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National Journal of Maxillofacial Surgery
 
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   Table of Contents - Current issue
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January-April 2021
Volume 12 | Issue 1
Page Nos. 1-129

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EDITORIAL  

Oral and maxillofacial surgery in the time of COVID - What it means for India? Highly accessed article p. 1
George Paul
DOI:10.4103/njms.njms_331_21  
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REVIEW ARTICLES Top

A review of techniques of iris replication and a novel method of fabrication of ocular prosthesis using two different iris location methods Highly accessed article p. 3
Anshul Trivedi, Roma Goswami, Nivedita Bawa, Shama Waheed, Jitendra Rao
DOI:10.4103/njms.NJMS_43_19  
Anophthalmic patients suffer from social, functional, and emotional agony. The role of a maxillofacial prosthodontist is to restore this loss and to restore the self-esteem of such patients. Fabrication of a prosthesis for the anophthalmic cavity can be successful with the judicious use of the materials, the vision, and the skill of the prosthodontist. This article describes various techniques used for iris replication and a novel method to locate the iris, which is the most crucial step to fabricate a natural gaze.
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Bilateral sagittal split osteotomy a versatile approach for correction of facial deformity: A review literature p. 8
Veerendra Prasad, Sanjay Kumar, Harsha Pradhan, Rehan Siddiqui, Iqbal Ali
DOI:10.4103/njms.NJMS_89_18  
Poor facial cosmesis resultant from dysgnathias usually accounts for a range of these individuals' psychological and social problems. Disturbances of both esthetics and function are caused by jaw deformity and associated structures' deformity such as malocclusion. The correction of these deformities is one of the most challenging and intriguing aspects of maxillofacial surgery. Despite having become routine only relatively recently, rigid internal fixation has advanced rapidly, its results are consistent and predictable and thus, its knowledge applies in orthognathic surgery besides other areas of maxillofacial surgery. The bilateral sagittal split osteotomy (BSSO) is a common orthognathic procedure performed on the mandible. First described by Trauner and Obwegeser in 1957, modified by Dal Pont and refined by Epker, several modifications of the BSSO have been introduced aiming to enhance surgical convenience, minimize morbidity, and maximize stability. The aim of this article is to review the literature of this technique from the historical perspective and to present a standard operation technique.
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ORIGINAL ARTICLES Top

A meta analysis for evaluation of marginal bone level changes at dental implants p. 13
Varun Kumar, Geeta Arya, Pranshu Singh, Pallavi Chauhan
DOI:10.4103/njms.NJMS_179_20  
Aim: The aim of this study was to assess the marginal bone level changes at dental implants after 1 year in function. Methods: Detailed searches from PubMed databases were made. A MEDLINE search (PubMed) published in the English language from 1980 to December 2018 was included in this study. Results: The electronic database research (MEDLINE) produced 166 corresponding articles. One hundred and twenty studies were excluded on the basis of abstract while the 46 researches were used chosen for full-text examination after the title and abstract testing, and 41 studies were excluded that did not meet the requirements of our inclusion and exclusion criteria. A total of 5 studies for a quantitative analysis were taken into account. Conclusion: Within the limits of the study, the mean marginal bone loss (MBL) was found to be 0.56 mm. A statistically significant difference in the MBL was found between the various studies.
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Evaluation of stability and esthetic outcome following rigid fixation of a new sagittal genioplasty technique – A clinical study p. 17
Subia Ekram, KV Arunkumar, Apoorva Mowar, Amit Khera
DOI:10.4103/njms.NJMS_76_20  
Background: Routine and popular conventional genioplasty procedure is often curvilinear, requires lower border extension below, and behind the mental foramen, which after advancement has a tendency to produce step deformity, butt contact, hence nonunion, instability, and increased relapse tendencies. The present technique is aimed to study the new sagittal genioplasty technique and its efficacy to overcome the above-mentioned drawbacks of conventional genioplasty. This technique also aids in correcting mild-to-moderate breathing irregularities. Materials and Methods: A total of 10 patients included in this study. The comparative analysis of the displacement of the chin in vertical and horizontal directions following surgery was evaluated by measuring the difference between preoperative, immediate postoperative, 3 and 6 months postoperative on lateral cephalometric radiographs. Results: The study of new sagittal chin advancement results showed an advantage over conventional technique in terms of esthetics outcome (no jowl), easy to perform without damaging the mental nerve, superior healing with less relapse, and better surface area contact. Conclusion: In this study, the new technique of sagittal genioplasty overcomes the disadvantages of conventional genioplasty. However, this technique is best suited for patients who require straight or moderately vertical augmentation advancement genioplasty and is not suitable for asymmetry corrections, i.e., centering genioplasty and double sliding genioplasty.
