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National Journal of Maxillofacial Surgery
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   Table of Contents - Current issue
January-June 2017
Volume 8 | Issue 1
Page Nos. 1-86

Online since Tuesday, June 27, 2017

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Sushruta: The father of surgery p. 1
Vibha Singh
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Medicinal plants and bone healing Highly accessed article p. 4
Vibha Singh
Fracture is defined as complete or incomplete separation in the continuity of bone Fracture healing is a complex physiological process that involves the coordinated participation of hematopoietic and immune cells within bone marrow. It conjunction with vascular and skeletal cell precursors it also includes mesenchymal stem cells which are recruited from the circulation and the surrounding tissues. It is estimated that 80% of the population in developing countries still rely on the traditional herbal medicines. Healing is practiced by people from all levels of society, who live and work in intimate relation with their environment. They range from bone setting, treatment of snake bite and mental disorders. Knowledge of Medicinal plants and their identification should be gain with the help of cowherds, hermits, hunters, forest dwellers and those who gather plants of forest for food. Sushruta Samita Sutrasthanam 36 V.10. Herbs can effective in reducing swelling pain and soreness of the fracture and al so speedy recovery of function. In last few decades there has been growing In alternative forms of therapy globally. Herbal medicines are currently in demand and their popularity is increasing.
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A comparative clinical evaluation of analgesic efficacy of Tapentadol and ketorolac in mandibular third molar surgery p. 12
Dixit Shah, Sanket Shah, Amit Mahajan, Navin Shah, Darshan Sanghvi, Rishabh Shah
Introduction: The surgical removal of impacted mandibular third molars is one of the most commonly performed dentoalveolar procedures in oral and maxillofacial surgery and is associated with varying degrees of postoperative discomfort. Pain, trismus, and swelling are the most common postoperative complaints, and these influence a patient's quality of life in the days after surgery. Materials and Methods: A comparative study of the 32 patients, 16 were allocated to receive ketorolac and 16 patients were allocated to receive tapentadol. As the data for this study were collected at different time points, analysis for the longitudinal study was done. The main outcome variable, pain level was measured in five-ordered categories. As we had ordinal data in our study, we first checked for marginal homogeneity through Cochran–Mantel–Haenszel test. Results: In the present study, the results show that there is no statistically significant difference between the two treatment groups (P = 0.1184). According to results, there is no significant group by time interaction, which means both drugs have shown almost equal efficacy at different time points. Similarly, there is no difference in efficacy of the two drugs across gender level. Conclusion: The present findings showed that there is no statistically significant difference between the two treatment groups, although ketorolac is more effective for immediate pain reduction than tapentadol. However, the overall reduction of pain using both groups has no significant difference.
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Efficacy of murva (Sansevieria roxburghiana Schult. and Schult.f.) as a suture material in closure of incisions in third molar surgeries: A prospective study p. 19
Pravin Lambade, Ashutosh Thorat
Introduction: Adequate closure of the surgical wound is one of the most important aspects of surgery; improper suturing techniques or improper suturing materials sometimes compromise the success of surgery. Many synthetic materials have replaced the natural materials, which were once used for suturing in the ancient era, and Murva is one of them. There are references of Murva (Sansevieria roxburghiana Schult. and Schult.f.) at various contexts of “Sushruta Samhita” where it has been used as a suture material. It is a xerophytic herbaceous plant occurring abundantly in the eastern coastal region of India. The aim of this study is to evaluate the efficacy of Murva fibers as a suturing material in closure of intraoral incision in third molar surgeries. Materials and Methods: Fifty incisions (Wards incision) placed for the surgical removal of mandibular third molar were sutured with Murva, and follow-up was carried out postoperatively on 1st, 2nd, 3rd, and 7th day. Patients were evaluated for pain, swelling, bleeding, infection, wound dehiscence, local tissue irritation, and bacterial colonization. Results: On various follow-ups, progressively significant and predictable healing was observed without any uneventful evidence. Conclusion: The use of Murva as a suture material proved to be effective in closure of intraoral incisions.
