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National Journal of Maxillofacial Surgery
 
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   Table of Contents - Current issue
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July-December 2020
Volume 11 | Issue 2
Page Nos. 157-310

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EDITORIAL  

Organizing craniofacial surgery teams p. 157
Arun K Singh
DOI:10.4103/njms.NJMS_248_20  
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REVIEW ARTICLES Top

Oral mucositis p. 159
Vibha Singh, Akhilesh Kumar Singh
DOI:10.4103/njms.NJMS_10_20  
Oral mucositis is one of the most common complications of cancer therapy. It is a nonhematologic complication of cytotoxic chemotherapy and radiotherapy and reduces the quality of life. It is estimated that 40% the cases on standard chemotherapy may develop oral mucositis. Patients receiving radiation, especially in the cases of head and neck cancer, have 30%–60% chances of developing mucositis. Chemotherapy and radiotherapy interfere with the normal turnover of epithelial cells, leading to mucosal injuries. These injuries can also occur due to indirect invasion of Gram negative bacteria and fungi as most of the chemo-therapeutic agents will cause neutropenia and will give a favorable environment for the development of mucositis. The patient-related factors are also responsible for developing mucositis in chemo-induced and radiation-induced mucositis. Poor oral hygiene may also be responsible for bacterial super infection followed by chemotherapy. Mucositis is of two kinds: direct and indirect mucositis. Direct mucositis - The epithelial cells of the oral mucosa undergo rapid turnover in usually 7–14 days due to which these cells are more susceptible to the effect of the cytotoxic therapy which results in oral mucositis. Indirect mucositis – it can develop due to the infection caused by Gram-negative bacteria and fungal infection. There will be a greater risk for oral infection due to neutropenia. The onset of mucositis secondary to mylo-suppression varies depending upon the timing of the neutrophil count associated with chemotherapy agents but they typically develop around 10–21 days after chemotherapy administration.
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Evaluating the role of local host factors in the candidal colonization of oral cavity: A review update p. 169
Imran Khan, Tanveer Ahmad, Nikhat Manzoor, Moshahid Alam Rizvi, Uqba Raza, Shubhangi Premchandani
DOI:10.4103/njms.NJMS_161_20  
Human oral cavity is home to a number of organisms, Candida albicans being one of them. This review article aims at understanding the correlation between the oral candidal colonization and the local host factors that may influence it with special emphasis on congenital craniofacial anomalies such as cleft lip and palate (CLP). Various scientific databases were searched online and relevant articles were selected based on the inclusion criteria. A comparative study was done to understand the interdependence of various factors (including CLP) and oral candidal colonization. The results revealed a strong association of certain local host factors which may influence the oral colonization of Candida species. Factors such as mucosal barrier, salivary constituents and quantity of saliva, congenital deformities like CLP, oral prostheses such as dentures/palatal obturators and fixed orthodontic appliances (FOAs) were identified. All these factors may directly affect the growth of Candida in the oral cavity. Although numerous studies have pointed a positive correlation between Oral Candidal colonization and local host factors such as oral prostheses, FOA, and oral mucosal barrier only one study has been done, in the Indian subcontinent with respect to the correlation of candidal colonization and CLP. After the evaluation of all the factors mentioned in various case studies, it can be concluded that the presence of local host factors such as orofacial clefts, dental prostheses, FOA, xerostomia, and atrophy of the oral mucous membrane lead to significant increase in candidal colonization, but since very few studies in regard to CLP have been done worldwide and in India, in particular, further studies are warranted.
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Evaluation of osseintegration between traditional and modified hydrophilic titanium dental implants – Systematic analysis p. 176
Geeta Arya, Varun Kumar
DOI:10.4103/njms.NJMS_44_20  
The aim of the study was to conduct a systematic review to access the osseointegration between traditional and modified Hydrophilic Titanium Dental Implants for period of 10 years. PUBMed articles were searched from last ten years up to 15/12/2019 from which 24 studies included in this review. This systematic review compiles the data about osseintegration in hydrophilic titanium implants in human trials. It sheds light on the mechanism of integration of hydrophilic surfaces and numeric data to support the purpose of the review.
