. Aim: To evaluate the peri-implant hard and soft tissue changes following immediately placed implants with a jumping distance of 2 mm with or without autogenous bone grafts. Settings: The study was conducted between January 2016 and December 2017 in the Department of Oral and Maxillofacial Surgery. Subjects and Methods: This was a prospective, single-center, two-arm, parallel, randomized study on patients undergoing replacement of missing anterior teeth with immediate implants. There were two groups: the study group which received bone graft and the control group which did not receive any graft. Temporary prosthesis was placed following implant placement which was replaced with definitive prosthesis 4 months later. Patients were followed up for a period of 9 months. The alveolar bone loss was evaluated radiologically using cone-beam computed tomography, and pain, suppuration, mobility, and periodontal probing depth were evaluated clinically. Results: There were 16 participants in the study group and 17 in the control group. The alveolar bone loss was greater in the study group; however, pain, suppuration, and mobility showed no difference between the groups. Conclusion: The immediate implants placed with or without bone grafts had similar alveolar hard and soft tissue changes when the jumping distance was <2 mm.
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Tongue and its ties: Posterior tongue width in gender estimation – A forensic gratuity p. 53
Jaya Singh, Shruti Singh, Mohd Saleem, Shaleen Chandra, Neelam Lodhi, Chai Pin Chang
DOI:10.4103/njms.NJMS_40_19  
Background and Objectives: Human identification is one of the challenging areas that man has been confronted with. The forensic odontologist deals with human identification based on unique features of the oral cavity. The human tongue is sheathed within the oral cavity, where it lies protected against the external atmosphere, just as the palatine folds. It is can be easily showed for inspection but at the same time be protected from the external environment. Aim and Objective: The objective of this study is to examine the uniqueness of tongue morphology and find out parameters to estimate gender of an individual using the same. Methodology: A total of 30 subjects (15 girls and 15 boys) were taken for this study whose tongue were examined, photographed and alginate impression were taken to create a database of tongue morphology. Result: The mean posterior width of the tongue was higher among the males in both cast as well as photographs.
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Comparative evaluation of buccal pad of fat with and without bovine collagen membrane in the management of oral submucous fibrosis: A prospective clinical study p. 57
Arun Pandey, Naresh Kumar Sharma, Neeraj Kumar Dhiman, Chandresh Jaiswara, Preeti Tiwari, Akhilesh Kumar Singh, Vishal Verma, Shankar Singh
DOI:10.4103/njms.NJMS_70_19  
Background: Oral submucous fibrosis (OSMF) is a chronic, debilitating disease characterized by juxtaepithelial fibrosis. The present study evaluates the efficacy of buccal fat pad (BFP) and bovine collagen membrane as reconstruction options. Materials and Methods: The sample size includes 22 patients between 20 and 60 years, randomly distributed in two groups: Group I in which BFP was used and Group II where BFP with bovine collagen membrane was used after surgical resection of fibrotic bands. The clinical evaluation on postoperative 1st, 3rd, and 5th days and 1st, 2nd, 3rd, 4th, 12th, and 24th weeks subsequently. Results: The mean age in Group I was 27.17 ± 3.157 years and Group II was 37.90 ± 6.657 years. The mean preoperative mouth opening was 9.75 ± 6.717 and 8.90 ± 3.784 mm in Groups I and II, respectively. The mean duration of presenting illness in Group I was 9.75 ± 2.598 years and in Group II was 8.80 ± 1.989 years. There was no significant difference observed between Groups I and II in relation to reduced mouth opening and duration of symptoms (P > 0.05) except for age. No significant difference was observed between both the groups in relation to preoperative pain, burning sensation, cheek stiffness, mucosal suppleness, postoperative infection, and postoperative pain at days 1 and 5 and 1st week. There was a significant difference observed in postoperative pain among both the groups on the 3rd day and 2nd week. Conclusion: In the present study, both the groups have proved to give better results, as BFP in the form of interposition material showed rapid epithelization and minimum wound contracture.