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A comparative evaluation of dental calcification stages and skeletal maturity indicators in North-Indian children p. 26
Vijayta Yadav, Anju Loomba, Ram Autar
Background: Many researchers have reported relationships between the calcification stages of individual teeth and skeletal maturity. A few studies are available in the literature about Indian populations. In view of this fact, this study was conducted to investigate the relationship between the dental calcification stages and skeletal maturity stages among North-Indian individuals. The objective of this study was to determine whether dental calcification can be used as a first-level diagnostic tool for assessment of skeletal maturity. Materials and Methods: The study participants included (60 males, 60 females) ranging from 7 to 13 years. A total of 120 dental panoramic radiographs and hand-wrist radiographs were obtained and analyzed. Calcification stages of the mandibular dentition (canines, first premolars, second premolars, and second molars) were rated according to the system of Demirjian et al. Skeletal maturity indicators stages were determined using the Fishman method. Results and Conclusion: Bivarate correlation ranged from 0.58 to 0.75 for males and 0.73 to 0.84 for females. Canine showed the highest correlation in males and second molar showed the highest correlation in females. Canine calcification Stage H represent prepeak of the pubertal growth spurt in male patients. Calcification Stage G for second molar represents the prepeak and Stage H represents the peak of pubertal growth spurt in females.
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Comparative evaluation of bite force analytical study following mandibular osteosysthesis using three-dimensional and conventional locking miniplates p. 34
Pallav Kumar Kinra, K Jayakumar, CS Soumithran, Manoj Joseph Michael, Deepak Passi, Mahinder Singh
Aims and Objectives: The aim is to study the effectiveness of 2 mm three-dimensional (3D) titanium miniplates and 2 mm conventional titanium miniplates in osteosynthesis of mandibular fractures by comparing the change in bite force. Methodology: The study comprised forty patients of age group 20–40 years, weighing 55–75 kg having mandibular fractures. Patients were randomly divided into two equal groups In Group A, twenty patients underwent osteosynthesis using 3D titanium miniplates (2.0 mm system), whereas in Group B, twenty patients underwent osteosynthesis using conventional titanium miniplates (2.0 mm system). After fixation of fracture segments with miniplates, the patients were assessed on the basis of evaluation of bite force at incisor, right molar and left molar region after 1, 3, 6 , and 8 weeks. Comparison of change in bite force was done between Group A and Group B at different follow-ups at incisor, right molar, and left molar. Results: Bite force recordings showed increasing values at subsequent follow-ups, corresponding to the healing of the fracture in both groups. At follow-up III (6 weeks) and IV (8 weeks), bite force values reached near to those in healthy individuals. A significant difference was observed in change in bite force of Group A and Group B at incisor left molar and right molar on subsequent followups. 3D titanium miniplate requires less surgical exposure of the underlying fracture site, with a minimal traction of the surrounding soft tissue. Interpretation and Conclusion: 3D miniplates in mandibular fractures are efficacious enough to bear masticatory loads during the osteosynthesis of fractures. It gives the advantage of greater stability, increased bite force, reduced implant material, and 3D stability.
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Efficacy of arthrocentesis versus arthrocentesis with sodium hyaluronic acid in temporomandibular joint osteoarthritis: A comparison p. 41
Tikaram Gurung, RK Singh, Shadab Mohammad, US Pal, Abbas Ali Mahdi, Manoj Kumar
Introduction: Temporomandibular joint osteoarthritis (TMJ OA) is a degenerative disease characterized by deterioration of articular tissue with concomitant osseous changes in the condyle and/or articular eminence, joint positive for TMJ noise with jaw movement or function, crepitus detected on palpation on opening, closing, right/left lateral, or protrusive movement. Hyaluronic acid (HA) is a polysaccharide of the family of glycosaminoglycans. HA has been shown to improve and restore normal lubrication in joint, provide nutrition to the avascular articulating disc, and stabilize the joint. Materials and Methods: Twenty patients with OA of TMJ with age limit between 18 and 60 years of age were enrolled in this study. Patients were randomly divided into two groups, in which one group received arthrocentesis only, and another group received arthrocentesis plus intra-articular injection of sodium HA (0.5 ml) in superior joint space in a cycle of 5 weekly arthrocentesis (one per week). Patients were followed at regular interval of 1st day, 5th day, 7th day, 4 weeks, 6 weeks, and 12 weeks. Assessment of clinical outcome was done in terms of reduction in pain (visual analog scale score), maximum mouth opening (MMO) in millimeters, painful/pain-free lateral or protrusive jaw movement, and clicking/crepitus in joint. Results: Significant reduction in pain was observed in both the groups. MMO, lateral and protrusive movements improved significantly in both groups; however, arthrocentesis with sodium HA was superior to arthrocentesis alone. Conclusion: Combination of arthrocentesis with HA injection showed much better outcome than arthrocentesis alone.
