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National Journal of Maxillofacial Surgery
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   2014| January-June  | Volume 5 | Issue 1  
    Online since September 5, 2014

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An eye for a lost eye: A case of self-inflicting gunshot injury
Indu Bhusan Kar, Rosalin Kar, Niranjan Mishra, Akhilesh Kumar Singh
January-June 2014, 5(1):74-78
DOI:10.4103/0975-5950.140184  PMID:25298724
Maxillofacial defects due to gunshot injuries can have detrimental functional and psychological effects on the patient. These occur predominantly in young males, although all are at risk. Military, civil, accidental or self-inflicted injuries employing guns of varying caliber and ballistic properties may produce a defect or deformity which encompasses the entire spectrum of reconstructive surgery. Patients with facial defects have major difficulties to re-establish their mastication, speech, soft-tissue projections and therefore social integration. Successful prosthetic rehabilitation is crucial for better quality of life in case of large facial deformities. We present a case of 24-year-old male with gunshot injury to the left side face leading damage to the eye, which was rehabilitated with oculo-facial prosthesis.
  14,724 575 -
Epidermoid cyst of the floor of the mouth
Mohan Baliga, Nandita Shenoy, Dharnappa Poojary, Ram Mohan, Ramdas Naik
January-June 2014, 5(1):79-83
DOI:10.4103/0975-5950.140185  PMID:25298725
Dermoid cysts are malformations that are rarely seen in the oral cavity. An intraoral dermoid cyst grows slowly, but may enlarge and interfere with deglutition and speech, or can pose a critical risk to the airway and therefore require immediate surgical intervention. Dermoid cysts may develop above or below the mylohyoid muscle, causing a submental or submandibular swelling. Surgical excision is the treatment of choice and recurrence is rare. An intraoral approach for the treatment of large lesions presenting above the mylohyoid muscle provides good cosmetic and functional results. We report a case of a 26-year-old female who developed an epidermoid cyst presenting as a large sublingual swelling causing speech and swallowing difficulties. The lesion was surgically excised using an intraoral approach. Microscopic examination revealed a dermoid cyst of the epidermoid type. This case shows that dermoid cysts may be successfully diagnosed and managed using a series of simple yet effective clinical procedure.
  10,119 422 2
Role of coronoidectomy in increasing mouth opening
Hemant Gupta, Parul Tandon, Deepak Kumar, Vijay Prakash Sinha, Sumit Gupta, Hemant Mehra, Jasmeet Singh
January-June 2014, 5(1):23-30
DOI:10.4103/0975-5950.140164  PMID:25298713
Aim: To evaluate the effectiveness of coronoidectomy in advanced (stage III-IV) oral submucous fibrosis (OSMF) and temporomandibular joint (TMJ) ankylosis. Materials and Methods: Five patients clinically diagnosed as grade III/IV OSMF (group 1) and seven patients clinically and radiographically confirmed as TMJ ankylosis (group 2) underwent surgery entailing coronoidectomy in addition to conventional surgical procedures required in both the conditions followed by vigorous mouth opening exercises. The results were evaluated using the interincisal distance at maximum mouth opening as the objective outcome over a follow-up period of 2 months. Results: OSMF patients (group I) showed a mean preoperative interincisal opening of 14.40 mm which increased to 24.60 mm after conventional procedures and showed further increment to 35 and 44.80 mm after unilateral and bilateral coronoidectomy, respectively; which was statistically significant (P = 0.043). Follow-up of 2 months showed a gradual increase in mean mouth opening compared to baseline which was also found to be statistically significant (P = 0.043). In TMJ ankylosis patients (group II), preoperative mean mouth opening of 6.71 mm increased to 24.29 mm after conventional procedures, and further to 37.29 mm after unilateral coronoidectomy which was statistically significant (P = 0.018). On subsequent follow-up of 2 months, a gradual increase in mean mouth opening compared to baseline was observed which was statistically significant (P = 0.018). Conclusion: Coronoidectomy is an effective adjunct in increasing intraoperative and stabilizing postoperative mouth opening.