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Predictive accuracy of estimating mandibular growth potential by regression equation using cervical vertebral bone age p. 25
Sneh Lata Verma, Tripti Tikku, Rohit Khanna, Rana Pratap Maurya, Kamna Srivastava, Vishal Singh
DOI:10.4103/njms.NJMS_264_20  
Introduction: The maturational changes both in size and shape of cervical vertebrae had been widely used not only to assess skeletal maturity but also to predict the same using regression equation. Thus, the aim of this cross-sectional study was to check the predictive accuracy of estimating mandibular growth potential in the North Indian population by regression equation of Mito et al. Materials and Methods: A total of 200 subjects divided into two groups, Group I had 100 adult subjects (18–20 years) and Group II had 100 young subjects (9–14 years) were subdivided according to the gender (50 subjects in each group). Seven linear parameters on cervical vertebral bodies of C3 and C4 were measured to derive cervical vertebral age and applied to the regression equation to estimate the mandibular growth potential in Group II. The mandibular length was measured for both the groups from Co-Gn. The mean value of the actual mandibular length in Group I was statistically evaluated against the corresponding mean value of the predicted mandibular growth potential of Group II. Results: The actual mandibular length (Group I) and calculated mandibular length obtained by adding mandibular growth potential (from regression equation) to the mandibular length of Group II did not differ significantly for both males and females. Chronological age showed a statistically significant difference and poor correlation with bone age, in Group II. Conclusion: The regression equation of Mito et al. using cervical vertebral bone age has proven to be applicable and accurate in predicting mandibular growth potential in growing young Indian individuals and can be of diagnostic and prognostic value in growth modification procedures in Orthodontics.
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Surgical scar revision using silicone gel sheet as an adjunct p. 36
Tripti Mukherjee, Sumit Chopra, Ankit Aggarwal, Vipul Garg, Himani Dadwal, Priyanka Sharma
DOI:10.4103/njms.NJMS_106_20  
Introduction: Scar is often referred to as an unattractive mark after healing of a wound. An undesirable scar may have negative social, emotional, and functional impact on the patient. It is our job as surgeons to adequately understand the expectations of the patient and counsel them for a successful procedure. Materials and Methods: Twelve patients were randomly chosen for the study, of which five were males and seven were females. The scar tissue was removed surgically, and silicone gel sheets (SGSs) were applied on the 14th postoperative day, and the dimensions of the new scar was measured periodically up to 12 months. Results: The study comprised of 12 patients- 5 males and 7 females. The descriptive statistics were calculated as median and interquartile range and comparison between time intervals was done using Wilcoxon signed rank test. Out of the 12 patients, 10 showing complete resolution of the scar and 2 patients had partial relapse of scar. However, they were satisfied with the final outcome. Conclusion: Our study found that SGSs applied to surgically revised scars significantly improves their appearance. The ease of use of the SGSs also makes it patient friendly. We observed almost complete resolution of the scar in ten patients and two patients exhibited partial relapse of the scar. However, there was a significant improvement in the overall appearance of the scar, and the patients were satisfied with the results of the procedure.