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Effect of antiplatelet therapy on minor dental procedures p. 64
Altaf Hussain Malik, Shabnum Majeed
DOI:10.4103/njms.NJMS_30_19  
Introduction: Minor oral surgical procedures are very common. Acetylsalicylic acid generically known as aspirin is used clinically as an analgesic, antipyretic, anti-inflammatory, and as a medication to prevent platelet aggregation. Objective: The aim of this study was to determine if aspirin or clopidogrel was associated with bleeding after minor oral surgical procedures. Materials and Methods: One hundred patients who were planned for extraction of the third molar were divided into two groups. In Group A, patients on antiplatelets were included and in Group B, patients who discontinued the drug before 5 days of procedure were included. The bleeding time of all patients was checked before extraction. The surgical procedure involved simple extraction of a single third molar tooth under local anesthesia. The extraction socket was sutured with 3–0 silk. A pressure pack of gauze was given for 1 h. Bleeding after 1 h and 24 h was compared between two groups. A Chi-square test was used to compare the variables. Results: None of the patients showed active bleeding in the postoperative period. The results for postsurgical bleeding were statistically insignificant with P = 0.05. Conclusion: Minor surgical procedures such as single-tooth extraction can be carried out without discontinuation of the antiplatelet therapy.
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Evaluation of efficacy of platelet-rich fibrin membrane and bone graft in coverage of immediate dental implant in esthetic zone: An in vivo study p. 67
Romesh Soni, Aditi Priya, Rahul Agrawal, Atul Bhatnagar, Lakshya Kumar
DOI:10.4103/njms.NJMS_26_19  
Objective: This study compared and evaluated the clinical and radiographic results of guided bone regeneration using platelet-rich fibrin (PRF) and collagen membrane as barrier membrane in immediately placed implants with severe buccal bone defect (with respect to marginal bone level, implant stability quotient [ISQ]), and histological analysis of new bone formation. Materials and Methods: Sixteen implants were placed in patients requiring immediate implant placement and having a buccal wall defect and randomly divided into two groups one receiving PRF membranes and other collagen membrane. The sites were grafted with bone-substitute material in both the groups. After 4 months, at the time of second-stage surgery, implant stability is measured by Osstell Mentor, crestal bone level on mesial and distal sides of implant by digital intraoral periapical, buccal defect clinically by probe and histological analysis of biopsied bone. Results: The results were insignificant and comparable in both the groups when comparison was made between the groups. The mean buccal defect, mean values of average ISQ, crestal bone level in both the groups at baseline and after 4 months were compared. No significant difference between both the groups was found after 4 months. Bone quality seemed to be equal in both groups after histological analysis. Within the limits of the study, both the groups had shown similar results in all criteria. Conclusion: Within the limitation of the study, it can be concluded that both the treatment modalities are successful in terms of buccal defect reduction, stability, and increase in crestal bone level.
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Perceived oral health status and treatment needs of dental students p. 76
Anchal Deep, Manas Singh, Ruchi Sharma, Mayank Singh, Khurshid Ahmed Mattoo
DOI:10.4103/njms.NJMS_14_19  
Introduction: The aim of this study is to determine the oral health status, anxiety levels, and perceived dental treatment needs of dental students in India. Materials and Methods: A descriptive cross-sectional study of students from Kalka Dental College, India, was conducted using self-administered questionnaire to obtain information on demography, self-reported oral health status, knowledge of the impact of oral health on daily life activity, anxiety levels, dental attendance, and perceived dental needs. Results: Fifty-three percent of respondents rated their oral health as good and almost all (99%) agreed that oral health is a part of general health. Out of 80.1% who had previous dental treatment, scaling and polishing accounted for 16%, whereas 19% had their orthodontic treatment done. At present, their perceived dental treatment needs range from scaling and polishing (36.98%) and fillings (29.79%) to orthodontic treatment (33.2%). Forty-six percent of patients reported a feeling of anxiety while visiting a dentist. Conclusion: This survey revealed that most of the students are aware that oral health is a component of general health and that it has an impact on an individual's daily life. More than half of the students perceived their oral health as good, but only a few knew that there is a need for a preventive approach to oral health as evident by the percentage that perceived scaling and polishing as a treatment need.