  6,673 854 5
Dumbbell-shaped lymphangioma of neck and thorax
Shailendra Kumar, Sanjeev Kumar, Surender Kumar, Ved Prakash, Vijay Kumar
January-June 2014, 5(1):90-92
DOI:10.4103/0975-5950.140187  PMID:25298728
Vascular malformations consist of a spectrum of lesions involving all parts of the body. They have different terminologies like vascular tumors, vascular malformations, vascular anomalies, and so on, which create a lot of confusion in understanding and treating these pathologies. Of late, classification on the basis of cellular kinetics and clinical behavior has been devised. Hemangioma is the most common vascular tumor. Vascular malformations are of either lymphatic or capillary and venous origin. Sometimes they are of a mixed origin. Lymphangiomas are common in the face and neck area. They are also not unusual in the mediastinum. We present a case where a huge lymphangioma occupied the right supraclavicular area of the neck, extending to nearly the entire right thoracic cavity, compressing the whole lung. The patient had occasional symptoms of cough. Ultrasonography (US) and computed tomography (CT) images clearly described the lesion as cystic, occupying both the supraclavicular and thoracic cavity compressing the lung parenchyma. Surgical excision was planned and we approached the lesion via both cervical and thoracotomy incisions. Complete excision was done, and the lung expended fully after the surgery.
  5,210 341 2
Hereditary gingival fibromatosis
Akhilanand Chaurasia
January-June 2014, 5(1):42-46
DOI:10.4103/0975-5950.140171  PMID:25298717
Hereditary gingival fibromatosis (HGF) is a rare condition that can occur as an isolated disease, chromosomal abnormality, or as part of a number of syndromes. The gingival enlargement in HGF can be so severe that it can cover the crowns of teeth completely, causing severe functional derangement and facial disfigurement. Through review of literature revealed that HGF is usually an autosomal dominant condition, however the recessive forms are also reported. The hyperplastic gingiva is firm on palpation and has normal color with abundant stippling on the adjacent gingiva. The buccal and lingual gingiva may be involved in both the mandible and maxilla. The degrees of gingival enlargement show both intra- and interindividual variations. Here, an interesting case report of massive HGF has been presented.
  4,709 449 2
Role of dental expert in forensic odontology
Anoop K Verma, Sachil Kumar, Shiuli Rathore, Abhishek Pandey
January-June 2014, 5(1):2-5
DOI:10.4103/0975-5950.140147  PMID:25298709
Forensic dentistry has become an integral part of forensic science over the past 100 years that utilizes dental or oro-facial findings to serve the judicial system. This has been due to the dedication of people like Gustafson's, Keiser-Nielson, and Suzuki for this field. They established the essential role which forensic dentistry plays mainly in the identification of human remains. The tooth has been used as weapons and under certain circumstances, may leave information about the identity of the biter. Dental professionals have a major role to play in keeping accurate dental records and providing all necessary information so that legal authorities may recognize mal practice, negligence, fraud or abuse, and identity of unknown individuals. This paper will try to summarize the various roles of dental experts in forensic medicine.
  3,747 845 3
Endodontic implants
Rakesh K Yadav, AP Tikku, Anil Chandra, KK Wadhwani, Ashutosh kr , Mayank Singh
January-June 2014, 5(1):70-73
DOI:10.4103/0975-5950.140183  PMID:25298723
Endodontic implants were introduced back in 1960. Endodontic implants enjoyed few successes and many failures. Various reasons for failures include improper case selection, improper use of materials and sealers and poor preparation for implants. Proper case selection had given remarkable long-term success. Two different cases are being presented here, which have been treated successfully with endodontic implants and mineral trioxide aggregate Fillapex (Andreaus, Brazil), an MTA based sealer. We suggest that carefully selected cases can give a higher success rate and this method should be considered as one of the treatment modalities.