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ORIGINAL ARTICLES Top

Does diagnostic accuracy of surgeon's perception outweigh frozen section analysis in determining intraoperative clear mucosal surgical margins in oral squamous cell carcinoma patients? p. 182
Chetan Gupta, Nitin Bhola, Anendd Jadhav, Apoorva Mishra, Pawan Hingnikar, Chinmay Ghavat
DOI:10.4103/njms.NJMS_50_20  
Introduction: The lucrativeness of the frozen section for intraoperative margin assessment in head and neck squamous cell carcinoma is debatable till date. The purpose of this study was to evaluate whether surgeon's perception by gross examination (GE) of margin is an alternative to frozen section. Aim: The aim was to compare the diagnostic accuracy (DA) of surgeon's perception of tumor-free mucosal and soft-tissue surgical margins intraoperatively assessed by GE and frozen section analysis (FSA). Methodology: A prospective, observational study was conducted on 59 histologically proven cases of oral squamous cell carcinoma. Two hundred and thirty-six mucosal margins were assessed by an experienced surgeon (ES) and thereafter subjected subsequently to FSA. These results were compared with the gold standard histopathology (HPE). The sensitivity (SS), specificity (SP), positive predictor value (PPV), negative predictor value (NPV), and DA of surgeon's perception by GE were calculated and subsequently compared with FSA and HPE using descriptive and inferential statistics. Results: The SS, SP, PPV, NPV, and DA of ES by GE were 80%, 99.12%, 80%, 99.12%, and 98.30%, respectively when compared to HPE, and the SS of 90%, SP of 98.32%, PPV, NPV, and DA were 69.23%, 99.57%, and 97.98%, respectively when compared with HPE. The results of the surgeon's perception by GE were comparable to the results of FSA. Conclusion: The study concludes that surgeon's perception by GE is upfront reliable alternative intraoperative method to FSA in places where FS is not available.
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Rhinoplasty in secondary nasal deformities: Subjective and objective outcome evaluation p. 186
Chandmani Tigga, Majumdar Swapan Kumar, Burman Subhasish, Mishra Siddartha, Hussain Mohsina
DOI:10.4103/njms.NJMS_67_20  
Introduction: Secondary nasal deformities are associated with trauma and secondary cleft nose (after primary cleft nose surgery). Nasal deformities affect esthetic, function, and psychological status of the patient. The goal of the secondary rhinoplasty is to correct both form and function, so that this positively impacts on their facial appearance. Aims: The study aimed to evaluate the patient satisfaction (subjective outcome) by rhinoplasty outcome evaluation questionnaire (ROEQ) preoperatively and postoperatively and esthetic outcome (objective outcome) by surgical team in patients with secondary nasal deformities. Materials and Methods: Secondary rhinoplasty was done in 13 patients of traumatic and unilateral secondary cleft nose through the external approach. Objective outcome was assessed by surgical team with clinical measurement, radiograph (lateral cephalometric), and photographic documentation pre- and postoperatively. Clinical measurements include nasolabial and nasofrontal angle. The patients completed the ROEQ for the subjective outcome evaluation. Results: There was significant improvement of subjective outcome (83.30%) based on the ROEQ and objective outcome based on the clinical measurement. Conclusion: Our study suggests that secondary rhinoplasty in trauma and cleft patients leads to both subjective and objective improvement of the facial appearance.
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Management of macrocystic lymphatic malformation at uncommon site with aqueous bleomycin sclerotherapy p. 193
Ankur Bhatnagar, Vijai Datta Upadhyaya, Rajnikant Yadav, Basant Kumar
DOI:10.4103/njms.NJMS_48_20  
Introduction: Lymphangioma are rare vascular malformation that results from maldevelopment of primitive lymphatic sacs. They are most frequently found in the neck and axilla, while intra-abdominal and mediastinal lymphangiomas are uncommon. Atypical site of cystic hygroma in pediatric age group are usually difficult to diagnose clinically but can be diagnosed easily by ultrasound. The aim of the study was to evaluate the result of the intralesional bleomycin for macrocystic lymphatic malformation (LM) presenting at atypical site Material and Method: All patients of LM of other than head& neck, axilla and abdomen presenting in pediatric age group were included in the study. Mainstay of diagnosis was ultrasound and was supplemented by CT scan wherever required. All patients were managed with intralesional bleomycin (ILB) and surgical excision was done only if primary therapy failed. Result: Total 15 cases of LM presenting at atypical sites were included in the study. Series include two case of cystic hygroma of breast, 4 cases of cystic hygroma of anterior chest wall, two case of substernal LM, three cases of LM of parotid gland, one case of inguinal region cystic hygroma and 4 cases involving submandicular area. Complete resolution was observed in 13 out of 15 cases, and two cases had less than 50% reduction in size and were managed with surgical excision after second session of ILB. Conclusion: Aqueous Intralesional bleomycin is a cost effective alternative to surgery even at rare sites of LM which provide better aesthetic outcome, and avoids complication associated with surgery.