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Efficacy of oral colchicine with intralesional hyaluronidase or triamcinolone acetonide in the Grade II oral submucous fibrosis p. 50
Dipti Daga, RK Singh, US Pal, Tikaram Gurung, Shilpi Gangwar
Background and Objectives: Oral submucous fibrosis (OSMF) is a potentially malignant disorder of oral mucosa affecting mainly population in South and Southeast Asia. The aim of this study is to compare the effectiveness of oral colchicine with intralesional injection of hyaluronidase or injection triamcinolone acetonide in patients with Grade II OSMF. Materials and Methods: The study included thirty patients of clinically diagnosed Grade II OSMF. Patients were divided randomly into two groups: Group A patients were treated by administrating tablet colchicine 0.5 mg twice daily with an intralesional injection of hyaluronidase 1500 IU with 0.5 ml of lignocaine hydrochloride at weekly interval for 12 weeks. Group B patients were treated by administering tablet colchicine 0.5 mg twice daily with an intralesional injection of triamcinolone acetonide 10 mg/ml at weekly interval for 12 weeks. Clinical diagnosis was based on burning sensation in mouth, blanching of mucosa, presence of vesicles or ulceration in oral cavity, and reduced mouth opening. Outcome assessment was done at intervals of 3 weeks, 6 weeks, 3 months, and 6 months. Results: Improvement in mouth opening and reduction in burning sensation was seen more in Group A patients. Improvement in blanching of mucosa was seen in both the groups. Conclusion: In conclusion, use of injection hyaluronidase with oral colchicine gave better results in terms of increase in mouth opening and improvement in burning sensation without notable side effects. However, for a definite conclusion, further study with large sample size and long follow-up is required.
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Bilateral parotidomegaly as an initial manifestation of acute lymphoblastic leukemia in a child: A case report and review of literature p. 55
Latha Magatha Sneha, Kaarthikeyani Sankaravadivelu Subbiah, Julius Xavier Scott, Aruna Rajendiran
The more common causes of parotid enlargement in children are infections and inflammatory conditions. Primary neoplasms of the parotid glands are rare in pediatric age group; however, secondary malignancies have been reported in survivors of childhood leukemia. The parotid glands have been the sites of relapses in acute lymphoblastic leukemia (ALL) and acute myeloid leukemia. However, bilateral parotid involvement as an initial presentation of ALL is rarely reported. We present a case of an 8-year-old boy who presented with bilateral parotid enlargement as an initial manifestation of ALL. General physicians should be aware of this extramedullary presentation of acute leukemia when they see a child presenting with organomegaly or abnormal blood counts.
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Unilateral condylar hyperplasia – A genetic link? Case reports p. 58
Monika Mahajan
Unilateral condylar hyperplasia is an uncommon condition with unknown etiology which causes overdevelopment of condyle leading to facial asymmetry, mandibular deviation, malocclusion, and articulation dysfunction. Two Indian families with unilateral condylar hyperplasia are presented where the similar abnormality was also detected in one of their parents. The condylar hyperplasia in these two families indicates that mandibular condylar hyperplasia could be genetic in origin.