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Periosteum eversion technique versus subpedicle connective tissue graft technique for root coverage of gingival recessions: A randomized split-mouth study Highly accessed article p. 81
Awadhesh Kumar Singh, Dhananjay Kumar Mali
DOI:10.4103/njms.NJMS_32_19  
Introduction: The connective tissue graft (CTG) with pedicle flap as subpedicle CTG technique (SPCTGT) is considered the gold standard technique in the treatment of gingival recessions. The aim of this study was to compare periosteum eversion technique (PET) with SPCTGT for root coverage of gingival recessions. Materials and Methods: Ten patients having bilateral gingival recessions of Miller class I and II were selected. The left or right side was randomly assigned into PET group and SPCTGT group. Before and after 1 year of surgery, depth of gingival recession (DGR), width of keratinized gingiva (WKG), width of attached gingiva (WAG), and probing depth (PD) were measured and compared. Pre- and post-groups were compared by paired t-test. Two independent groups were compared by independent Student's t-test. A two-tailed (α =2) P < 0.05 was considered statistically significant. Results: Comparing the pre to post mean of PET and SPCTGT showed decrease (net improvement) in DGR (−5.80 ± 0.42 vs. −4.65 ± 0.39, mean difference = −1.15 ± 0.57, t = 2.02, P = 0.058) and in PD (−1.05 ± 0.12 vs. −0.60 ± 0.12, mean difference = −0.45 ± 0.17, t = 2.64, P = 0.017); and increase (net improvement) in WKG (5.80 ± 0.42 vs. 4.80 ± 0.41, mean difference = 1.00 ± 0.58, t = 1.71, P = 0.104) and in WAG (5.60 ± 0.32 vs. 4.90 ± 0.24, mean difference = 0.70 ± 0.41, t = 1.73, P = 0.101). PET showed 19.8% and 42.9% higher decrease in DGR and PD; and 17.2% and 12.5% higher increase in WKG and WAG, respectively, than SPCTGT. Conclusions: The study found that both the modalities were effective in the management of root coverage of gingival recessions. However, PET was found more effective than SPCTGT.
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Perception and outcome of oral cancer awareness among clinical undergraduate dental students of Tertiary health care centre at Kanpur city: A cross-sectional study p. 89
Rahul Srivastava, Sartaj S Wazir, Bhuvan Jyoti, Sachin Kushwah, Devina Pradhan, Pankaj Priyadarshi
DOI:10.4103/njms.NJMS_6_19  
Background: The International Agency for Research on Cancer has predicted that India's incidence of cancer will increase from 1 million in 2012 to more than 1.7 million in 2035. Lack of knowledge about oral cancer among general dental practitioners leads to delay in the diagnosis and treatment of such lesions. The aim of the present study was to investigate the awareness and knowledge of prevention and early diagnosis of oral cancer among dental undergraduate students. Materials and Methods: A cross-sectional questionnaire study was conducted. A total of 139 undergraduate students who received teaching on oral diseases including oral cancer in their clinical postings in the department of oral medicine and radiology were included in the study. All the students were subjected to evaluation using structured questionnaires with multiple choices. Data collected were subjected to statistical analysis using the Statistical Package for the Social Sciences (SPSS) software version 18. Chi-square test was done to evaluate the statistical significance. Results: The present study showed that the participants had average awareness and knowledge of oral cancer and its clinical presentations. The awareness and knowledge toward oral cancer protocols revealed a decreasing trend from final-year students to 3rd-year and interns. Nearly 66.2% of the undergraduates felt less well informed regarding oral cancer. All the undergraduates (100%) requested further information about oral cancer. Conclusion: The present study concluded that knowledge and awareness of undergraduate dental students with respect to early detection and prevention of oral cancer was satisfactory. It is recommended that the syllabus of dental courses should be expanded to provide knowledge regarding the prevention and early diagnosis of oral cancer.