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Comparative evaluation of crestal bone level in patients having low level of Vitamin D treated with dental implant with or without Vitamin D3 supplements p. 199
Pooja Garg, Pankaj Ghalaut, Kiran Dahiya, Reena Ravi, Anshu Sharma, Poonam Wakure
DOI:10.4103/njms.NJMS_49_20  
Introduction: Vitamin D has been shown to play a vital role in bone mineral homeostasis by stimulating the intestinal absorption of calcium and phosphate. The critical role of Vitamin D in bone metabolism triggered the need to evaluate the effect of Vitamin D deficiency and hence replacement of the same on osseointegration of dental implants. This prospective study evaluated the crestal bone level in patients having low level of Vitamin D treated with dental implant with or without Vitamin D3 supplements. Materials and Methods: A prospective clinical study was conducted on 32 patients based on the inclusion and exclusion criteria. Patients were divided into two groups on the basis of Vitamin D level < 30 ng/ml (Group I: patients receiving Vitamin D3 supplements, i.e., cholecalciferol 1 g sachet 60,000 IU/month) or <30 ng/ml (Group II: not receiving Vitamin D3 supplements). The crestal bone level measurements were made with the help of Digimizer Image Analysis, MedCalc software. Results: All implants showed clinically acceptable crestal bone level at interval of 1 week (baseline), 3 months, and 6 months. There was a statistically nonsignificant difference seen for the values between the groups (P > 0.05) for all other values at various time intervals. However, there was a statistically significant/highly significant difference seen for the values between the groups (P < 0.01, 0.05) for 3 months distal with higher values for Group I as compared to Group II. Conclusion: From the study, it can be concluded that cholecalciferol has systemic effects on accelerating bone formation around titanium implant.
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Evaluation of polycaprolactone scaffold for guided bone regeneration in maxillary and mandibular defects: A clinical study p. 207
Charudatta Naik, N Srinath, Mahesh Kumar Ranganath, DN Umashankar, Himani Gupta
DOI:10.4103/njms.NJMS_35_20  
Objective: This study was carried out to assess bone regeneration following the use of polycaprolactone (PCL) scaffold in maxillary and mandibular osseous defects. Materials and Methods: This prospective study included ten patients with maxillary or mandibular osseous defects present due to enucleation of periapical cysts or alveolar clefts requiring bone grafting and for lateral ridge augmentation that were treated with PCL scaffold. The patients were assessed clinically for pain, swelling, infection, and graft exposure at 1 week, 3rd, and 5th month postoperatively and were also evaluated radiographically for bone fill using intraoral periapical and/or panoramic radiographs at 4th, 6th, and 9th month postoperatively. Results: PCL scaffold was used in a total of six alveolar clefts and three cases of periapical cysts and one case of lateral ridge augmentation. Nine out of ten cases demonstrated wound dehiscence and scaffold exposure in the oral cavity. Radiographically, on comparison to the control regions, all these nine cases failed to demonstrate appreciable bone density gain. Only one case of radicular cyst in the mandible was recorded to have satisfactory healing. Conclusion: Although PCL scaffold has the potential for bone regeneration in osseous defects, the scaffold exhibited marked tendency for dehiscence in intraoral defects that significantly affected bone healing. A long-term study designed with a larger sample size and categorization of the defects is required to assess its efficacy in varied defects. Moreover, comparative evaluation of PCL and autogenous or alloplastic bone grafting material could provide assenting results.
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Graftless crestal hydraulic sinus lift with simultaneous implant insertion p. 213
Varsha Sunil Manekar
DOI:10.4103/njms.NJMS_38_19  
Background: The posterior maxilla is always a challenge for dental implant restoration. The presence of maxillary sinus and reduced subantral bone height are the limitations for implant insertion. The need of the hour is to make the surgical procedures simple, minimally invasive, andpredictable. Can we perform the sinus lift and simultaneous implant insertion by minimally invasive,simple, cost-effective, and less time-consuming technique? With this in consideration, the author carriedout this study for graftless crestal hydraulic sinus lift (CHSL) and simultaneous implant insertion in partially edentulous posterior maxilla for 26 implants. The aim is to evaluate the clinical and radiological success of graftless CHSL with simultaneous implant insertion. Material and Method: The sample size was 17 patients and 26 implants were inserted. The clinical as well as radiological follow-up was done for 1 year. The outcome variables were the gain in bone height and implant survival. Result: Mean Bone height Gain is 5.6 mm; Mean torque used 32 nm, Mean age of the patient was 53 years. The literature shows a success of graftless lateral and osteotome-mediated sinus lift. The concept is the blood filling the gap around the implant in tented sinus lining can eventually result in the ossification to form bone. Until now, no study has demonstrated the bone formation in the peri-implant area of CHSL with simultaneous implant insertion. CHSL, a minimally invasive sinus lift surgery is very encouraging, easy to master, and predictive. The simultaneous implant insertion acts to retain the elevated sinus lining by tenting. It also reduces treatment time. After a sinus lifting procedure, the compartment around the implants under the sinus mucosal lining in the sinus floor is filled with a blood clot from surrounding bleeding. Blood clot can be considered autologous osteogenic graft material, to which osteoprogenitors can migrate, differentiate, and regenerate bone. Conclusion: The graftless CHSL is predictable and safe for the sinus lift. The gain of up to 5–6 mm of subantral bone is possible.