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Nasoorbitoethmoid fractures in a tertiary care hospital of eastern India: A prospective study p. 42
Debashish Pati, Niranjan Mishra, Indubhusan Kar, Brundabati Meher, Dipti Samal, Krushna Chandra Rath
DOI:10.4103/njms.NJMS_151_20  
Purpose: The purpose of this study was to report on the pattern of occurrence of nasoorbitoethmoid (NOE) fractures in Odisha and the various factors that influence their distribution. Methods: The study period was from January 1, 2016 to December 15, 2017. After approval from the Institutional Ethics Committee, all patients diagnosed with naso-orbito-ethmoid fractures reporting to the department of OMFS and Level-1 trauma centers were included in the study. Sociodemographic data along with the etiology and type of fracture were mentioned. Associated injuries to other body parts were noted. Open reduction was possible only in five cases of NOE fractures. The treatment plan including the operative approach and postoperative results was evaluated. Results: A total of 1192 patients with facial fracture were seen, of which 52 (4.36%) patients had NOE fractures. Males far outnumbered females in a ratio of 9:1. Thirty-three patients (63.46%) had unilateral NOE fracture, while the rest 19 (36.54%) had bilateral NOE fracture. Sixteen (30.76%) cases were classified as Type I, 35 (67.30%) as Type II, and 1 (1.92%) as Type III. Road traffic accidents were the most common cause of NOE fractures (69%), followed by fall (17%) and assault (10%). The most common neurological injury to be associated with NOE fractures was pneumocephalus (29%), followed by diffuse axonal injury (8%). Telecanthus (100%) was found to be the primary clinical feature in patients of NOE fracture, followed by a depressed nasal bridge (92%). Fracture of the nasal bone was invariably associated with NOE fracture. Complications observed due to untreated NOE fractures included a shortened and retruded nose, shortened palpebral fissures, telecanthus, and enophthalmos. Conclusion: Contemporary management of NOE complex fractures demands precise diagnosis and immediate surgical management with anatomic reduction and rigid fixation of the involved bone segments. With an improvement in socioeconomic status and increased awareness among maxillofacial surgeons, hopefully, a greater number of NOE fracture patients will avail the benefits of open reduction in future.
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Assessment of oral health status and treatment needs of drug abusers in Bhubaneswar city: A cross-sectional study p. 50
Gunjan Kumar, Shilpa Rai, Alok Kumar Sethi, Akhilesh Kumar Singh, Ranjan Mani Tripathi, Avinash Jnaneswar
DOI:10.4103/njms.NJMS_152_20  
Introduction: Oral health of drug abusers has received less attention. Drug users may also have special needs in relation to receiving dental care. Evaluation of the oral health status of drug abusers is important as in India, where the disease burden is enormous, and availability of curative treatment is quite inadequate, preventive approach shall prove to be better than curative treatment. Aim: To determine the oral health status and treatment needs of drug abusers residing in rehabilitation centers in Bhubaneswar. Materials and Methods: A cross-sectional study was conducted in the drug de-addiction cum rehabilitation centers in Bhubaneswar city, Odisha. A self-administered questionnaire was used to record oral health practices of the inmates and the type of drugs used by them in the past. Oral health was recorded using modified WHO 2013 pro forma. Mann–Whitney U-test and Kruskal–Wallis test were applied to find any significant differences between different variables in groups. Results: All the participants were male and alcohol was the most commonly used drug, followed by tobacco and ganja. The horizontal brushing technique was the most widely used technique. Mean decayed, missing, and filled teeth (DMFT) score was recorded to be 1.48. Leukoplakia, acute necrotizing ulcerative gingivitis, candidiasis, and ulceration were among the few oral lesions found in the inmates. Around 67.66% of inmates exhibited erosion of the enamel surface, while 6.59% had signs of enamel fracture. Statistically, significant difference was found for the types of drugs used and DMFT score and type of drug used and dental erosion. Conclusion: Oral health status of drug users is poor and needs immediate attention. Oral health education needs to be imparted among them. The government needs to enforce the establishment of dental clinics in these centers so that the oral health of these people can be taken care of.