  2,428 818 1
Rapid maxillary canine retraction by dental distraction: A clinical study
NK Koteswara Prasad, Arun Chitharanjan, Vignesh Kailasam
January-June 2014, 5(1):6-13
DOI:10.4103/0975-5950.140148  PMID:25298710
Aim: The aim of this clinical study was to perform rapid maxillary canine retraction through distraction of the periodontal ligament and investigate the rate and amount of canine retraction, amount of anchor loss, the nature of tooth movement achieved, and radiographic changes in the periodontal ligament region during and after canine distraction. Materials and Methods: This study was conducted on 10 distractions ranging in age from 14 years to 25 years who needed canine retraction and first premolar extraction in the maxillary arch. Ten canine distractions were carried out with custom-made, tooth-borne intra-oral distraction device. Results: The results indicate that the periodontal ligament can be distracted just like the mid-palatal suture in rapid palatal expansion and the maxillary canines are retracted rapidly into the first premolar extraction space at the rate of about 2.53 mm/week. Conclusion: Though this study indicates that the periodontal ligament can be distracted to elicit rapid tooth movement, the long-term effects of canine distraction are not well known and need close monitoring. Clinical Significance: This technique has the potential to significantly reduce orthodontic time.
  2,664 559 1
Honey a sweet approach to alveolar osteitis: A study
Vibha Singh, US Pal, Ranjana Singh, Nikita Soni
January-June 2014, 5(1):31-34
DOI:10.4103/0975-5950.140166  PMID:25298714
Background: Honey is one of the oldest known medicines. Its use has been rediscovered in later times by the medical profession, especially for dressing wounds. It has been reported from various clinical studies on the usages of honey as a dressing for infected wounds that the wound become sterile in 3-6 days, others have al so reported that the honey is effective in cleaning up infected wound. Materials and Methods: The 54 patients of dry socket were selected from the from the outpatient department of oral and maxillofacial surgery. A diagnosis of dry socket was made clinically. This study was under taken to evaluate the effect of honey dressing in management of dry socket. Results: In this study there was significant reduction if inflammation, hyperemia, edema and exudation after honey dressing that results in soothing effect and reduction in pain and discomfort. There was al so significant reduction in CRP level post operative days .There was side effect of honey was observed in our study, so it can be used as alternative for the management of dry socket. Discussion: It has al so been reported that the honey dressing halt advancing necrosis. It has al so been found to act as barrier preventing wounds from becoming infected, preventing cross infection, and allowing burn wound to heal rapidly. Conclusions: There are no side effects of honey. Excess use of euginol, can lead to necrosis of bone. The honey can be used as medicament for the management of dry socket.
  2,534 680 6
Ortho-surgical management of condylar hyperplasia: Rare case reports
Virendra Singh, Ajay Verma, Gyanander Attresh, Jitender Batra
January-June 2014, 5(1):54-59
DOI:10.4103/0975-5950.140180  PMID:25298720
Condylar hyperplasia of the mandible is a clinical condition of over-development and growth because of excessive cellular growth of one condylar part of the mandible leading to facial asymmetry, mandibular deviation and enlargement of condyle. The elongation of the condylar neck in turn leads to malocclusion and articular dysfunction. In the past the interceptive and corrective procedures of growth and deformity in condylar hyperplasia were either condylectomy or high condylotomy. However, the deformity ceases after growth is completed. Therefore, other surgical procedures have to be undertaken to correct the manifested deformity of condylar hyperplasia. Further it has to be stressed that no single procedure can completely correct the deformity. So in addition to condylectomy, other orthognathic surgical procedures both on body and ramus and also on maxilla can be undertaken to correct the canting of occlusion. Two rare cases of unilateral hyperplasia encountered in our hospital are presented which required different lines of treatment.