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Effect of duloxetine in temporomandibular joint disorders: A comparison with arthrocentesis p. 219
Pawan Goyal, RK Singh, Shilpi Gangwar, Shadab Mohammad, US Pal, Geeta Singh
DOI:10.4103/njms.NJMS_86_19  
Purpose: This study was conducted to compare the efficacy of temporomandibular joint (TMJ) arthrocentesis, duloxetine therapy alone, and duloxetine in combination with TMJ arthrocentesis in the treatment of painful TMJ. Materials and Methods: Thirty patients with TMJ pain were included in the study who were divided into three groups with ten patients in each group. Group A included patients having only TMJ arthrocentesis; in Group B, only duloxetine therapy (30 mg) was given twice a day orally for 3 months; and in Group C, a combination of TMJ arthrocentesis with duloxetine therapy (30 mg) was given twice a day orally for 3 months. Patients were followed at regular interval of the 1st day, 5th day, 7th day, 4th week, 6th week, and 12th week and assessed in terms of pain, maximum mouth opening (mm), clicking, Hospital Anxiety and Depression Rating Scale and estimation of interleukin-6 (IL-6). The data collected were compiled and statistically analyzed. Results: The pain was found to be significantly lower in Group C than other groups at weeks 4, 6, and 12. In Group C, mouth opening increased significantly than Groups A and B on subsequent follow-ups. On biochemical analysis of IL-6 levels in lavage fluid, a significant decrease was observed in levels of IL-6 in lavage fluid in Groups A and C postoperatively. Conclusion: The present study states that pain was observed to be much less after arthrocentesis along with duloxetine therapy. This combination therapy leads to much better and faster outcome, but still, long-term follow-ups with larger number of patients are required.
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Comparison of calretinin expression in dentigerous cysts and ameloblastoma: An immunohistochemical study p. 224
Anchal Varshney, Shivani Aggarwal, Sharanjeet Kaur Gill, Ashim Aggarwal, Yashmi Jaiswal, Jaishree Sharma
DOI:10.4103/njms.NJMS_71_19  
Background: Calretinin is a calcium-binding protein of 29-kilodalton (kDa), which is widely expressed in normal human tissues and tumorigenic tissues. Its expression in the odontogenic epithelium during odontogenesis and in neoplastic odontogenic tissues has been demonstrated. Unicystic ameloblastoma poses a diagnostic challenge, as its histologic presentation can be sometimes mistaken for cystic odontogenic lesions. In the present study, an attempt is made to overcome the confusion encountered in the diagnosis of dentigerous cyst and unicystic ameloblastoma, using the expression of calretinin in both lesions and to compare this expression with conventional ameloblastoma to accurately diagnose and differentiate these lesions. Materials and Methods: A total of eighty cases, in which twenty cases each of ameloblastoma, unicystic ameloblastoma, dentigerous cyst, and odontogenic keratocyst (OKC) were included in the study. Slides were made from the archival blocks of each case and were stained immunohistochemically with calretinin. Results: Correlation between calretinin staining and histopathological diagnosis was done, and it was found that all twenty cases of ameloblastoma showed positivity for calretinin, whereas 17 of twenty cases of unicystic ameloblastoma showed positivity for calretinin staining. All the cases of OKC and dentigerous cyst were negative for calretinin. Conclusion: Calretinin may serve as an important diagnostic adjunct in the differential diagnosis of ameloblastoma and cystic odontogenic lesions.