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Helmet shielding effect in mandibular fractures during road traffic accident p. 56
RK Singh, Virendra Kumar, Roop Ganguly, Jatin Patel, Dipti Daga
DOI:10.4103/njms.NJMS_150_20  
Objective: The objectives of this study are to evaluate the proportion of helmeted and nonhelmeted patients sustaining mandibular fractures. Materials and Methods: A retrospective study was conducted on 200 patients reporting to oral and maxillofacial surgery (OMFS) unit, trauma center, and department of OMFS. A predesigned questionnaire was used to collect the necessary data. Patients were evaluated for age, gender, mode of transport (2/4 wheeler), presence of safety measure at the time of accident (helmet/seatbelt), maxillofacial injury in two wheeler (with helmet and without helmet), type of impact, and its association to maxillofacial fractures, particularly site of maxillofacial fractures. The association between mode of injury, presence of safety measures, impact type, and site of maxillofacial injuries was assessed using the Chi-square test. P < 0.5 was considered statistically significant. Results: The mean age of patients was 30 years, and approximately 92.5% of accidents patients were male. In this study, 35% nonhelmeted riders were reported head injury and 5% of the helmeted rider reported head injury. 54.5% of the patients suffered frontal impact, 28% collision, and 17.5% lateral slide collision. Head injuries are the main cause of death among the riders of all two wheelers. Lateral sliding collision injuries (17.5%) resulted 60.6% of the fractures mandible, 24.2% midface injury, and associated injury (15.15%). Conclusion: The use of helmet is strongly recommended to prevent head injuries and facial injuries. In the nonhelmeted riders in motorcycle accidents, the incidence of mandible fractures increases proportionally.
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Awareness among anesthesia residents pertaining to various intubation techniques in craniofacial surgery: A questionnaire study p. 62
Malti Tuli, Shreyas Orvakonde, Shrinivas TR, Jyothsna Manchikalapudi, Dhananjay Rathod, Jignaben Patel
DOI:10.4103/njms.NJMS_85_20  
Aim: This study was intended to evaluate the knowledge and clinical skill of anesthesia residents pertaining to various intubation techniques employed in craniofacial surgery. Materials and Methods: A cross-sectional survey research design was employed in this study. A self-administered questionnaire survey was used to validate the knowledge and clinical skill of anesthesia residents pertaining to various intubation techniques employed in craniofacial surgery. In this regard, a preliminary study with a convenience sample of 156 anesthesia residents studying in various medical institutions across South India was conducted so as to assess the knowledge and clinical skill of anesthesia residents pertaining to various intubation techniques employed in craniofacial surgery. This study, while limited in sample size, benefits the craniofacial surgeons and anesthetists as target readers to assess the knowledge and clinical skill of anesthesia residents pertaining to various intubation techniques employed in craniofacial surgery Results: The results of this study reveal that majority of the anesthesia residents encountered craniofacial surgery during their residency period. However, only 19.87% have performed various intubation techniques that are employed in craniofacial surgery. Nearly 38.46% of the participants felt that blind awake intubation is the most difficult intubation technique to employ in the head-and-neck region and requires expertise. Nearly 78.84% of the participants felt that special training is required for handling craniofacial surgical cases under general anesthesia. Conclusion: The results of this study reveal that there is a dearth of knowledge and clinical exposure among anesthesia residents regarding various intubation techniques employed in craniofacial surgery. Educational and quality improvement initiatives in various intubation techniques could enhance anesthesia residents' knowledge and clinical exposure in managing various craniofacial surgical cases.
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Association of maternal periodontal health with preterm birth and a low birth weight among newborns: A cross-sectional study p. 67
Jyotirmay, Amit Kumar, Saakshi Gulati, Stuti Kumari, Jazib Nazeer, Pankaj Singh
DOI:10.4103/njms.NJMS_135_20  
Background: Despite numerous advancements in prenatal and natal care, complications arising in pregnancy and related to child-birth are major concerns in public health. Various risk factors responsible for poor outcomes include - life-style, biological, social, infectious, hormonal, and metabolic conditions. Oral diseases have been identified as a risk factor for low birth weight both under preterm and at-term states. Aim: The aim of this study was to find an association of maternal periodontal health with preterm births and low birth weight among newborn infants. Materials and Methods: This was a cross-sectional observational study comprising of 300 pregnant females who had underwent child deliveries within the past 24 h with an age range of 21–30 years. Study participants were selected after interviewing for gestational history and obtaining prior informed consent. Postpartum female subjects following delivery within a time period of 24 h were included in the study. Gingival index (by Loe and Silness) was calculated for the evaluation of bleeding from gingival tooth surfaces. All data tabulations were done by performing statistical analysis into Microsoft Excel Worksheet 2007. Results: Mean age group of study participants was calculated to be 25 years. On analyzing brushing frequency, it was observed that approximately 40% brushed three times daily whereas 35% used to brush twice daily while the remaining, 25% brushed only once daily. No statistical significance was obtained on comparing brushing frequency with gingival health (P = 0.8). Similarly, no association was found between periodontal health and preterm low weight child births. Conclusion: This study found no association between maternal periodontal health and preterm and low-birth weight births among newborns.