  2,034 444 -
Awareness of basic life support among dental practitioners
Neha Baduni, Prem Prakash, Dhirendra Srivastava, Manoj Kumar Sanwal, Bijender Pal Singh
January-June 2014, 5(1):19-22
DOI:10.4103/0975-5950.140159  PMID:25298712
Background: It is important that every member of our community should be trained in effective BLS technique to save lives. At least doctors including dental practitioners, and medical and paramedical staff should be trained in high quality CPR, as it is a basic medical skill which can save many lives if implemented timely. Aim: Our aim was to study the awareness of Basic Life Support (BLS) among dental students and practitioners in New Delhi. Materials and Methods: This cross sectional study was conducted by assessing responses to 20 selected questions pertaining to BLS among dental students, resident doctors/tutors, faculty members and private practitioners in New Delhi. All participants were given a printed questionnaire where they had to mention their qualifications and clinical experience, apart from answering 20 questions. Statistical Analysis: Data was collected and evaluated using commercially available statistical package for social sciences (SPSS version 12). Results: One hundred and four responders were included. Sadly, none of our responders had complete knowledge about BLS. The maximum mean score (9.19 ± 1.23) was obtained by dentists with clinical experience between 1-5 years. Conclusion: To ensure better and safer healthcare, it is essential for all dental practitioners to be well versed with BLS.
  1,984 477 -
Ameloblastoma of the anterior mandible
Hariram , Shadab Mohammad, Laxman R Malkunje, Nimisha Singh, Sugata Das, Gagan Mehta
January-June 2014, 5(1):47-50
DOI:10.4103/0975-5950.140173  PMID:25298718
Ameloblastoma or adamantinoma is the rarest of the three forms of tumor of the odontogenic type. They are benign, locally aggressive neoplasms arising from ameloblasts, which typically occur at the angle of the mandible, and are often associated with an un-erupted tooth and must, therefore, be differentiated from a dentigerous cyst which will be centered on the crown. When in the maxilla (less common), they are located in the premolar region, and can extend up in the maxillary sinus. Ameloblastoma is reported to constitute about 1-3% of tumors and cysts of the jaws. The tumor is by far more common in the mandible than in the maxilla and shows predilection for various parts of the mandible in different racial groups. The relative frequency of the mandible to maxilla is reported as varying from 80-20% to 99-1%. Here, we are representing a case of ameloblastoma of anterior mandible which was considered as a rare site of occurrence.
  1,782 434 4
Recurrent case of central giant cell granuloma with multiple soft tissue involvement
Suresh Yadav, Anurag Singh, Prince Kumar, Shallu Tyagi
January-June 2014, 5(1):60-66
DOI:10.4103/0975-5950.140181  PMID:25298721
Central giant cell granuloma is a fairly common lesion in the jaws aetiology of which is still completely unknown but thought to be of a reactive process to some unknown stimuli. It usually arises either peripherally in periodontal ligament, mucoperiosteum, or centrally in the bone. The histological hallmark for both peripheral and central giant cell granuloma (CGCG) is the presence of distinctive multinucleated giant cells (MGCs) in a prominent fibrous stroma. Central giant cell granuloma is an uncommon benign proliferative lesion that almost exclusively occurs within the jaw. Eventually, it may become aggressive leading to the expansion and perforation of cortex resulting into mobility and displacement of teeth with root resorption. The present case focuses on the dilemma and perplexity in diagnosing aggressive CGCGs, due to its close proximity with respect to pathology, behavior and prognosis from giant cell tumors (GCT). Central giant cell granuloma persuaded extensive destruction to the hard and soft tissues with high rate of recurrence encourage us the need of exploring the possibilities of giant cell tumors having a definitive presence in the jaws.