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Prevalence of maxillectomy defects among patients visiting in an institutionalized hospital setting: A prospective, single-institute study p. 231
Mayank Singh, Saumya Kapoor, Lakshya Kumar, US Pal, Anshulika Singh, Mohd Anwar
DOI:10.4103/njms.NJMS_61_20  
Introduction: The rehabilitation of a patient undergone maxillectomy requires a prosthesis that provides with the optimum appearance and functional results. Scarce literature has been published regarding the prevalence of maxillary defects related to palatal obturator prosthesis. This study evaluates the incidence of the maxillectomy defects among different age groups, gender, side involved, and etiology. Materials and Methods: This is a prospective study of maxillectomy defects cases which reported and were treated in the department over a period of 2 years (2015–2017). Information regarding general identification, gender, and age at which the patient was operated for surgical resection of the maxilla or diagnosis of the tumor, affected side and etiology, and the time lag between surgical resection and rehabilitation was recorded from the clinical records of the patients. Results: A total of 30 patients reported to the department in the 2 years. However, the detailed data were available for only 22 patients, and these patients were treated in the department. Information regarding general identification, gender, and age at which the patient was operated for surgical resection of maxilla or diagnosis of the tumor, affected side and etiology, and the time lag between surgical resection and rehabilitation was recorded from the clinical records of the patients. Conclusion: The finding of the study revealed a predominance of the males being more affected, with the predominance of the left side involvement over the right side, with most frequently involved the age group of 21–40 years, and the etiology revealed the predominance of carcinoma of the maxilla for its resection.
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Tramadol versus ketorolac for pain management after third molar surgery p. 236
Jugajyoti Pathi, KC Vidya, NC Sangamesh
DOI:10.4103/njms.NJMS_78_17  
Objectives: To compare the analgesic efficacy of preoperative intravenous (IV) ketorolac versus tramadol in preventing postoperative pain after mandibular third molar surgery. Methodology: Two hundred patients in the age group of 18–40 years with asymptomatic impacted mandibular molars were randomly allocated into one of the two groups (100 in each group) and underwent third molar surgery under local anesthesia. Group I received IV ketorolac 30 mg and Group II received IV tramadol 50 mg preoperatively. The difference in postoperative pain was assessed by five primary end points: pain intensity being measured hourly by Wong-Baker pain assessment scale for 6 h, onset of analgesia, duration of action, total number of analgesics consumed, and patient's global assessment. Results: Throughout the 6 h investigation period, patients reported significantly lower pain intensity scores, longer duration of action, lesser postoperative analgesic consumption, and better global assessment in ketorolac when compared to tramadol group. Patients in the ketorolac group significantly performed better than the tramadol group in terms of all parameters except onset of analgesia. All the drug-related complications were mild and did not require any investigation. Conclusion: The result of the present study shows that preoperative IV ketorolac 30 mg is more effective than tramadol 50 mg for postoperative pain following third molar surgery.
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Comparative evaluation of bone regeneration with platelet-rich fibrin in mandibular third molar extraction socket: A randomized split-mouth study p. 241
Aayush Malhotra, Ishita Kapur, Debdutta Das, Atul Sharma, Monika Gupta, Mamit Kumar
DOI:10.4103/njms.NJMS_50_19  
Purpose: Platelet-rich fibrin (PRF) is a new platelet concentrate concept consisting of an autologous fibrin gel having accumulation of platelets and the released cytokines in a fibrin clot. The study aims to evaluate the efficacy of autologous PRF in accelerating bone regeneration and repair in fresh third molar extraction sockets. The investigators hypothesized the cicatricial properties and accumulation of growth factors in a single clot which will improve bone density and quality. Materials and Methods: PRF results from a natural and progressive polymerization occurring during centrifugation. Two groups were made with bilaterally impacted third molar patients. PRF was obtained and surgical extraction was carried out under aseptic conditions. Quantitative data are presented as mean. Statistical significance was inferred at P < 0.05. Results: Results obtained were evaluated statistically and found a significant difference between the groups in improvement in alveolar bone density of regenerate measured radiographically. The study demonstrates a faster bone formation in the extracted sockets with PRF as compared to control. Conclusion: PRF proved to be an autologous biomaterial with useful features that allowed efficient postextraction bone defect filling and faster bone regeneration.
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Detection of undiagnosed and inadequately treated high blood pressure in dentistry by screening p. 248
Satish Kumar, Hari Ram, Isha Atam, Virendra Atam, Satyendra Kumar Sonkar, Munna Lal Patel, Ajay Kumar
DOI:10.4103/njms.NJMS_31_20  
Background: Worldwide, hypertension is considered as an important health issue due to its unbearable complication of cardiovascular, renal, and nervous system diseases. Aims and Objective: The aim was to find the prevalence and inadequately treated undiagnosed hypertension in the general population attending the Outpatient Department (OPD) of the Department of Oral and Maxillofacial Surgery, King George's Medical University, Lucknow. Materials and Methods: A total of 2500 patients were enrolled in the study within the age group of 20–60 years, attending dental clinics. For every patient, blood pressure (BP) was taken three times, and all the readings were grouped into four categories including normal, prehypertensive stage, Stage 1, and Stage 2 of hypertension. In the dental clinic, the BP assessment was done considering parameters such as sex, smoking and alcohol, the effect of local anesthesia, gutkha chewing, age group, and regular exercise. Results: About 24.39% of undiagnosed hypertensive patients were found among all who attended the OPD of the department of oral and maxillofacial surgery. It was observed that the rise in BP was 16.71% and 2.35% in Stage 1 and Stage 2, respectively, after giving the local anesthesia. Conclusion: This study reveals that early diagnosis of undiagnosed and inadequately treated hypertension among general people notified by dentists is an important role, and this should be promoted and emphasized to restrict fatal life complications.