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The efficacy of intralesional dexamethasone versus intravenous dexamethasone in surgery for impacted third molars: A randomized controlled trial p. 94
Amiya Agrawal, Siddhartha Chandel, Nishi Singh, Arunesh Kumar Tiwari, Akhilesh Kumar Singh, Gaurav Singh
DOI:10.4103/njms.NJMS_46_17  
Objectives: A randomized prospective double-blind study was conducted to determine the efficacy of sub-mucosal local infiltration vs. intravenous dexamethasone in reducing postoperative pain, swelling and trismus after surgical removal of impacted mandibular third molars. Materials and Methods: Forty five patients were included in the study and were randomly divided into three groups. Each group consisted of 15 patients for which the first and second groups were given 8 mg of dexamethasone intrlesionally & intravenously respectively, at 30 minutes prior to surgery; the third group served as control. Duration of facial swelling was evaluated subjectively by the patients themselves. Severity of postoperative pain was quantified by counting the number of analgesics taken by the patients during and after surgery (six subsequent days). Postoperative trismus was determined by measuring the maximum incisal opening before surgery and on the seventh day. Results: Results showed that duration of postoperative edema was almost the same in the three test groups. During surgery, the intravenous dexamethasone group showed a significantly lesser pain than the other two groups; the intralesional dexamethasone group showed less marked pain than the control group. Additionally, patients who had taken steroids had a marked increase in the incisal opening postoperatively over the control group. Trismus was significantly reduced in the methylprednisolone group as compared to the dexamethasone group. Conclusion: It is concluded that both preoperative local infiltration and intravenous administration of dexamethasone significantly reduced postoperative pain and trismus after surgical removal of mandibular third molars. An intravenous dexamethasone is more effective in reducing postoperative inflammatory sequelae than its intralesional route.
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Efficacy of bioresorbable plates in the osteosynthesis of linear mandibular fractures p. 98
Satyavrat Arya, Krushna Bhatt, Ongkila Bhutia, Ajoy Roychoudhury
DOI:10.4103/njms.NJMS_54_19  
Background and Objectives: There are limited evidences available about the performance of biodegradable system in the treatment of linear mandibular fractures without the aid of postoperative maxillomandibular fixation (MMF). Hence, the present study was planned to evaluate the treatment outcomes in mandibular fractures, using 2.5 mm bioresorbable plates and screws without postoperative MMF. Methodology: This cohort study compares both prospective and retrospective data. The prospective study treated 20 adult patients with linear mandibular fracture using bioresorbable plates and screws, without using postoperative MMF (Group 1). Retrospective data were collected from a previous published study in which patients were treated with bioresorbable plates and screws with 2 weeks postoperative MMF (Group 2) and those treated with metal plates and screws without postoperative MMF (Group 3). Group 1 patients were followed up at 2 and 4 months to evaluate the functional outcomes in terms of fracture mobility, malocclusion, pain, and soft-tissue deformity and compared with its preoperative findings. Further, the treatment outcomes of Group 1, Group 2, and Group 3 were compared among themselves at 2-month follow-up. Results: Group 1 patients showed a significant improvement in the treatment outcomes at 2 and 4-month follow-up. In addition, when 2 months postoperative outcomes were compared among the three groups, no statistically significant difference was observed in the treatment outcomes. Conclusion: Endpoint osteosynthesis can be achieved with the bioresorbable fixation system when used in the treatment of un-displaced linear mandibular fractures, without postoperative MMF. A minor modification of using a lower size osteotomy drill can prevent screw loosening.
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Temporomandibular disorders in North Indian population visiting a tertiary care dental hospital p. 106
Akhilanand Chaurasia, Saman Ishrat, Gaurav katheriya, Prabhat Kumar Chaudhary, Kunal Dhingra, Amit Nagar
DOI:10.4103/njms.NJMS_73_17  
Background: The terminology “temporomandibular disorders” (TMDs) encompasses a wide spectrum of conditions. Several hypothesized causes are occlusal disharmony, muscle hyperactivity, central pain mechanisms, psychological distress, and trauma. In day-to-day practice, TMDs had become more prevalent in Indian population due to changed dietary pattern and food habits, excessive stress of modern life, and other environmental causes. This study is an attempt to find the prevalence of TMDs in North Indian population. Aims: The present study is taken into account to determine the prevalence of TMDs on the basis of signs and symptoms based on the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Materials and Methods: The present cross-sectional study was conducted in the Department of Oral Medicine and Radiology. A total of 1009 patients aged between 6 and 80 years with a mean age of 42.04 ± 16.8 years seeking dental treatment from January 2016 to June 2017 were included in the study. All the patients were screened for TMD sign and symptoms. The demographic data and the signs and symptoms of TMDs were recorded in designed structured questionnaires which were based on the RDC/TMD criteria. Results: The study population consisted of 1009 patients aged between 6 and 80 years. In the present study population, based on RDC/TMD criteria, the incidence of clicking sound (42.5%) was highest in TMD joint followed by deviation of mandible on mouth opening (40.8%), internal derangement (36.8%), myofacial pain dysfunction syndrome (33.7%), osteoarthritis (29.5%), crepitus (25.8%), joint tenderness (5.8%), and pain on mouth opening (4.8%). Conclusion: Clicking sound was the most common sign of TMD disorders in Indian population.