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Surgical outcomes in oral cancer involving the central arch of the mandible in elderly patients: An institutional experience p. 72
Shiv Rajan, Puneet Prakash, Naseem Akhtar, Vijay Kumar, Sameer Gupta, Arun Chaturvedi, Dhruv Mahajan, Resham Srivastava, Sumaira Qayoom, Deep Chakrabarti, Shirin Parveen
DOI:10.4103/njms.NJMS_114_20  
Backgrounds: Oral squamous cell cancer (SCC) is one of the most common cancers. The most common age of presentation is fifth to sixth decade. Management of this disease is dictated by stage, age, and related comorbidities. Elderly patients have their own set of limitations as far as their management is concerned. Carcinoma involving central mandibular arch is a challenging disease for surgeons, especially in the elderly. This article describes our experience with the surgical treatment of oral cancer involving the central arch of the mandible in elderly patients. Methods: Forty elderly (≥60 years) patients with histologically proven SCC of the oral cavity in which disease was involving the central arch of the mandible, were included in our study. Demographic, clinical, and treatment-related factors were recorded. The outcome was assessed in terms of postoperative complications, recurrence, and patient survival. Results: The median age of the patients was 63 years. The male:female ratio was 7:3. A history of oral tobacco use was present in 95% of patients. The most common site of disease was lower alveolus (80%) followed by carcinoma of the lower lip (20%). Majority of our patients (77.3% [30]) were having Stage IV disease. Mandibulectomy was either segmental (62.5%) or marginal (37.5%). Bilateral neck dissection (37/40, 92.5%) was done in most patients. Among all patients, 62.5% (25) received adjuvant radiotherapy. The local recurrence rate after a median follow-up of 30 months was 15% (6). Two-year disease-free survival and overall survival were 89% and 90%, respectively. Conclusion: Central arch of the mandible is a difficult disease to treat. It needs a complex and lengthy reconstructive procedure. Comorbidities such as extreme age, diabetes, and pulmonary and cardiac illnesses make it more challenging to manage. With the proper evaluation of comorbidities and avoiding long, cumbersome procedures, we can provide patients a fairly good chance of survival.
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Habit-associated salivary pH changes in oral submucous fibrosis: A cross-sectional study p. 78
Rohit Kumar Sahu, Sangram Patro, Bikash Nayak, Debajyoti Bardhan, Swagat Panda, Jagdish Prasad Rajguru
DOI:10.4103/njms.NJMS_39_20  
Background: Salivary pH plays a significant role in the pathogenesis of various oral diseases and conditions. Chewing of areca nut and various tobacco products changes salivary pH. Aim: The aim of the study was to measure the effect of habitual chewing of areca nut and various tobacco products on salivary pH. Materials and Methods: The present study included 360 individuals (chewers and nonchewers) of age group between 20 and 30 years who visited the Outpatient Department of Hi-Tech Dental College and Hospital. The patient's salivary pH was measured with the help of a digital pH meter before and after chewing areca nut and various tobacco products. Results: It was observed that, in all the groups of chewers, pH decreased after chewing except in the gutkha and lime chewing group, where pH increased (pH before chewing was 7.43 ± 0.41 and after chewing was 7.51 ± 0.399), the difference was strongly significant (P < 0.001). pH was found to be less in lime and tobacco chewers (6.83 ± 0.33) and more in tobacco, betel nut, and lime chewers (7.50 ± 0.41) in comparison to other groups before chewing; the difference was strongly significant (P < 0.001). In the mean ± standard deviation, increase in pH was found among chewers (7.32 ± 0.49) as compared to nonchewers (6.99 ± 0.14), which is the control group, and the data were statically significant (P < 0.001). Conclusion: pH is altered in areca nut and various tobacco chewers, rendering the oral mucosa vulnerable to the toxic effects of areca nut and various tobacco products.