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Ergonomics among dentists in the states of Telangana and Andhra Pradesh p. 253
Uday Kiran Uppada, M Susmitha, Syed Wajahat Ullah Hussaini, Inayaat Virk, Teja G Yadav, Mohasin Abdul Khader
DOI:10.4103/njms.NJMS_33_20  
Aim: This study is designed to evaluate the work-related musculoskeletal disorders among dentists in the states of Telangana and Andhra Pradesh. Materials and Methods: This study was conducted to disclose the incidence, location, and intensity of musculoskeletal pain among dentists in the states of Telangana and Andhra Pradesh. A questionnaire study was designed. Six hundred and twenty-four dentists participated in the survey working in different centers of Telangana and Andhra Pradesh. Demographic information, type of professional practice, duration of working hours, posture of working, and the distance of travel from home to workplace were collected. This was related to whether a dentist is suffering from any musculoskeletal disorder. The location of pain, intensity of pain, and the preventive measure they employ in their daily life are noted. Results: It was observed that oral and maxillofacial surgeons followed by general dentists were more prone to musculoskeletal disorders. Due to the lack of a well qualified/trained assistant in addition to lack of sophisticated equipment is resulting in professional induced musculoskeletal disorders among oral and maxillofacial Surgeons. General dentists who try to perform all the dental procedures by themselves without the support of specialists were more prone to musculoskeletal disorders. The majority of the participants have lower back pain with a visual analog scale score of 5. It was believed by most of the participants that a good physical exercise in the morning helps from preventing such professional-induced musculoskeletal disorders. Conclusion: Oral and maxillofacial surgeons, due to their unique work, are more prone to muscle imbalances, and hence ergonomic interventions are essential to maintain optimal health during the course of their professional career.
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Histological evaluation of two different anorganic bovine bone matrixes in lateral wall sinus elevation procedure: A retrospective study p. 258
Lanka Mahesh, Glenn Mascarenhas, Meenu Taneja Bhasin, Calvo Guirado, Saurabh Juneja
DOI:10.4103/njms.NJMS_81_19  
Introduction: Grafting in oral implantology involves bone augmentation procedures with various bone graft materials. Success of such procedures is evaluated through the amount of bone volume and bone formed at the grafted site. The primary aim of this prospective study was to histomorphometrically evaluate and compare the new bone formation with Bio Oss or Cerabone in the lateral approach sinus augmentation procedure. Materials and Methods: The research targeted 22 patients who were either partially or completely edentulous posterior maxilla with residual alveolar height 3 mm at the site of implantation and underwent a two staged surgical protocol, with a lateral approach sinus grafting with either Bio Oss or Cerabone. Bone trephine biopsies for histological analysis were harvested 6 months after augmentation while preparing the osteotomies for implant placement trephine. The histologic evaluation was performed comparing the newly formed bone, marrow spaces, biomaterial particles remnants, and presence of osteocytes embedded in both trabecular bone and bone tissue near the anorganic bovine bone. Results: The present study showed that neither of the graft material showed any active osteoclasts and host inflammatory reaction. From sites grafted with Cerabone, an ample amount of mature lamellated bone formation was seen, also host inflammatory response was indicative of minimal reactive inflammatory response suggestive of good acceptability of the graft material by the host. No significant differences between the groups could be detected with regard to new bone formation and residual bone substitute. Conclusion: The results of the study illustrates that both the bone substitute materials allow predictable new bone formation in sinus augmentation procedures.