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CASE REPORTS Top

Pleomorphic adenoma of the upper lip p. 110
Kadir Cagdas Kazikdas, Eda Tuna Yalcinozan, Mehmet Alp Dirik
DOI:10.4103/njms.NJMS_55_17  
We present a rare case of pleomorphic adenoma in the upper lip region, with erosion of the maxillary bone and distortion of the facial appearance. A 20-year-old man presented with a painless mass on his upper lip, which had gradually increased in size over a period of 2 years. Computed tomography demonstrated a 30 mm × 28 mm enhancing mass in the upper lip region with no invasion to the surrounding tissues. Erosion of the maxillary bone posterior to this lesion was noted. The lesion was excised completely with a wedge of mucosa overlying the tumoral mass, accompanied with abdominal fat grafting to prevent labial asymmetry. Histological examination confirmed the diagnosis of a minor salivary gland pleomorphic adenoma in the upper lip. The pathology, clinical manifestations, and treatment of intraoral pleomorphic adenomas are reviewed.
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Incipient Warthin tumor of intraparotid lymph node in a patient with squamous cell carcinoma of the external auditory canal: An incidental finding p. 113
Deepak Pandiar, Sithara Aravind, Sangeetha K Nayanar, Sajith Babu
DOI:10.4103/njms.NJMS_46_18  
The occurrence of intranodal salivary gland neoplasm is uncommon; squamous cell carcinoma (SCC) of the external auditory canal (EAC) is another rare occurrence. Clinically, SCC of EAC presents with symptoms similar to other benign otologic conditions. A case of Stage I SCC in EAC region is presented here in a 60-year-old male patient with incidental intranodal Warthin tumor along with the histological differential diagnosis. The patient is being followed up. There is no evidence of recurrence 1 year and 11 months after surgery.
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Congenital infiltrating lipomatosis of the face with temporomandibular joint ankylosis p. 117
Ruchi Gupta, Sailesh Kumar Mukul, Prem Kumar, Amit Kumar
DOI:10.4103/njms.NJMS_59_17  
Congenital infiltrating lipomatosis of the face (CIL-F) is characterized by unilateral diffuse infiltration of facial soft tissue by mature adipose cells with associated skeletal hypertrophy. The disease is also considered a subtype of partial hemifacial hyperplasia. We present a case of right hemifacial swelling with severely restricted mouth opening diagnosed with CIL-F associated with temporomandibular joint ankylosis which is very rare, and very few case reports of the same have been published. Computed tomography findings have been discussed in detail with review of literature.
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Frontoethmoidal mucocele causing proptosis and visual loss p. 121
Subhankar Dey, Mehak Agarwal
DOI:10.4103/njms.NJMS_93_18  
Mucoceles are benign mucus-containing cysts formed due to the obliteration of sinus ostium. They are most commonly found in the frontal sinus. Mucoceles can spread both intraorbitally and intracranially causing complications such as meningitis, brain abscess, and loss of vision. Radiological investigations are required for diagnosis, with both computed tomography (CT) and magnetic resonance imaging (MRI) being useful. Surgical approaches for management have changed from external to endonasal these days. We report a case where a 54-year-old patient presented to us with a 14 days' history of loss of vision and complete closure of eyes over 2 days. Contrast-enhanced CT scan and MRI confirmed the diagnosis of frontoethmoidal mucocele breaching the left frontal sinus floor. Endoscopic orbital decompression with functional endoscopic sinus surgery was done. Eye movements and ptosis recovered completely after the surgery, but the vision did not. Although the etiology of mucocele is multifactorial, obstruction of sinus ostium is the most plausible cause. Increasing pressure on adjacent structures by the expanding mucocele can cause intraorbital and intracranial complications. MRI is superior to CT in differentiating mucocele from soft-tissue neoplasms, although CT gives a more detailed information on bone structure. Endoscopic approaches have become the most preferred way to access frontoethmoidal mucoceles, with external approaches being reserved for mucoceles in certain inaccessible locations. Timely intervention is imperative to prevent undesirable complications.