  1,782 378 2
Herbal remedies for mandibular fracture healing
Shadab Mohammad, US Pal, R Pradhan, Nimisha Singh
January-June 2014, 5(1):35-38
DOI:10.4103/0975-5950.140167  PMID:25298715
Purpose: When a bone is fractured it is usually necessary to employ a mechanical means to reduce and maintain the fragments in position. However, healing of the fracture is governed by biological principles, with which the mechanical measures must be coordinated to the end, such that a satisfactory bony union and restoration of form and function are obtained. We have studied the effect of Cissus quadrangularis (Harjor) and Ocimum sanctum (Tulsi), in the healing of mandibular fractures. Materials and Methods: A total of 29 cases having a fracture in the body of the mandible were included in the study and divided into three groups. Groups A and B were treated with Ocimum sanctum and Cissus quadrangularis, respectively, and fracture healing was assessed with biochemical markers and the bite force. Group C was the control group. Results: The period of immobilization was the lowest in the Group A followed by Group B. A significant increase in alkaline phosphatase and serum calcium was seen in Group B. The tensile strength in terms of the biting force was the maximum in cases of Group B. Conclusion: We conclude that Cissus quadrangularis and Ocimum sanctum help in fracture healing, and use of such traditional drugs will be a breakthrough in the management and early mobilization of facial fractures.
  1,683 439 4
Schwannoma of the hard palate
Pradyumna Kumar Sahoo, Palash Kumar Mandal, Saradindu Ghosh
January-June 2014, 5(1):39-41
DOI:10.4103/0975-5950.140169  PMID:25298716
Schwannomas are benign encapsulated perineural tumors. The head and neck region is the most common site. Intraoral origin is seen in only 1% of cases, tongue being the most common site; its location in the palate is rare. We report a case of hard-palate schwannoma with bony erosion which was immunohistochemically confirmed. The tumor was excised completely intraorally. After two months of follow-up, the defect was found to be completely covered with palatal mucosa.
  1,571 316 6
Oral and maxillofacial surgery in south Asian countries - bridging the gap
Vidya Rattan
January-June 2014, 5(1):1-1
DOI:10.4103/0975-5950.140145  PMID:25298708
  1,460 303 -
Management strategy for facial venous malformations
Shailendra Kumar, Vijay Kumar, Sanjeev Kumar, Surender Kumar
January-June 2014, 5(1):93-96
DOI:10.4103/0975-5950.140188  PMID:25298729
Venous malformations (VMs) are slow-flow vascular malformations, caused by abnormalities in the development of the veins. Venous malformations vary in size and location within the body. When the skin or tissues just under the skin are affected, they appear as slightly blue-colored skin stains or swellings. These can vary in size from time to time because of swelling within the malformation. As these are vascular malformations, they are present at birth and grow proportionately with the child. Venous malformations can be very small to large in size, and sometimes, can involve a significant area within the body, When the venous malformation is well localized, this may cause localized swelling, however, when the venous malformation is more extensive, there may be more widespread swelling of the affected body part. Some patients with venous malformations have abnormal blood clotting within the malformation. Most venous malformations cause no life-threatening problems for patients. Some venous malformations cause repeated pain due to intermittent swelling and congestion of the malformation or due to the formation of blood clots within the malformation. Rarely, venous malformations may be part of a syndrome (an association of several clinically recognizable features) or be linked to an underlying genetic abnormality. We present 12 cases of venous malformations of the head and neck area, which have been managed at our hospital.
  1,422 312 2
Evaluation of intubating conditions using stylet by conventional through-tube technique and through Murphy's eye in patients with high Mallampati scores
Haider Abbas, Nikhil Kothari, Aman Agarwal, Sulekha Saxena, Jaishri Bogra
January-June 2014, 5(1):14-18
DOI:10.4103/0975-5950.140149  PMID:25298711
Background: Difficult intubation is always a nightmare for an Anaesthetist. This study was planned to study the alternative method of stylet use during difficult oro-tracheal intubation. Outcome measures assessed were ease of intubation, hemodynamic stability and reducing complications. Materials and Methods: A cohort of 60 patients of Mallampati class III patients was formed and patients were divided into two groups. In group 1 patients, conventional through tube method was used for inserting stylet, whereas, in group 2 patients, Murphy's eye was used for inserting malleable flexi tip stylet. Results: Hemodynamic stability in terms of mean arterial blood pressure and heart rate was observed in group 2. Intubating time, number of attempts of successful intubation and post operative pharyngo-laryngeal complications was also low in group 2 patients. Conclusion: The use of Murphy's eye to pass stylet during difficult airway manoeuvre is a safe alternative over conventional rail-road technique.