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Third molar impaction in different facial types and mandibular length: A cross-sectional study p. 83
K Moinuddin Hasan, CR Sobhana, Saurabh Kumar Rawat, Deepika Singh, Prakhar Mongia, Ansari Fakhruddin
DOI:10.4103/njms.NJMS_111_20  
Background: The etiology of mandibular third molar impaction is proposed to be mainly due to inadequate space between the distal of the second mandibular molar and the anterior border of the ramus of the mandible. This study was aimed to assess whether an association exists between different facial types and mandibular length to impaction of mandibular third molars. Materials and Methods: The study consisted of 170 patients who were assessed for facial type clinically based on facial index and mandibular length radiographically on lateral cephalogram. The impaction status was determined clinically and radiographically on orthopantomogram. The facial type was categorized as euryprosopic (broad face), mesoprosopic (normal facial type), leptoprosopic (long face), hypereuryprosopic (extra broad face), and hyperleptoprosopic (extra long face). Results: Of 170 patients, 18.8% of cases were with hypereuryprosopic profile, 33.5% of cases with euryprosopic profile, 24.7% with mesoprosopic profile, 21.8% with leptoprosopic, and 1.2% with hyperleptoprosopic profile were found. Nearly 42.2% of cases with hypereuryprosopic profile, 52.6% of cases with euryprosopic profile, 53.6% cases of mesoprosopic profile, and 60.3% cases of hyperleptoprosopic and leptoprosopic profile had impacted mandibular third molars. As for mandibular length assessment, 66% cases of short mandibular length, 64.5% cases of normal mandibular length, and 27.9% cases of long mandibular length had impaction. Conclusion: Within the limitations of the study, it was concluded that, though a higher incidence of impacted third molar was noted in patients with long facial pattern, no significant difference could be established among facial types and their association with impacted mandibular third molars. A significant association was noted between mandibular length and impaction.
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Histological changes at the commissure of the lip on approaching from its cutaneous to the mucosa region in males p. 88
Swati Saxena, Arvind Kumar Pankaj, Sachin Panwar, Anita Rani, Jyoti Chopra, Archana Rani
DOI:10.4103/njms.NJMS_15_20  
Introduction: The morphology of the epithelium of the oral lips comprised keratinized external epithelium (anteriorly) and nonkeratinized or sometimes parakeratinized mucous membrane epithelium (posteriorly). Knowledge of morphometry of the lip lining helps in deciding the best site for choosing graft for its better uptake during several dermal grafting procedures following trauma or tumor excision following craniofacial cancers or cosmetic procedures. Materials and Methods: Ten human male cadavers were procured at the Department of Anatomy King George's Medical University, Lucknow, Uttar Pradesh. The rectangle-shaped skin specimen through the right commissure of the lip which included the skin, mucocutaneous junction, and mucosa was stained with hematoxylin and eosin stain. A total of 30 slides were prepared. Thus, the readings were obtained for three regions, respectively, with the help of CAT-CAM E-series HD cameras which were installed in a light microscope. Results: Thickness of skin (epidermis + dermis) of the lip ranged from 756 μm to 1068 μm among males. Epidermal thickness increases on moving from the cutaneous region to the mucosa region of the lip. The lowest contribution of the stratum corneum in thickness of the epidermis was observed in the vermillion region, while the highest contribution was observed in the skin region. It was found to be absent in the mucosa region of the lip. Rete pegs at the dermoepidermal junction was found to be maximum in the vermillion region and minimum in the skin region. Its depth increased as we move from the skin to the mucosa region of the lip. Depth of the dermis was found to be maximum in the skin region, while minimum in the vermillion region. It ranged between 291 μm and 693 μm. Conclusion: Care should be taken while using dermal fillers in lip augmentation surgeries, especially in the vermillion region due to its close proximity to musculature in the core of the lip.