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Tongue–lip adhesion in Pierre-Robin sequence: Role redefined p. 124
Veena Singh, Chandni Sinha, Nishant Sahay, Ansarul Haq, Sarsij Sharma, Shilpa Payal
DOI:10.4103/njms.NJMS_11_17  
The triad of retrognathia, glossoptosis, and airway obstruction characterizes the Robin sequence along with the detrimental effects of mandibular hypoplasia on feeding, swallowing, and growth, which are very well described. Most of the babies are managed successfully on nonsurgical measures, but selected patients require surgical intervention in the neonatal period for survival. Conventionally, tracheostomy was done, which still remains a first-line surgical procedure for some surgeons. However, presently, most of the craniofacial centers have switched over to mandibular distraction procedures at an early stage and only sometimes tongue–lip adhesion (TLA). The literature is unclear as to which surgical procedure for securing the airway is more effective for these patients, and hence, the choice of procedure depends on the resources and surgical expertise. This article tells the tale of a neonate who survived by just placing a simple U-stitch between the tongue and lip, retracting the tongue outside, which is the basic concept of all TLA procedures. It also reemphasizes the importance of TLA in Robin patients to improve the airway obstruction and helps buy the time in which the mandible and associated structures grow.
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Calcifying epithelial odontogenic tumors (Pindborg tumor) of maxilla in pediatric patients p. 127
Atul Kumar Singh, Rahul Mishra, Gourav Jain, Arvind Kumar Singh
DOI:10.4103/njms.NJMS_75_15  
The calcifying epithelial odontogenic tumor (CEOT) was first described by Pindborg as a distinct entity in 1955. Odontogenic tumors are derived from epithelial, ectomesenchymal, and/or mesenchymal elements that are or have been a part of the tooth-forming apparatus. Of all the odontogenic tumors, CEOT accounts for 1% of the cases. There is no sex predilection, with a 2:1 predilection for the mandible, mostly in the premolar/molar region. The CEOT typically presents clinically as an intraosseous, expansile, and painless mass that exhibits slow growth. It is often locally invasive. Most often, it is associated with an impacted tooth, is asymptomatic, and requires biopsy for diagnosis. Although most of these cases are primarily intraosseous, an extraosseous tumor is also known to occur, first observed by Pindborg in 1966. The lesions were surgically enucleated, and histopathological examination confirmed CEOT. The purpose of this article is to describe one additional case of both variants of CEOT.
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A simplified approach in the management of osteochondroma of the mandibular condyle p. 132
Nitin Verma, Jaspreet Kaur, Gurmej Singh Warval
DOI:10.4103/njms.NJMS_1_19  
Osteochondroma of condyle is an exophytic lesion that arises from the cortex of bone and is capped with cartilage. It is one of the most common benign tumors of the bone. It usually appears in endochondral bones. In the mandible, it occurs most frequently at the condyle or coronoid processes. There has been ambiguity in understanding the nature of osteochondroma, whether it is neoplastic or just a reactive phenomenon. Here, we are presenting a case report of a 43-year-old male patient with a chief complaint of deviation of jaw toward the right side and progressive facial asymmetry for the past 1 year. There was an asymmetric prognathism of the lower jaw with ipsilateral open bite and contralateral crossbite. The patient was planned for surgery under general anesthesia. The tumor was dissected from its soft-tissue attachments, and then, complete excision of the tumor was done. Histopathological examination of the lesion showed a proliferation of bony and hyalinized cartilage-like tissues. Two-year postoperative follow-up was uneventful, and no second surgical intervention was required. Computed tomography scan after 2-year follow-up revealed no reoccurrence of lesion, and the patient's facial profile was significantly improved.