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Comparative study of outcomes between locking plates and three-dimensional plates in mandibular fractures p. 263
Shaikh Amjad, MD Kalim Ansari, Syed S Ahmad, Tabishur Rahman
DOI:10.4103/njms.NJMS_53_19  
Objectives: The objective was to compare the efficiency and assess postoperative complications of 2.00 mm unicortical locking plates and three-dimensional (3D) plates in surgical correction of uncomplicated mandibular fracture. Materials and Methods: A prospective cohort study of twenty patients of uncomplicated mandibular fractures, who were operated either by noncompression unicortical 2-mm locking mini-plate or by noncompression unicortical 2-mm 3D mini-plate, were enrolled and followed up for the study outcomes such as operative time, postoperative infection, and postoperative occlusion. Results: Majority of the patients (90%) were male who had road traffic accident. In 80% of cases, mandibular fracture site was parasymphysis. The mean operating time for 3D plates (43.20 min) was significantly lower than that for locking plates (54.82 min), P < 0.001. All cases operated by 3D plates compared to 60% by locking mini-plates did not need intermaxillary fixation, P = 0.025. The 80% of cases operated by 3D plates did not require postoperative occlusion correction compared to 30% in another group, P = 0.01. For other parameters such as postoperative sensory disturbance, postoperative infection, incidence tooth damage, vertical displacement of mandible, feeling of plate after platting, and chewing efficiency after 1 week, there were no statistical significant differences between the two groups. Conclusions: The outcome of 2.0mm 3D mini-plate is better in terms of operating time required, post-operative need of intermaxillary fixation and occlusal correction. While the outcome is similar to the use of non-compression unicortical 2.00mm locking miniplate in parameters like infection rate and incidence of tooth damage etc.
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CASE REPORTS Top

Total joint prosthesis for ankylosis after multiples condylar traumas p. 270
Leonardo Augustus Peral Ferreira Pinto, Marco Aurélio de Guimarães, Bernardo Correia Lima, George Patrick Sotero Sturzinger
DOI:10.4103/njms.NJMS_91_20  
Temporomandibular joint (TMJ) ankylosis is a disease commonly associated with facial trauma, especially in the condylar region. Described as a heterotopic bone growth that causes mouth opening limitation, it may occur in trauma cases misdiagnosed or mistreated. We present the case of a 37-year-old female, with decreased mouth opening after three traumas in the region of the right condyle by a motorcycle accident. We performed custom-made total joint replacement of the TMJ to rehabilitate the patient post arthroplasty. TMJ Concepts® protocol was followed to perform the patient's rehabilitation. She is being followed since then by a physical therapist to regain the pre-pathosis status of mouth opening, speech, and mastication function.
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Iatrogenic displacement of impacted mandibular third molars or their roots into adjacent soft tissues and spaces: A report of three cases p. 275
Vaia-Aikaterini Alexoudi, Dimitris Tatsis, Kyriaki Zamani, Dimitris Zelkas, Konstantinos Paraskevopoulos, Konstantinos Vaxtsevanos
DOI:10.4103/njms.NJMS_95_19  
Iatrogenic tooth displacement is a rather unusual but significant complication during extractions' procedures. The most common anatomic positions of displacement for the lower teeth include the pterygomandibular, submandibular, sublingual, and lateral pharyngeal spaces. A retrospective analysis of three cases of tooth displacement to adjacent anatomic sites is presented. These patients were treated at the Oral and Maxillofacial Surgery Department, G. Papanikolaou General Hospital of Thessaloniki, Greece. Two cases refer to displaced roots in the submandibular space, and one refers to a lower third molar displaced in the lateral pharyngeal space. Third molar displacement is a clinical complication that should be considered during mandibular third molar extraction, and proper preventive measures should be taken into consideration.
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Temporalis myofascial flap in reconstruction of maxillary defect: A case series p. 280
Akhilesh Kumar Singh, Nitesh Mishra, Janani T, Naresh Kumar Sharma
DOI:10.4103/njms.NJMS_163_20  
Ablative surgery of midface often leads to compromised aesthetics as well as function. Defects caused by ablative surgery need reconstruction that provides satisfactory results with minimal or no compromise in form and function. Various flaps can be used to reconstruct the maxillary defect. However, medium to large-sized defects can only be appropriately reconstructed using free or regional flaps. Moreover, as free flap reconstructions are tedious and require technique sensitive procedure whereas loco-regional flaps are versatile and more predictable. Temporalis myofascial flap (TMF) seems to be one of the best options among all other regional flaps as it has a reliable blood supply, adequate bulk and its anatomical location is close to primary defect.
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Bilateral mandibular condyle fractures: Should we open both? p. 285
Kedarnath Nakkalahalli Seshappa, Shruthi Rangaswamy
DOI:10.4103/njms.NJMS_10_19  
Bilateral condylar fractures are common but are frequently undertreated. In most of the cases, only one side is surgically addressed and the other side is managed conservatively. Bilateral condylar fractures lead to loss of ramal height bilaterally, accentuated anterior open bite, disruption of articular surfaces, and disc and muscle attachments. In a mandibular bilateral condylar fracture, even though open reduction and internal fixation (ORIF) is done on one side, a patient still needs Inter Maxillary Fixation (IMF) for 2–4 weeks postoperatively to correct occlusion and deviation. The possibility of doing ORIF on the other is never explored. Here, we present two cases of bilateral condylar fracture treated both sides by ORIF. The article discusses the advantages and new approach to consider treating both sides.