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Role of sclerotherapy in management of vascular malformation in the maxillofacial region: Our experience p. 64
Madan Mishra, Gaurav Singh, Amit Gaur, Sapna Tandon, Abhishek Singh
The management of vascular anomalies is an extremely challenging area and is as divergent as the nature of lesions. Traditionally, embolization with the resection of the lesion has been used. The purpose of this report is to present cases treated successfully using sclerosing solution injections alone. Management of the vascular malformation using intralesional injections of sodium tetradecyl sulfate to the lesion is discussed. The procedure was performed two times at 2 weeks interval. Complete resolution of the lesion was found following sclerotherapy. Conservative interventional management using intralesional injection of sclerosing solution was successful in treating vascular anomaly.
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Recurrent keratocystic odontogenic tumor of right maxillary sinus involving the right infraorbital rim p. 70
Karthikeyan Maruthamuthu, G Vasupradha, Janardhanam Dineshshankar, Abishek Rajaram Balaji
Keratocystic odontogenic tumor (KCOT) is a benign odontogenic tumor with an aggressive behavior and high recurrence rate. The most common site of predilection is the posterior mandible. In contrast, KCOTs occurring in the maxillary region are relatively rare. However, the maxillary involvement poses a greater and increased threat, due to proximity to vital structures such as maxillary sinus, orbital floor, and infratemporal fossa. This report presents such a case of KCOT involving the maxillary sinus eroding the floor of the orbit and provides an account of the factors that need to be considered during management.
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Concomitant hypodontia and hyperdontia: A report of two cases p. 75
Nitesh Tewari, Ramesh Kumar Pandey, Subash Singh
“Concomitant hypodontia and hyperdontia” is a very rare dental anomaly of number, having a prevalence rate of 0.002%–3.1%. It describes the simultaneous presence of hypodontia or missing teeth and supernumerary teeth in the same individual. It represents the opposite forces of nature acting simultaneously. Two rare cases of this anomaly involving different jaws and a classification based on the literature review have been presented here.
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Verruciform xanthoma of the tongue p. 78
Sanjay Byakodi, Barun Kumar, Sandeep Patil, Swapnil Shinde
Verruciform xanthoma is a benign, soft tissue lesion occurring on the orogenital mucosa. Presentation of oral lesions can be pink, yellow, or gray raised plaque or papule with granular, papillary, or verrucous in nature. There are many theories proposed for the etiopathogenesis of verruciform xanthoma. Clinical observations may be misguiding as the lesion resembles malignant and premalignant lesions. Histopathological confirmation is essential for diagnosis and avoiding radical surgery. Once excised, the lesion does not recur. Here, we present a case report of verruciform xanthoma of the tongue in a 50-year-old female patient.
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Report of a rare cyst at a rare site: Heterotopic gastrointestinal cyst partially lined with dermoid cyst epithelium p. 81
Anjali Narwal, Anju Devi, Achla Bharti Yadav, Virender Singh, Ambika Gupta
Heterotopic gastrointestinal cysts (HGCs) of the oral cavity are rare benign lesions mimicking benign or malignant pathologies. These cysts are usually discovered during infancy but may not appear until well into adulthood. The epithelial lining of these cysts shows variable presentation with the presence of an enteric lining as an essential component. The histogenesis is related to entrapment of undifferentiated, noncommitted endoderm within the oral cavity during the 3rd–4th week of fetal life. We report a rare case of oral HGC located at a very rare site, i.e., infratemporal fossa with histopathologic features that included portions resembling dermoid cyst also. Histopathology and etiopathogenesis of the lesion are discussed. Origin from misplacement of embryonic remnants, i.e., undifferentiated endodermal cells is suggested.
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Common peroneal nerve palsy in maxillofacial surgery setting p. 85
Jimish Desai
Common peroneal nerve palsy in maxillofacial surgery setting is an uncommon and rarely reported complication. A patient who developed common peroneal nerve palsy following reduction and fixation of pan facial fractures under general anesthesia is presented. The patient developed common peroneal nerve palsy on the second postoperative day. He recovered with conservative treatment after 3 months. The authors consider that the nerve palsy was a result of compression of common peroneal nerve related to patient positioning in the perioperative period. Patient- and surgery-related risk factors are also to be considered. Thus, for at risk patients, positioning is of utmost importance in both intra- and peri-operative period.
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