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Pleomorphic adenoma of the nasal septum – A rare entity p. 136
Sukrit Bose, Mehak Agarwal, Kundan Nawale
DOI:10.4103/njms.NJMS_4_19  
Pleomorphic adenoma (PA) is the most common benign tumor of major salivary glands, and it rarely arises in minor salivary glands. PA has been reported at various sites where minor salivary glands are found and include nasal cavity, nasopharynx, pharynx, larynx, hypopharynx, and even lacrimal glands. We report one such a case in the nasal cavity in a middle-aged woman. The patient presented with nasal mass and symptoms of obstruction and epistaxis. After clinical and radiological evaluation, the mass was excised endoscopically, and histopathological examination revealed a biphasic benign cellular tumor with scant hyalinized stroma. On immunohistochemistry, the tumor was diffusely positive for CK7 and focally positive for P40 and smooth muscle actin (SMA). Proliferation index was 2%–3%. Finally, the diagnosis of PA was rendered. PA is generally restricted to the cavity due to paucity of space and presents early in the course. Surgical excision with wide margins is the treatment of choice. There are chances of recurrences and malignant transformation of the tumor. To conclude, although rare, one should consider a possibility of PA in the differentials of nasal masses, and accurate diagnosis of this entity is essential to ensure follow-up as recurrence and malignant transformation are reported in PA.
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Buccinator muscle repositioning: A rare case report, short discussion, and literature review p. 140
Nirma Yadav, Anand Kumar, Balaji Manohar, Mihir Shah, Neema Shetty
DOI:10.4103/njms.NJMS_8_19  
Anatomical abnormalities are commonly associated with many problems. Among all anomalies, one is crestal attachment of the frenum or muscle on the alveolar process. Crestal attachment of the buccinator muscle is a rare phenomenon. It may cause various problems in routine oral exercises or restore the edentulous area. The present case report is a case of abnormal buccinator muscle attachment, which was relocated apically by surgical means using an acrylic stent. The healing was uneventful, and significant apical repositioning was observed. The area was then considered for implant placement. An implant was placed, and the long-term results were assured because the patient could maintain oral hygiene well after the muscle repositioning.
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Full-mouth rehabilitation of screw-retained maxillary and mandibular hybrid denture p. 146
Harchintan Kaur, Vishwas Bhatia, Meera Singh, Abhijeet Buragohain
DOI:10.4103/njms.NJMS_22_19  
Difficulty in eating and speaking, ill-fitting denture, and sore mouth syndrome has been life longing among the elderly using dentures. The evolution from conventional denture to implant-supported prosthesis provides these patients normal healthy life with functional and esthetic benefits. An elderly man reported to the Department of Prosthodontics and Oral Implantology of ITS Dental College, Hospital and Research Centre, Greater Noida, with the chief complaint of mobility of upper and lower teeth. After diagnosis and treatment planning, it was decided for immediate implant placement to fabricate a full-mouth implant-supported hybrid prosthesis.
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TECHNICAL NOTE Top

Minimal access fixation of mandibular angle fracture p. 150
Biju Pappachan, Raghav Agrawal
DOI:10.4103/njms.NJMS_44_17  
Angle fractures represent the highest percentage of mandibular fractures. Fixation using a single miniplate ventral to oblique line of buccal cortex of the mandible was described by Champy et al. (1976). Ellis has documented low complication rate with monocortical miniplate fixation as a treatment for angle fractures. Most often used approaches are (a) extraoral approach, (b) intraoral approach, and (c) transbuccal approach. Each of these techniques has its pros and cons. We, in this note, propose an approach which sidelines the drawbacks of these approaches and has the combined advantages of these techniques. This technique results in no external scarring or injury to marginal mandibular nerve, and it also allows direct visualization and confirmation of occlusion during plate placement. This approach is through a contaminated area that poses a risk of infection. This approach of ours is based upon this pioneering works of Forrest. The approach proposed by us can aid an experienced maxillofacial surgeon to provide economical outpatient-based care to patients with minimally displaced/undisplaced angle fracture in a routine dental setup. This technique can be breakthrough for introduction of endoscopic approach for treating angle fracture.
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LETTER TO EDITOR Top

Pathogenesis of temporomandibular joint ankylosis: A perspective p. 154
Krushna V Bhatt, Ajoy Roychoudhury, Ongkila Bhutia
DOI:10.4103/njms.NJMS_91_18  
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