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CASE REPORTS Top

Autotransplantation of a mature mandibular third molar as alternative to dental implant placement: Case report p. 93
Luigi Tagliatesta, Federico Guerri, Simone Moscone, Jason Motta Jones
DOI:10.4103/njms.NJMS_192_20  
Dental autotransplantation is defined as the movement of one tooth from one position to another, within the same patient. Autotransplantation has predictable results; in fact, many studies describe a success rate of over 90%. This article describes a case report concerning the surgical management of this surgical technique. An 18-year-old patient comes for the treatment of her left first mandibular molar (3.6) involved in decay process. An accurate radiological analysis (periapical X-ray and orthopantomographic evaluation) showed an immature left mandibular third molar (3.8), suitable as donor tooth. The mandibular first molar was extracted in an atraumatic way. The intra-alveolar septum was modified with a piezoelectric device. The tooth was slightly depressed in the socket and remained in infra-occlusion. It was stabilized by sutures and a metallic splint. Then, the autotransplanted molar was fixed with a double splinting for 4 weeks. In conclusion, the autotransplantation was followed by endodontic treatment. After 36 months of follow-up, wisdom tooth showed an improvement in clinical features in agreement with radiological examination. The success of this case can be attributed to the atraumatic surgical technique and the immature stage of the transplanted element.
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An extremely rare pseudoaneurysm of posterior superior alveolar artery arising after orthognathic surgery p. 96
K P Manoj Kumar, Aswin Mullath, Depesh Vijayakumar, Aswathi Vinod
DOI:10.4103/njms.NJMS_74_20  
Le Fort 1 osteotomy is one of the most versatile techniques in orthognathic surgery employed for the correction of dentofacial deformities and is considered technically safe. Pseudoaneurysms (PAs) which can cause life-threatening hemorrhage are rare after corrective jaw surgery. Here, we describe a clinical case of delayed postoperative epistaxis secondary to an extremely rare PA of the posterior superior alveolar artery followed by Le Fort 1 osteotomy subsequently managed with endovascular selective embolization.
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Severe insulin resistance syndrome – A rare case report and review of literature p. 100
Sourabh Ramesh Joshi, Gowri Swaminatham Pendyala, Pratima Shah, Bhushan Pustake, Viddyasagar Mopagar, Neeta Padmawar
DOI:10.4103/njms.NJMS_55_20  
Insulin Resistance syndromes (IR's), are a group of genetic disorders caused due a functional defect in chromosome 19p13. It is an autosomal recessive condition. Donohue Syndrome was initially described by Donohue and Uchida in 1948 and 1954, a case of sisters born to parents with a first-degree consanguineous marriage. Infants presented with typical facial features that resembled the Leprechaun elves of Irish fairy tales. The following is a report of a rare case of dental complications of Severe Insulin Resistance Syndrome. An eight year old female child, with characteristic features of severe insulin resistance syndrome, reported to the Department of Pediatric and Preventive Dentistry, Pravara Institute of Medical Sciences, Loni, presenting with cariously destructed molars and a previous history of dental treatment under local anaesthesia. Given her condition, it was decided to reduce the multiple appointments, to one appointment with all procedures done under general anaesthesia. The following case report discusses the advantages, disadvantages and post operative complications faced when forming a treatment strategy for Severe Insulin Resistance Syndrome.
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Management of parotid fistula and Frey's syndrome with Botulinum neurotoxin type A p. 106
Ripon Chowdhury, Dev Roy, Abhimanyu Roy
DOI:10.4103/njms.NJMS_72_20  
The common cause of parotid fistula is parotid gland surgery and is frequently due to injury to the gland rather than to the duct. The frequency of postparotidectomy fistula is 14%. Other causes include facial trauma, congenital anomalies of the parotid gland, malignancies originating from the parotid gland and infections. Although there are several options for the treatment of parotid fistula and Frey's syndrome, very few treatment options are deemed optimal. The use of Botulinum A neurotoxin as a conservative method of treatment for parotid fistula and Frey's syndrome is a recent and evolving concept.