  1,478 220 -
A Type I first branchial cleft cyst masquerading as a parotid tumor
Arvind Krishnamurthy, Vijayalakshmi Ramshanker
January-June 2014, 5(1):84-85
DOI:10.4103/0975-5950.140189  PMID:25298726
Branchial cleft anomalies are caused by incomplete regression of the cervical sinus of "His" during the 6 th and 7 th weeks of embryologic development. Although congenital in origin, first branchial cleft cysts (FBCCs) can present later in life. FBCCs are rare causes of parotid swellings, accounting for <1% of all the branchial cleft abnormalities. The diagnosis of FBCCs is a clinical challenge; the condition is often overlooked and mismanaged. We report a case of Type 1 FBCC in a 22-year-old female with an asymptomatic 3.5 cm × 2.5 cm sized cystic mass. It was removed completely under the impression of a cystic tumor of the parotid. On histopathology, the cyst had a squamous epithelium-lined wall with lymphoid aggregation which was characteristic of a branchial cleft cyst. A good understanding of the regional anatomy and embryology can lead to an early diagnosis and thereby effective management of FBCC.
  1,380 280 2
Bilateral keratocystic odontogenic tumor: A report of two cases
KS Srivatsan, Vikas Kumar, Ashish Mahendra, Preeti Singh
January-June 2014, 5(1):86-89
DOI:10.4103/0975-5950.140186  PMID:25298727
The designation "keratocyst" was used to describe any jaw cyst in which keratin was formed to a large extent. A rare incidence of bilateral mandibular cysts (odontogenic keratocysts) was related to third molar teeth. Herein, we report two cases of bilateral keratocystic odontogenic tumor in a 22-year-old male and 15-year-old female, which was diagnosed by a series of investigations and treated appropriately.
  1,219 280 -
Concomitant hypo-hyperdontia with an endocrine etiology
Sharmila Surendran, A Venkatachalapathy, K Vimalageetha, A Eapen Thomas
January-June 2014, 5(1):51-53
DOI:10.4103/0975-5950.140174  PMID:25298719
The simultaneous occurrence of hypodontia and supernumerary teeth in the same individual is termed as "concomitant hypohyperdontia" and it is an uncommon condition with the etiology still unknown. Presented here is a very rare case of simultaneous presence of multiple supernumerary teeth and multiple missing teeth (bilateral maxillary second premolars and bilateral mandibular second molars) involving both jaws with a history of subclinical hypothyroidism. Systemic diseases could probably play a role in the etiologic occurrence of co-existent partial anodontia and supernumerary teeth.
  1,273 215 1
Retrieval of foreign body from a postoperative defect in the mandible during the follow-up period: A bizarre occurrence
Harish M C Saluja, Bhimmapa Mallapa Rudagi, Uma Rajan Mahindra, Prafful T Gaikwad, Vipin V Dehane
January-June 2014, 5(1):67-69
DOI:10.4103/0975-5950.140182  PMID:25298722
Though reported cases of foreign bodies left intraoperatively in the oral cavity are very few, there is no case mentioned in the literature where foreign body was left behind during follow-up visits. Here, we present an operated case of unicystic ameloblastoma of mandibular ramus region, in which a needle hub was left at the operated site (cavity created because of wound dehiscence) during some of the follow-up visits, which was detected accidently by radiograph and later on retrieved. The case reported was because of negligence of trainee surgeons, might be because of overburden or because of minimal interest in these repeated follow ups. But, a trainee should understand that their work also has similar importance as that of surgeon's work.
  1,092 196 1