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Pleomorphic adenoma of the upper lip: A rare case report p. 289
Baabar Ali Shah, Amrit Pal Singh, Afak Yusuf Sherwani, Syed Masood Ahmad
DOI:10.4103/njms.NJMS_20_17  
Pleomorphic adenoma (PA), also called mixed tumor, is the most common benign tumor of the salivary glands that mostly occurs in the parotid or submandibular glands but may also occur in the minor salivary glands that are distributed throughout the oral cavity. The common sites of PA of the minor salivary glands are the palates followed by lips and cheeks. Surgical removal with adequate margins is the principal treatment. We present a case of PA (arising from the minor salivary gland of the upper lip) – a rare site in a 65-year-old female who presented with a swelling upper lip of 2-year duration. Fine-needle aspiration cytology of the swelling revealed PA which was confirmed by histopathological examination after complete excision of the swelling.
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A vacillating swelling in maxillary anterior region- Diagnostic challenges and management Highly accessed article p. 292
Vinod Nair Sreekumar, Shiad Salim, Sangeeth K Cherian, Richie John
DOI:10.4103/njms.NJMS_84_18  
In most of the cystic lesions appearing in the oral cavity, proper diagnosis and treatment remains a challenge. As glandular odontogenic cyst (GOC) is a rare type of developmental odontogenic cyst, it was not included in our differential diagnosis. The report of GOC was quite surprising as it was rare and never came in this discussion. A 25-year-old male patient was reported to our center with a chief complaint of painless swelling in the right anterior region of the maxilla. The swelling was oval shaped and diffuse extending from the distal aspect of 11 to the mesial aspect of 14 and superiorly extending into the sulcus. Working diagnosis was a periapical cyst, so conventional treatment of root canal treatment, cyst enucleation, and apicoectomy was done. This article presents a rare case which was primarily misdiagnosed and treated and has been subsequently revealed histopathologically as a rare clinicopathological entity.
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Benign fibrous histiocytoma of the maxilla: A rare case report and literature review p. 298
Jitendra Pratap Singh Chauhan, Abhay Kumar, Prateek Kumar Porwal, Rajesh Kumar Thakur, Kailash Mittal, Harshita Singh
DOI:10.4103/njms.NJMS_85_18  
Benign fibrous histiocytoma (FH) is a benign soft-tissue tumor that can present as a fibrous tissue mass anywhere in the body. The involvement of the paranasal sinuses is extremely rare, and very few cases have been reported in literature till date. We here report a case of benign FH localized in the maxillary sinus. The clinical and histological features of the lesion are discussed with a brief literature review of this pathology in the paranasal sinuses.
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Dimensional changes in soft tissue as a plausible cause for error in computer-aided design and computer-aided manufacturing stent-guided implant osteotomy p. 302
Yazad Gandhi
DOI:10.4103/njms.NJMS_51_20  
Dental implants have been in vogue for more than three decades as a successful mode of rehabilitation of lost dentition. With time, there have been updates in methods and science including a positive tilt toward incorporation of digital technology into treatment protocols. This report elucidates a rare case of faulty osteotomy preparation through a computer-aided design computer-aided manufacturing stent that was detected and corrected before implant placement. The manuscript also emphasizes the possible shrinkage of soft-tissue graft beyond the normal postulated time frame and the importance of periodical checks on the drilling protocol throughout the flapless placement procedure even though it may have been seamlessly planned on the digital platform.
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To ponder beyond hype!!! p. 307
Bhakti Patil Soman, Deepa Das
DOI:10.4103/njms.NJMS_33_19  
To date, no treatment strategies for oral submucous fibrosis (OSMF) have been proved to be completely effective, and one of the most accepted medical lines of therapy advised in every stage of OSMF is antioxidants. One of the antioxidant drugs has increasingly earned popularity, which is due to its less expensive market price than other available antioxidants formulations. The presence of copper in its composition questions its ability to be effective in the management of OSMF. Moreover, we would like to emphasize that the presence of copper adds on to the disease burden and antioxidants with copper in its composition should not be advised as an antioxidant of choice for the management of OSMF.
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Erratum: Medicinal plants and bone healing p. 309

DOI:10.4103/njms.NJMS_265_20  
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Erratum: 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. 310

DOI:10.4103/njms.NJMS_266_20  
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