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Management of complex asymmetric deficiency of hard and soft tissue for implant-based rehabilitation p. 109
Yazad Gandhi
DOI:10.4103/njms.NJMS_56_20  
Dental implants are a successful treatment modality for rehabilitation of missing dentition. Optimal placement from the prosthetic standpoint is imperative for function, form, and esthetics, but at the same time, attention has to be focused on the biologic aspect of three dimensionally optimal placement within a stable hard and soft-tissue envelope. Bone and soft-tissue quality, quantity, and location of these two important variables are equally important in determining the longevity of osseointegrated fixtures. Numerous methods have been reported to tackle bone and soft-tissue deficit with variable outcomes of each. This report presents one such case where alongside tissue deficit, there is severe arch asymmetry which needs correction for optimal prosthetic rehabilitation
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Transoral robotic surgery for angiomyxoma of upper alveolus p. 116
Swati Nair, Deepika M Vijay, C Venkatakarthikeyan
DOI:10.4103/njms.NJMS_116_20  
Angiomyxomas are benign, slow-growing mesenchymal tumors. Intraoral angiomyxoma are extremely rare with very few reported cases in the existing literature. The primary line of management is surgical resection with a long-term follow-up, due to their tendency to recur. Here, we report a rare case of angiomyxoma of the upper alveolus eroding the hard palate and extending into the maxillary antrum, in a middle-aged male. Transoral robotic surgery (TORS) was performed due to the nature of the tumor (bulky benign lesion with bony erosion), inaccessibility and poor visualization of the superior extent of the tumor. The three-dimensional endoscopic camera and flexible robotic arms allowed easy dissection around the tumor margins and en bloc resection of the tumor. The patient had a smooth recovery with the best possible functional outcome. This is the first case of robot-assisted excision of a large benign oral tumor with superior extension through erosion of the palate and can be included as an extended indication of TORS.
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Fibrodysplasia ossificans progressiva or Munchmeyer's disease: A rare case report p. 120
Sonal Priya Bhansali, Anjali Dave Tiwari, Sankalp Mittal, Sitaram Pareek, Iram Nasir
DOI:10.4103/njms.NJMS_52_19  
Fibrodysplasia ossificans progressiva (FOP) is a rare autosomal dominant disease. It is characterized by widespread soft tissue ossification and congenital stigmata of the extremities, affecting all ethnic backgrounds. The worldwide reported prevalence is approximately 1/2,000,000. Based on history and clinicoradiological findings, FOP should be diagnosed as early as possible and noninvasively. The hallmark of diagnosis of FOP is bilateral great toe anomaly present from birth. Misdiagnosis may lead to inadvertent managements, such as manipulations, biopsies, and surgery. Surgery, till now, does not seem to have any role in the management of this condition and may lead to further trauma and disease progression. FOP may be precipitated due to trauma to muscle. In masticatory muscle, it mainly affects masseter muscle and presents with symptom of trismus. Herein, we present a case of FOP which presented to us with trismus after wooden thorn injury and immobility of the left leg. This article also emphasize on diagnosis, precaution, and treatment of disease.
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Clear cell odontogenic carcinoma of maxilla: A rare case report p. 124
Anubhav Jannu, Gautam Rao, Mithun Kulambi, Arun Kumar Talkal, MS Suma, KK Deepa, Rachana Srinivas
DOI:10.4103/njms.NJMS_102_19  
Clear cell odontogenic carcinoma is a rare, infrequent, aggressive in nature, locally reoccurring odontogenic tumor with a tendency of distant metastasis, occurring during to 4th to 6th decades with a mostly female predilection. Histologically, it is characterized by sheets and islands of vacuolated/clear cells. Till date, only 74 cases have been reported in the literature. We present a case of 45-year-old woman with a tumor mass extending from the maxillary right first premolar till the third molar region measuring 4 cm × 4 cm. The diagnosis was given based on the histopathological findings. Being locally aggressive, the reported data and understanding of this infrequent tumor needs to be strengthened by reporting new cases, and it also demands to be distinguished from other primary and metastatic clear cell tumors of the head-and-neck region.
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LETTER TO EDITOR Top

Letter to the editor regarding recently published systematic integrated review related to the role of preoperative laboratory testing in elective oral and maxillofacial surgeries p. 128
Keerthana Gowthaman, Morankar Rahul, Tewari Nitesh
DOI:10.4103/njms.NJMS_134_20  
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